DESIGN OF POSTERIOR LUMBAR

INTERBODY FUSION CAGES WITH

VARIOUS INFILL PATTERNS FOR 3D
PRINTING APPLICATION
Muhammad Hazli Mazlan1, Wan Nur Arifah Mior Idris1, Nur Sarah Abdullah1, Nur Dalilah
Diyana Nordin2
1
Electronic Engineering Department, Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn
Malaysia, Malaysia.
2
Center of Information Technology, Universiti Tun Hussein Onn Malaysia, Malaysia.
mhazli@uthm.edu.my

Abstract: Degenerative disc disease is a spinal condition when intervertebral disc which can help to protect the
nerves and increase the flexibility of the spine begin to breakdown. Mostly this disease occurs in the lumbar
spine, because the main function of the lumbar spine is to bear the weight of the body and these vertebrae are
much larger in size to absorb the stress of carrying heavy objects. There are many treatments for this disease
and one of the treatment techniques is Posterior Lumbar Interbody Fusion (PLIF) surgery. There are many
unresolvable clinical implications due to Posterior Lumbar Interbody Fusion (PLIF) procedures such as cage
retropulsion, mechanical cage failure, cage migration and stress shielding effects. In order to overcome these
problems, the effectiveness of the interbody cages should be improved. In this project, various infill pattern of
interbody cage design were used to develop the ideal interbody cage that can be implanted to suit bones’
compatibility’s order to reduce the consequences of PLIF technique by using Finite Element Analysis (FEA).
Type of material that used was Polylactic Acid (PLA) and Solidworks software was used to design the interbody
cages. The cage dimension was set to 205 mm in length, 100 mm in height and 60 mm in width. The designed
interbody cage was implanted between first lumbar (L1) and second lumbar (L2) vertebra which was extracted
from CT scan images in 3D Slicer software. The implanted model was analysed in Ansys workbench software
to determine the structural strength of the designed interbody cage after implantation. From Ansys Workbench
Software, the implanted model analysed in terms of Von Mises Stress, and Maximum Principal Stress values,
then compared to their theoretical values. The main factors were the limitations of the load and the conditions
of the motions or movements such as flexion, extension, axial rotation, lateral bending and compression force.

Keywords: Degenerative Disc, Finite Element Analysis, Posterior Lumbar Interbody Fusion, Von Mises Stress

INTRODUCTION
Spine of human is consist of the cervical spine, the thoracic spine, the lumbar spine, and sacral bones.
The entire spine was called as vertebrae and made up of 24 bones. Lumbar osteoarthritis, disk degeneration,
degenerative disk disease, and spondylosis are terms that used to describe functional changes to the
vertebral bodies and intervertebral disk spaces that may be related with clinical pain syndromes [1]. One of
the most prevalent disease of human spine is disc degeneration. The cause of degenerative disc can be
difficult to identify, as there are various potential anatomic sources of pain in the lumbar spine [2]. Low
back pain occurs due to the changes of degenerative in the intervertebral disc, facet joint degeneration and
deep soft tissues surrounding the spine. The potential risk factors includes age, body weight index (BMI),
lifestyle and osteoporosis.
In order to treat the degenerative discs disease, the most usually method used is Posterior Lumbar
Interbody Fusion (PLIF) surgery. PILF procedure is a method that eliminating a disc and combining
vertebrae together in the lower back which is in the lumbar region [3]. However, the retropulsion of the
interbody cage following the surgery is one of the issue that have the addressed [4]. To overcome the
complication, two different of the interbody cage patterns will be used to identify which pattern is more
compatible to implant between spinal bones.

