Biomechanical effects of direction-changeable cage positions on lumbar spine: a finite element study

This finite element (FE) study of lumbar biomechanics aims to predict how the parameters like range of motion (ROM), intervertebral disc pressure (IDP), cage stress and screw stress are affected by different direction-changeable cage positions. Firstly, the three-dimensional FE model of L3-L5 segment was developed, and the model was adjusted to adapt different direction-changeable cage positions at the L4-L5 level though transforaminal lumbar interbody fusion (TLIF) with pedicle screws. The effects of Type A (the lateral region), Type B (the lateralcentral region) and Type C (the anteriocentral region) on ROM, IDP, cage stress and screw stress were examined. The results showed that after implantation of interbody cages at different positions, the ROM at surgical level L4-L5 decreased substantially in all motion modes. The maximal stress in cage decreased with Type A, B and C in all motion modes except flexion and extension. The maximal cage stress was observed in Type A with 720.5 MPa in left rotation, in Type B with 707 MPa in flexion, in Type C with 397.3 MPa in left rotation, respectively. The maximal IDP was similar in three types, with 1.6 MPa in left lateral bending in Type A, 1.5 MPa in flexion in Type B, and 1.4 MPa in flexion in Type C. The range of screw peak stress was 16.4 to 61.1 MPa in Type A, 15.9 to 50.9 MPa in Type B, and 14.6 to 46.1 MPa Type C. In conclusion, comparing the cages with different positions, anteriocentral position cage has more advantages like lower cage stress, ODL and screw stress.