title: Analysis of stress distribution in lumbar interbody fusion.
abstract: METHODS
  A 2-dimensional axisymmetric finite element model of an intervertebral segment was used to investigate the stress patterns in the adjacent vertebrae of fused spinal segment incorporating 4 common cage designs. The same was used to study the effect of maturation of bone graft on stress distribution pattern.
  
  
  OBJECTIVE
  To study and compare the stress distribution patterns in a normal spinal segment and in the adjacent vertebrae of a fused spinal segment. The effect of bone graft incorporation around the mesh cage was also investigated.
  
  
  BACKGROUND
  Lumbar fusion surgery is thought to relieve discogenic low back pain by eliminating the abnormal intersegmental movement at the level of disc degeneration. Successful spinal fusion does not guarantee symptomatic pain relief. Discogenic pain is also known to be associated with an abnormal load transmission pattern across the degenerate disc. We hypothesized that the lumbar interbody fusion results in relief of discogenic pain by normalizing the load distribution pattern.
  
  
  METHODS
  We used a 2-dimensional axisymmetric finite element model of an intervertebral segment to investigate the stress patterns in the vertebrae adjacent to a fused spinal segment incorporating 4 common cage designs: (1) anterior lumbar interbody fusion, (2) posterior lumbar interbody fusion rectangular, (3) posterior lumbar interbody fusion threaded, and (4) mesh cage.
  
  
  RESULTS
  High stress concentrations and abnormal overall stress patterns were noted for all the cage designs studied. The anterior lumbar interbody fusion cage with its larger contact area showed the least abnormal stress magnitude in comparison with the other cages. Incorporation of bone in and around the mesh cage increased the area of contact and decreased the abnormal high stresses. The spine fusion model representing final bony healing showed restoration of near physiologic stress pattern.
  
  
  CONCLUSIONS
  Interbody fusion cages with larger area of contact between cage and vertebral endplate produces a lower stress distribution pattern. A successful bony fusion restores near physiologic stress distribution pattern. Restoration of near normal load distribution pattern may become an important aim of surgery for discogenic low back pain.
authors.affiliation: New Cross Hospital, Wolverhampton, United Kingdom. naresh@doctors.org.uk
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Meakin R
authors.initials: MR
authors.lastname: Judith
authors.forename: Aravind
authors.initials: A
authors.lastname: Kumar
authors.forename: Viren
authors.initials: V
authors.lastname: Mishra
authors.forename: Mulholland C
authors.initials: MC
authors.lastname: Robert
mesh_terms: D016268:Internal Fixators / Q000706:statistics & numerical data; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008954:Models, Biological; D013123:Spinal Fusion / Q000295:instrumentation / Q000706:statistics & numerical data*; D013314:Stress, Mechanical