METHODOLOGY
1. Methodology Flow Chart
Figure 1 illustrates the whole process of the project development. It involves the process of developing
interbody cages using rectilinear and honeycomb infill pattern as well as its corresponding Finite Element
Analysis (FEA) approach to analyse the strength of developed cages. Basically there are four stages to be
accomplished in order to achieve the objectives of the study [5]. It consists of CT data acquisition, 3D
model development of interbody cages, Finite Element Analysis (FEA) of the constructed cages and
conclusion. The L1 and L2 vertebra were first extracted from CT scan image using 3D Slicer Software.
After that the interbody cages were developed using the Solidworks software. Interbody cages were
designed based on two different types of infill patterns namely as rectilinear and honeycomb pattern. Next,
the interbody cage was implanted and attached in between L1 and L2 vertebra. Finally, the cage models
were analysed using FEA software. The analysis is consider on basic physiological motions of L1 and L2
which are compression, flexion, extension, axial rotation and lateral bending. From the data obtained by
the Ansys Workbench software, the conclusion was determined as which infill pattern design parameters
are more suitable to be implanted in the lumbar vertebrae, without jeopardizing the structural integrity of
the lumbar segment.
 Figure 1. Flowchart of the project.
2. Lumbar Vertebrae development using 3D Slicer Software
Firstly the images of CT scan must be extracted using 3D Slicer software. The data of the spine must
be downloaded from the 3D Slicer by selecting the human cardiovascular system from CTACardio. The L1
and L2 vertebra location were carefully selected from the data to be extracted.
3. Interbody Cage Development
The dimensions of interbody cage were set to 205 mm in length, 100 mm in height and 60 mm in width.
These dimensions of interbody cage are the commercialized specifications available on the market to meet
the requirements for supporting the vertebral body after insertion. The external edges of the cage have
dimensions of 25 mm both left and right side. The shape of rectilinear was designed on the surface of the
interbody cage which located in front and the right of the two planes. The dimensions of the rectilinear
shape were set at 4.24 mm for the length of each side and the distance between the rectilinear was set at
2.12 mm. After the rectilinear design was completed on the interbody cage surface, extrude cut the shape
with through two-dimensional to obtain rectilinear shape extruded cut for both front planes. Same goes to
the right plane, the rectilinear shape was extruded with through two-dimensional. Figure 2 shows the
rectilinear pattern after extruded cut at the frontal plane.
 Figure 2. Rectilinear infill pattern after extruded cut the infill design

For the interbody cage with honeycomb infill pattern, the surface of interbody cage was extruded cut
with honeycomb hexagonal pattern. The shape of the honeycomb pattern was designed in the surface of the
interbody cage which located in front and the right of two sided. The dimensions of the honeycomb shape
were set at 3.46 mm for each length and the distance between of the rectilinear is 2 mm. Figure 3 shows
the honeycomb pattern design view from the frontal plane of interbody cage.

Figure 3. Honeycomb infill pattern design at the frontal view of interbody cage
4. Implant the interbody cage in between L1 and L2 vertebra
From the 3D Slicer software, the vertebral model of L1 and L2 was transferred to the Solidworks
software by converting the format of the model to the Stereolithography (STL) format. In the Solidworks,
the interbody cages were implanted between L1 and L2 vertebra. This assembled Solidworks file was saved
and imported to the Ansys analytics software in IGS () file format.
5. Analysis the design in Ansys Workbench Software
In the Ansys Workbench, Static Structural analysis system was chosen. This is because, the static
structural is used to determine the stresses, strength and forces in the structures or components. It is related
to this research which is to apply the load on the interbody cage. In order to obtain the results, some steps
should be followed in the analytic static structural which are engineering data, geometry, model, setup and
solution. In the engineering data, the mechanical properties information of the material need to key in such
as the Young Modulus, Density, Poisson’ ratio. Yield Strength and Tensile Ultimate Strength of the material
used. In this research, the material used was Polylactic Acid (PLA).

FINDINGS
A. RESULTS
1. Von Mises Stress
The whole strength of the developed interbody cage was evaluated based on Von Mises stress and
Maximum Principal Stress. These values are essentially reflected in the Yield strength and Ultimate Tensile
strength of the cages. Von Mises stress wasused to compare withthe material yield strength. Von Mises
Stress can be used as an index in biomechanical research to measure the impact of loading on the tissue.
Thus, the higher the stress value of Von Mises Stress as compared to the Yield Strength of the materials,
the higher the risk of failures the structure Figure 4 and 5 show the results of the Von Mises Stress
distributed on the honeycomb and rectilinear infill pattern cage produced during the compression motion.
The external force applied was 400N while the compression motion force applied was 1000Nmm.

