ArticleBioMed research international2022
Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis.
Article in BioMed research international, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Reply Letter: A Commentary on "Disuse Bone Loss in Fusion Constructs After Multilevel Lumbar Fusion: A Computed Tomography Hounsfield Unit Analysis".Neurospine · 2026Article
- A Review of Finite Element Analysis in Spine Surgery Decision-Making.Journal of clinical medicine · 2026Review
- The Impact of Proton Pump Inhibitors on Pseudarthrosis Rates Following Multi-Level Lumbar Fusion.Spine surgery and related research · 2026Article
- Biomechanical Analysis Comparison of Different Cervical Posterior Screw Fixation Techniques: A Finite Element Study.Neurospine · 2026Article
- Biomechanical Effects of Cement Augmentation and Prophylactic Vertebroplasty on Adjacent Segment Stability in Multilevel Spinal Fusion: A Finite Element Analysis.Bioengineering (Basel, Switzerland) · 2025Article
- Article
- A Finite Element Study of Simulated Fusion in an L4-L5 Model: Influence of the Combination of Materials in the Screw-and-Rod Fixation System on Reproducing Natural Bone Behavior.Biomimetics (Basel, Switzerland) · 2025Article
- Activity and sports resumption after long segment fusions to the pelvis for adult spinal deformity: survey results of AO Spine members.Spine deformity · 2023Article
- Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery.Frontiers in bioengineering and biotechnology · 2023Article
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Multilevel lumbar fusion with posterior pedicle screw fixation is a widely performed surgical procedure for the management of adult spinal deformity. However, there has not been a comprehensive biomechanical study on the different types of fusion levels in terms of stability and possible complications. We aimed to investigate the biomechanical properties of multilevel lumbar fusion according to different types of upper and lower fusion levels. Six different types of fusions were performed using three-dimensional finite element models. Type A and B referred to the group of which upper fusion level was L1 and T10, respectively. Subtype 1, 2, and 3 referred to the group of which lower fusion level was L5, S1, and ilium, respectively (A1, L1-L5; A2, L1-S1; A3, L1-ilium; B1, T10-L5; B2, T10-S1; B3, T10-ilium). Flexion, extension, axial rotation, and lateral bending moments were applied, and the risk of screw loosening and failure and adjacent segment degeneration (ASD) was analyzed. Stress at the bone-screw interface of type B3 was lowest in overall motions. The risk of screw failure showed increasing pattern as the upper and lower levels extended in all motions. Proximal range of motion (ROM) increased as the lower fusion level changed from L5 to S1 and the ilium. For axial rotation, type B3 showed higher proximal ROM (16.2°) than type A3 (11.8°). In multilevel lumbar fusion surgery for adult spinal deformity, adding iliac screws and increasing the fusion level to T10-ilium may lower the risk of screw loosening. In terms of screw failure and proximal ASD, however, T10-ilium fusion has a higher potential risk compared with other fusion types. These results will contribute for surgeons to provide adequate patient education regarding screw failure and proximal ASD, when performing multilevel lumbar fusion.
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