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Biomechanical analysis of lumbar interbody fusion with an anisotropic

hyperelastic model for annulus fibrosis

Article in Archive of Applied Mechanics · April 2013

DOI: 10.1007/s00419-012-0705-6

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Arch Appl Mech (2013) 83:579–590
DOI 10.1007/s00419-012-0705-6

O R I G I NA L

Xiongqi Peng · Yu Wang · Shaoqing Shi · Zaoyang Guo

Biomechanical analysis of lumbar interbody fusion

with an anisotropic hyperelastic model for annulus fibrosis

Received: 16 November 2011 / Accepted: 1 October 2012 / Published online: 11 October 2012
© Springer-Verlag 2012

Abstract Based on computed tomography scanning images, this paper developed a detailed finite element
model for the human L2–L4 lumbar spine segment with or without L3–L4 fusion. The model included verte-
brae, intervertebral disc, facet articulating surfaces and various ligaments. A previously developed hyperelastic
fibre-reinforced constitutive model was used to characterize the material property of annulus fibrosus. Numer-
ical results of L3–L4 motion unit such as load–displacement curves and nucleus pressure were compared
with experimental data to validate the FE model. The normal and fused lumbar spine segments under various
loading conditions, such as flexion, extension and axial rotation, were analysed. The motion range and stress
distribution of the L2–L4 models under different loading conditions were then obtained to investigate the effect
of lumbar fusion operation. It was shown that under the same loading condition, the fused model had a much
smaller body motion range. Interbody fusion brought out obviously different stress distribution in adjacent
intervertebral disc annulus fibrosus. And it also increased the intradiscal pressure of adjacent intervertebral
disc significantly.
Keywords Lumbar · Fusion · Biomechanics · Constitutive model · FE analysis

1 Introduction

Lower back pain is a common spine disease which brings great inconvenience to patients’ daily life. The
main etiological factor of lower back pain is the degeneration of intervertebral discs [1]. Surgical treatment
for lower back pain can be mainly divided into two groups: interbody fusion and artificial disc replacement
[2]. Various fusion surgical techniques have been developed in recent years [3]. However, their outcomes still
remain controversial and unclear [4]. Some studies suggested fusion accelerates the degeneration of adjacent
functional spine units [5–7], while others showed completely different conclusions [8,9]. Hence, it is necessary
to evaluate the effect of interbody fusion on the spine via biomechanical analysis.

X. Peng (B)
School of Materials Science and Engineering, Shanghai Jiao Tong University,
1954 Huashan Road, Shanghai 200030, China
E-mail: xqpeng70@gmail.com; xqpeng@sjtu.edu.cn

X. Peng · Y. Wang
School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an 710072, China

S. Shi
Department of Civil Engineering, Logistical Engineering University, Chongqing 401311, China

Z. Guo
College of Resources and Environmental Sciences, Chongqing University, Chongqing 400044, China
580 X. Peng et al.

Experimental study is a direct way to investigate the spine biomechanical behaviour. It provides the first-
hand knowledge of biomechanical behaviour of normal and pathological spine, and provides guidelines for
human lumbar fusion surgery. A dynamic nonfusion system for stabilizing bridged spine segments was inves-
tigated by Schmoelz et al. [10]. Lumbar cadaver spines with four different stabilization stages were tested
in their experiment. Their results showed that none of these stabilization methods have effect on the motion
of adjacent segments. Gerber et al. [11] determined the biomechanical difference between anterior lumbar
interbody fusion using different supplementary fixation devices. Compared with stand-alone interbody fusion,
fusion with screw-plate and pedicle screws-rods reduces spine motion range and increases stiffness. However,
experimental study cannot provide detailed motion data and stress distributions of spine components, such as
discs, ligaments and vertebrae [12].
Numerical approaches, especially FE method, are widely used in human spine biomechanics research in
recent years [13]. It is an important complement to clinical study and can be applied to evaluate the effect
of interbody fusion on lumbar spine. Lee et al. [14] investigated the axial stiffness of interbody fusion with
or without fused bone under the changes of spacer position. Their results showed that the spacer was very
important in initial stability for fusion. However, spacer position had little effect on the mechanical property
of lumbar spine. In recent years, many interbody fusion cages have been developed and applied in spinal
surgery [15,16]. Researchers investigated this type of interbody fusion. Based on FE analysis, Chen et al. [17]
compared a new stand-alone cage with conventional fixation methods. They found that stand-alone cage plays
an important role in providing stability required for interbody fusion. These FE studies provided useful infor-
mation for physiological performance and reduced the dependence of spine research on cadaveric experiments
[12].
To evaluate the effect of interbody fusion on the spine, FE models for human L2–L4 lumbar spine seg-
ment with or without L3–L4 fusion were developed. The normal and fusion FE models under various loading
conditions, such as compression, flexion, extension and axial rotation, were analysed.

