title: Biomechanical analysis of fusion segment rigidity upon stress at both the fusion and adjacent segments: a comparison between unilateral and bilateral pedicle screw fixation.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of unilateral pedicle screw fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models.
  
  
  METHODS
  Four L3-4 fusion models were simulated according to the extent of decompression and the method of pedicle screws fixation in L3-4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3-4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motion at the L2-3 and L3-4 segments were analyzed under flexion, extension, lateral bending, and torsional moments.
  
  
  RESULTS
  Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment, but larger motions were noted at the fusion segment (L3-4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superior adjacent L2-3 segments and fusion segment.
  
  
  CONCLUSIONS
  The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely, in the case of hemi-laminectomy, unilateral fixation could be an alternative option, which also has potential benefit to reduce the stress of the adjacent segment.
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Mechanical Engineering, Yonsei University, Seoul, Korea.
authors.forename: Kyoung-Tak
authors.initials: KT
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Bong-Soon
authors.initials: BS
authors.lastname: Chang
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Choon-Ki
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jang-Woo
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. highcervical@gmail.com.
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
mesh_terms: D001696:Biomechanical Phenomena; D003198:Computer Simulation; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D065289:Pedicle Screws; D016059:Range of Motion, Articular; D012984:Software; D013123:Spinal Fusion; D013314:Stress, Mechanical
keywords: Unilateral pedicle screw fixation; adjacent segment degeneration; finite element model; lumbar fusion surgery