Figure 4. Von Mises Stress applied on the Honeycomb Infill Pattern in between L1 and L2 during the compression motion

Figure 5. Von Mises Stress applied on the Rectilinear Infill Pattern in between L1 and L2 during the compression motion

2. Maximum Principal Stress Results

Theoretically, the failure of any material occurs when the Principal Stress of the material was exceeded
the Ultimate Tensile Strength of of the material when the load is applied. Figure 6 shows the results of the
Maximum Principal Stress of interbody cages of honeycomb infill pattern during compression motion.
Figure 7 shows the result of the Maximum Principal Stress of rectilinear infill pattern during compression
motion.

Figure 6. Maximum Principal Stress applied on the Honeycomb Infill Pattern in between L1 and L2 during the
compression motion
Figure 7. Maximum Principal Stress applied on the Rectilinear Infill Pattern between L1 and L2 during the compression
motion

B. DISCUSSION

Table 1 show the results of the Von Mises Stress of honeycomb infill pattern and rectilinear infill pattern
cage design during compression, flexion, extension, axial rotation and lateral bending motions. All the Von
Mises Stress values that obtained were compared to the Yield Strength of the Polylactic Acid (PLA). Yield
Strength is the strength at which a determined amount of enduring deformation occurs. In other words, the
strength that a material can withstand without any deformation. From the Table 1 it can be observed that
all the values of the Maximum Von Mises Stress of physiological movements L1 and L2 are lower than the
actual Yield Strength of Polylactic Acid (PLA). This is because, honeycomb infill pattern is more resistant
to Von Mises Stress on it. For Rectilinear Infill Pattern, it can be observed that all the values of Maximum
Von Mises Stress that applied on Rectilinear Infill Pattern with physiological movements L1 and L2, are
higher than the actual Yield Strength of Polylactic Acid (PLA). This shows that the rectilinear pattern is
unable to withstand the applied loads.

Table 1. Summary on Von Mises Stress

Physiological Honeycomb Infill Pattern Rectilinear Infill Pattern
motions of L1 and Actual Yield Maximum Actual Yield Maximum Von
L2 Strength Von Mises Strength (MPa) Mises Values
(MPa) Values (MPa) (MPa)
Compression 70 18.459 70 182.98
Flexion 70 8.57 70 594.04
Extension 70 28.186 70 87.626
Axial Rotation 70 31.658 70 355.07
Lateral Bending 70 20.181 70 360.24

Table 2 show the Maximum Principal Stress of honeycomb infill pattern and rectilinear infill pattern
design cage that produced during all physiological motions namely as compression, flexion, extension,
axial rotation and lateral bending. It can be observed that, for the all physiological movements of the spine,
Maximum Principal Stresses for the rectilinear infill pattern cage tend to produce higher stress if compared
to the honeycomb infill pattern cage. More importantly, some of the stresses have exceeded the Ultimate
Tensile Stress of the cage material. This condition might significantly increase the risks of cage failures.
This condition can be observed when the cage was exposed to flexion, extension, lateral bending and axial
rotation movement. Overall, the honeycomb infill pattern cage exhibits better structural integrity that can
withstand the stress generated on the cage without pose any risks of cage failure if compared to the
rectangular infill pattern cage.
 Table 2. Summary on Maximum Principal Stress
Physiological Honeycomb Infill Pattern Rectilinear Infill Pattern
motions of L1 Ultimate Tensile Maximum Principal Ultimate Tensile Maximum Principal
and L2 Strength (MPa) Stress (MPa) Strength (MPa) Stress (MPa)
Compression 73 25.261 73 41.976
Flexion 73 8.112 73 196.12
Extension 73 32.076 73 30.041
Axial Rotation 73 37.117 73 283.39
Lateral 73 21.811 73 148.21
Bending

CONCLUSION
In this study, the structures of the interbody cage of honeycomb and rectilinear were investigated using the
Finite Element Analysis (FEA). Our results indicated that the honeycomb infill pattern exhibited higher
dimensional accuracy and higher compressive properties than rectangular structures. The value of Von
Mises Stress and Maximum Principal Stress obtained on the honeycomb infill pattern is lower than the
value of Von Mises Stress and Maximum Principal Stress on the rectilinear infill pattern.

ACKNOWLEDGEMENT
This research was supported by Universiti Tun Hussein Onn Malaysia, under TIER1-H118. We thank and
acknowledge our colleagues from Kyushu University and Juntendo University Japan who provided insight
and expertise that greatly assisted the research.

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