2 Materials and methods

Based on computed tomography (CT) scanned images of human lumbar spine and 3D reconstruction tech-
niques, FE models for L2–L4 lumbar spine segments with or without L3–L4 vertebral body fusion were
developed in this paper to investigate the effect of fusion operation on spine functionality. The FE models
delineated detailed anatomical structure of human lumbar spine by including vertebrae, intervertebral disc,
facet articulating surfaces and various ligaments. A previously developed hyperelastic fibre-reinforced con-
stitutive model was applied on the intervertebral disc annulus fibrosus to represent its nonlinear anisotropic
biomechanical behaviour [18]. Vertebral body motion range, intradiscal pressure and stress distribution of
both models under extension, flexion and axial rotation were obtained by numerical analysis using commercial
CAE software package ABAQUS/Standard.

2.1 FE model

Two-dimensional image data of L2–L4 lumbar spine segment from spiral CT sectional scanning were imported
into CAD software Pro/E to generate three-dimensional solid body, and the solid body was meshed in CAE
software ANSYS according to the anatomical structure of human lumbar spine. The CT scanned images were
from a 43-year-old male volunteer without preexisting disc spine disease. The images were obtained using
transverse slices at every 2-mm interval. The FE models were then imported into commercial FEA software
package ABAQUS/Standard to investigate their biomechanical behaviours under various loading conditions
by taking advantage of its powerful nonlinear analysis capability.
The lumbar FE model developed included vertebrae, intervertebral disc, facet articulating surfaces and
various ligaments, such as anterior longitudinal, posterior longitudinal, ligamentum flavum, interspinous,
supraspinous, transverse and capsular ligaments. The outline of soft material in the spine was difficult to
distinguish from CT images. According to the anatomical structure, the position and size of ligamentum fla-
vum, interspinous, anterior longitudinal and posterior longitudinal ligaments were determined. Supraspinous,
transverse and capsular ligaments were defined using spring element to link their approximate attachment
points on adjacent vertebrae [19]. According to literature and the CT image, contact surfaces with a distance
of 0.5 mm were used to simulate the facet articulation [20]. The outline of disc was also defined according to
Biomechanical analysis of lumbar interbody fusion 581

Posterior longitudinal
Vertebra L2
ligament

L2-3 disc Transverse ligament

Supraspinous ligament
Vertebra L3

Ligamentum flavum
L3-4 disc
Capsular ligament

Vertebra L4
Interspinous ligament

Anterior longitudinal
ligament

Fig. 1 FE model of lumbar L2–L4 motion segment

the anatomical structure. The disc nucleus was defined according to the volume ratio. In this paper, about 50 %
volume was defined as nucleus. And the rest of the region was defined as annulus fibrosus.
3D tetrahedron (C3D4) and brick (C3D8) solid elements in ABAQUS were used for meshing vertebrae.
Brick solid elements were also adopted for disc annulus fibrosus and endplates. Hydrostatic fluid elements
(F3D4) were employed to simulate nucleus. Membrane elements (M3D4R) were used for meshing the lig-
amentum flavum, interspinous, anterior longitudinal and posterior longitudinal ligaments. Spring elements
(SPRINGA) were for supraspinous, transverse and capsular ligaments. There are totally 20,327 nodes and
42,217 elements in the FE model, as shown in Fig. 1.
The intact FE model described above was modified to simulate a lower level fusion spine motion unit. In
the fusion FE model, the upper intervertebral disc remained the same as the normal one; the lower disc, which
includes annulus fibrosus, nucleus and endplates, was replaced with a homogeneous solid part to simulate an
interbody fusion [2]. It was assumed that this solid part has the same size as the normal disc. Brick elements
(C3D8) were used for meshing the fusion part. The anterior longitudinal ligament between L3 and L4 vertebral
bodies was excised in the model to keep consistent with real anterior fusion operation.

2.2 Material properties

The material model for the annulus fibrosus used in current study was a previously developed anisotropic
hyperelastic fibre-reinforced constitutive model [18]. The remaining material properties were from literature.
Vertebral bodies consisted of cortical shell and cancellous core. The material behaviours of the two parts were
different. The Young’s modulus and Poisson’s ratio were set to be 12,000 MPa and 0.3, respectively, for cortical
shell and 100 MPa and 0.2 for cancellous core [21]. The material properties of the fusion part were assumed to
be the averaged values of those of the vertebral bodies. The intervertebral disc was constituted with superior
and inferior endplates, nucleus and annulus fibrosus, as illustrated in Fig. 2. The endplates, which locate at
the top and bottom of the annulus fibrosus, were cartilaginous structure and can be considered as an elasto-
mer. Nucleus surrounded by annulus fibrosus was a nearly incompressible material which can withstand large
pressure and was modelled as hydrostatic fluid. Spring elements were used for modelling the supraspinous,
transverse and capsular ligaments. The equivalent stiffness for springs was calculated from Young’s modulus
and Poisson’s ratio of these components used in [19]. Contact surfaces with a distance of 0.5 mm were used
to simulate the facet articulation. The facet joints could transmit only compressive forces, and the friction was
neglected [20].
582 X. Peng et al.

