ArticleJOR spine2025
Impact of Habitual Flexion on Bone Formation After Spinal Fusion Surgery: An In Silico Study.
Article in JOR spine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Article
- Biomechanical Analysis and Injury Prediction in Pilots With Lumbar Spondylolysis Under Different Seat Inclination Angles.JOR spine · 2026Article
- Research Progress on Personalized Bone Implants Based on Additive Manufacturing.Micromachines · 2025Review
- Impact of Habitual Flexion on Bone Formation After Spinal Fusion Surgery: An In Silico Study.JOR spine · 2025Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Lumbar spinal fusion is currently regarded as one of the most effective surgical treatments for patients with spinal deformities, degenerative disc disease, and degenerative spondylolisthesis. However, the procedure still faces a high incidence of non-unions. A key factor contributing to non-union is stress shielding effects related to unfavorable mechanical signals at the fusion site. Mechanical conditions at the fusion site are determined by the loading conditions that result from daily activities. Recent studies have reported that humans spend most of the day with their spine in a flexed position. The role of flexion loading in the progression of bone fusion remains poorly understood. This study explores the influence of habitual flexion loading on the spinal fusion process using a computational modeling framework that integrates finite element analysis with bone healing algorithms to simulate bone regeneration following fusion surgery. Methods: A finite element model of the lumbar spine based on a healthy subject was developed and validated with in vitro experimental data. Thereafter, a virtual posterior lumbar interbody fusion was performed where 2 intervertebral cages were inserted at the L4-L5 level together with posterior fixation. The influence of two loading conditions on the predicted fusion process were investigated: (1) A compression load (2) A hybrid (compression + flexion) loading protocol simulating habitual flexion encountered during daily living. Results: Bone bridging was predicted to occur 14 weeks after surgery. At week 14, for the hybrid loading, the model predicted a bone volume of 70%, whereas for compression load, the bone volume prediction was 59%. Computer model predictions showed that habitual flexion loading can promote bone formation in the anterior and peripheral regions by inducing a mechanical environment favorable for bone formation. Conclusion: Flexion loading may enhance bone healing by promoting mechanically advantageous conditions. The computational framework could guide the development of optimized rehabilitation protocols to improve fusion outcomes.
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