ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2018
The influence of spinal fusion length on proximal junction biomechanics: a parametric computational study.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- L5 vs. pelvic fixation as the lowest instrumented vertebra in long-segment fusion for adult spinal deformity: a systematic review and meta-analysis.Spine deformity · 2026Pooled it
- Distal junctional failure in posterior cervical and cervicothoracic fusion: A systematic review and meta-analysis of associated factors.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Pooled it
- Single level versus multi-level lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta analysis.Journal of orthopaedic surgery and research · 2026Pooled it
- Low bone density at the upper instrumented vertebra, not the residual fractional curve, predicts mechanical failure in adult spinal deformity: a ten-year single-center series.Spine deformity · 2026Article
- Not just alignment: body shape influences adult spinal deformity biomechanics.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Superior displacement of the inflexion point does not predict proximal junctional kyphosis after fusion for adult spinal deformity.Journal of spine surgery (Hong Kong) · 2026Article
- Proximal junctional kyphosis and failure risk around the thoracolumbar junction: Impact of anterior malalignment, pelvic retroversion, and upper instrumented level selection.Brain & spine · 2026Article
- Biomechanical Evaluation of the Effect of MIS and COS Surgical Techniques on Patients with Spondylolisthesis using a Musculoskeletal Model.Journal of biomedical physics & engineering · 2025Article
- Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model.Bioengineering (Basel, Switzerland) · 2023Article
- Adhesive Hydrogel Building Blocks to Reconstruct Complex Cartilage Tissues.ACS biomaterials science & engineering · 2023Article
- Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Article
- Adjacent segments biomechanics following lumbar fusion surgery: a musculoskeletal finite element model study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Article
- Can Machine Learning Accurately Predict Postoperative Compensation for the Uninstrumented Thoracic Spine and Pelvis After Fusion From the Lower Thoracic Spine to the Sacrum?Global spine journal · 2022Article
- Fusing to the Sacrum/Pelvis: Does the Risk of Reoperation in Thoracolumbar Fusions Depend on Upper Instrumented Vertebrae (UIV) Selection?International journal of spine surgery · 2021Article
- Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine.Scientific reports · 2021Article
- Upper and lower adjacent segment range of motion after fixation of different lumbar spine segments in the goat: anThe Journal of international medical research · 2021Article
- Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright open MRI.JOR spine · 2021Article
- The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading.Frontiers in bioengineering and biotechnology · 2021Article
- Biomechanical Effects of Fixation of Different Segments of Goat Lumbar Spine on Adjacent Segmental Motion and Intradiscal Pressure Change.Medical science monitor : international medical journal of experimental and clinical research · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeProximal junctional kyphosis and failure are frequent complications in adult spinal deformity surgery with long fusion constructs. The aim of this study was to assess the biomechanics of the proximal segment for fusions of various lengths.
methodsA previously established musculoskeletal model of thoracolumbar spine was used to simulate full-range flexion task for fusions (modeled by introduction of rigid constraints) with lower instrumented vertebrae at L5 or S1 and upper instrumented vertebrae (UIV) at any level above, up to T2. Inverse dynamics simulations with force-dependent kinematics were performed for gradually increasing spinal flexion in order to predict global and segmental range of flexion, maximum passive moment, segmental compression and shear forces, which were compared to the uninstrumented case.
resultsFor long fusions, with the UIV at T11 or higher, the model predicted an increase in segmental flexion (by 33-860%, or 1.6°-4.7°) and passive moment (by 39-1370%, or 13-31 Nm) at the proximal junction-generally increasing with fusion length. While the maximum shear force was 57-239% (135-283 N) higher for the proximal junction at the upper thorax (UIV at T6 or above), the compression forces were reduced by up to 44% (375 N).
conclusionsThe length of the instrumentation has an important effect on the proximal segment biomechanics. Despite the limitations of the current model, musculoskeletal modeling appears to be a promising and versatile method to support planning of spinal instrumentation surgeries in the future. These slides can be retrieved under Electronic Supplementary Material.
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