Annulus fibrosus

Nucleus

Endplate
Fig. 2 FE model of intervertebral disc

x2

Nucleus

2α
x1

Annulus fibrosus
x3
Fig. 3 Schematic of intervertebral disc and annulus fibrosus with two families of fibres [30]

Annulus fibrosus is a concentric thin-layered structure which mainly consists of nonfibrosus matrix and
collagen fibre bundles. The fibre bundles distribute in the direction of about 30◦ and 150◦ with respect to
the vertebral transverse plane [22]. The overlapped fibre distribution structure of annulus fibrosus allows it to
withstand large bending and torsion load. During simulation, annulus fibrosus can be regarded as composite
material which consists of multilayer matrix with parallel fibres embedded in each layer (see Fig. 3), and
the fibre direction in different layers is different. A hyperelastic constitutive model was proposed in [18] for
annulus fibrosus by decomposing the strain energy function into three parts, namely energy contribution from
matrix, fibre stretch and fibre–matrix shear interaction, respectively. Accordingly, the strain energy function
can be defined as follow
W = W (C, a0 ) = W M + W F + W F M = W (I1 , I2 , I3 , I4 , I5 ) (1)
where W M, W F and W FMare the strain energy contributions from the ground substance, fibre stretch and
fibre–matrix shear interaction, respectively. C = FT F is the right Cauchy–Green deformation tensor, F is the
deformation gradient tensor, and a0 is the original fibre directional vector. The invariantsIi are given by
 
I1 = trC, I2 = 1/2 (trC)2 − trC2 , I3 = det C,
I4 = a0 · C · a0 = λ2F , I5 = a0 · C2 · a0
where λ F is fibre stretch.
A simple neo-Hookean model was employed to represent the hyperelastic behaviour of matrix in the soft
tissue
 
W M = C10 I¯1 − 3 + (1/D1 ) (J − 1)2 (2)

whereJ = I3 is the total volume change and I¯1 = J −2/3 I1 is the first deviatoric invariant.
1/2

The fibre strain energy stems from its stretch and can be defined by a simple polynomial function of the
fibre stretch:

C2 (I4 − 1)2 + C3 (I4 − 1)4 I4 > 1
WF = (3)
0 I4 ≤ 1
Biomechanical analysis of lumbar interbody fusion 583

Table 1 Material properties specified in the finite element models

Component Element type Young’s modulus (MPa) Poisson’s ratio References
Cortical shell Solid 12,000 0.30 Tsuang et al. [21]
Cancellous core Solid 100 0.20 Tsuang et al. [21]
Fusion part Solid 2,500 0.30 Current study
Posterior element Solid 3,500 0.25 Tsuang et al. [21]
Anterior longitudinal ligament Membrane 20 0.30 Tsuang et al. [21]
Posterior longitudinal ligament Membrane 20 0.30 Tsuang et al. [21]
Ligamentum flavum Membrane 19.5 0.30 Tsuang et al. [21]
Interspinous ligament Membrane 12 0.30 Tsuang et al. [21]
Capsular ligament Spring – – Chen et al. [19]
Transverse ligament Spring – – Chen et al. [19]
Supraspinous ligament Spring – – Chen et al. [19]
Endplate Solid 600 0.30 Kumaresan et al. [29]
Annulus fibrosus Solid – – Peng et al. [18]
Nucleus Hydrostatic fluid 1,666.7* – Kumaresan et al. [29]
*Bulk modulus

where I4 = a0 · C · a0 = λ2F . Here, the fibre was assumed to have no compressive stiffness when it is under
contraction (λ F < 1).
Assume that the fibre and matrix are fully integrated with each other, the strain energy contribution from
the fibre–matrix interaction originates from the shearing between the fibre and matrix. The fibre–matrix shear
interaction strain energy function W F M was defined as [18]

W F M = W F M (I4 , ϕ) = f (I4 )χ 2 = f (I4 ) [(I4 /I3 ) (I5 − I1 I4 + I2 ) − 1]2 (4)

Hereχ = tan2 ϕ (ϕ is the angle between the matrix plane normal and fibre direction [18]) and f (I4 ) is the
fibre–matrix shear interaction factor [18].
   
f (I4 ) = γ / 1 + exp −β λ F − λ∗F (5)

Substituting Eqs. (2)–(4) into Eq. (1) yields

 
W= W M + W F + W F M = C10 I¯1 −3 +(1/D1 ) (J − 1)2 + C2 (I4 − 1)2 + C3 (I4 −1)4 + f (I4 ) χ 2 (6)

The above-described constitutive model was implemented in ABAQUS by a user material subroutine to char-
acterize the material behaviour of the annulus fibrosus. In this paper, the annulus fibrosus was divided into
eight parts. Each part was made up of two bunches of fibres with their own averaged directions according to
anatomical site. The element types and material properties used in the FE model are listed in Table 1.

