Objective:

Adjacent segment degeneration (ASD) is a common phenomenon after lumbar fusion. Lateral lumbar interbody fusion (LLIF) may provide an alternative treatment method for ASD. This study used finite element analysis to evaluate the biomechanical effects of LLIF with various fixation options and identify an optimal surgical strategy for ASD.

Methods:

A validated L1-S1 finite element model (FEM) was modified for simulation. Six FEMs of the lumbar spine were created and were divided into group 1 (L4-5 PLIF + L3-4 LLIF) and group 2 (L5-S1 PLIF + L4-5 LLIF). Each group consisted of a) cage-alone, b) cage + lateral screw fixation (LSF), and c) cage + bilateral pedicle screw fixation (BPSF) models. The range of motion (ROM), intradiscal pressure (IDP), and facet loads (FL) of adjacent segments as well as interbody cage stress were analyzed.

Results:

The stress on the LLIF cage-superior endplate interface was highest in the cage-alone model followed by the cage + LSF model and cage + BPSF model. The increase in ROM, IDP, and FL at the adjacent segment was highest in the cage + BPSF model followed by the cage + LSF model and cage-alone model. However, the biomechanical effect on the adjacent segment seemed similar in the cage-alone and cage + LSF models.

Conclusions:

LLIF with BPSF is recommended when performing LLIF surgery for ASD after L4-5 and L5-S1 PLIF. Considering cage subsidence and biomechanical effect on the adjacent segment, LLIF with LSF may be a suboptimal option for ASD surgery.