2.3 Boundary and loading conditions

The coordinate system shown in Fig. 1 was used for imposing loading and boundary conditions. Directions 1,
2 and 3 are positive directions of three coordinate axes, and directions 4, 5 and 6 are the rotation directions
of 1, 2 and 3 axes, respectively. Rigid surfaces were created on the superior and inferior surfaces of the spine
unit to clamp it for the purpose of simulating experimental set-up. Each rigid surface had its own reference
node for imposing boundary and loading conditions. During all simulations, the L4 rigid surface was fixed by
constraining all the degrees of freedom of its reference node.
The FE model was first validated by comparing simulation and experimental results of normal L3–L4
lumbar spine segment under various loading conditions: axial compressive loading along the 2-axis direction
and moment loading cases in 4 and 5 directions in Fig. 1. Nucleus pressure of experiments and FE simulations
for three specific loading conditions: 500 N axial compression load, 90 N distraction load plus 5 Nm extension
torque, and 90 N distraction plus 5 Nm flexion torque were also investigated. The experimental data were from
Virgin [23], Markolf and Morris [24], Gay et al. [25], Steffen [26].
After validation, three loading cases were applied on the L2 vertebral body of the normal and fused L2–L4
models, respectively: ±10 Nm torque in the 4-direction to simulate extension and flexion; 10 Nm torque in the
5-direction for axial rotation. The corresponding angular displacements under the same applied torque of the
normal and fused models were compared to investigate the effect of interbody fusion on the spine segment
584 X. Peng et al.

Fig. 4 L3–L4 motion unit load–displacement relationship under compression

Fig. 5 L3–L4 motion unit load–displacement relationship under flexion

motion. On the other hand, prescribed 10◦ angular displacements were imposed on the L2 vertebral body along
their respective directions to simulate extension, flexion and axial rotation loading cases. The stress distribution
in adjacent annulus fibrosus and intradiscal pressure of the two models were compared to investigate the effect
of interbody fusion.
Furthermore, the compressive biomechanical responses of the normal and fused models were investigated
by imposing a 2 mm axial compressive displacement along the 2-axis direction on both models.

2.4 Model validation

Numerical and experimental load–displacement relationships of the normal L3–L4 motion unit under three
different loading conditions, which were axial compressive, flexion and axial rotation, were obtained and are
shown in Fig. 4, 5 and 6 for comparison.
As can be seen from Fig. 4, for the axial compressive loading case, the simulation result showed good
consistency with cadaveric experimental data from Virgin [23], and they were all in the range of experimental
standard deviation of Markolf and Morris [24]. As demonstrated in Fig. 5, the simulation results of the flexion
loading case also showed good consistency with the experimental data from Gay et al. [25]. The simulation
results of the axial rotation case were higher than the average value of experimental result, as presented in
Fig. 6. But it was still in the range of experimental deviation.
Biomechanical analysis of lumbar interbody fusion 585

Fig. 6 L3–L4 motion unit load–displacement relationship under rotation

Fig. 7 Nucleus pressure comparison under the same loading case. (C = compression, D = distraction, E = extension, F = flexion)

Figure 7 compares the nucleus pressure of experiments [26] and FE simulations under three different con-
ditions. In Fig. 7, C = compression, D = distraction, E = extension, F = flexion. The simulation results in the
figure were all in the range of experimental standard deviation.
Overall, simulation results showed good consistency with experimental data under the same loading
conditions. The FE model was validated and can be used for biomechanical analysis of interbody fusion.

3 Results

The predicted angular displacements of the normal and fused models under extension, flexion and axial rotation
are shown in Fig. 8. The angular displacements of the normal model under the three loading cases were 5.4◦ ,
2.8◦ and 2.7◦ , respectively, while the angular displacements of the fused model were only 62, 77 and 74 %,
respectively, of that of the normal one under the same loading conditions.
Figure 9 illustrates the model position in the description of stress distribution in annulus fibrosus. Table 2
shows the maximum von Mises stresses in the L2–L3 intervertebral disc annulus fibrosus of the normal and
fused models. In Table 2, S and I stand for the superior and inferior regions of the annulus fibrosus, respectively.
As listed in Table 2, the positions of the local maximum von Mises stresses in the intervertebral disc annulus
fibrosus of the two models were almost the same. However, under the same loading case, the values of the
local maximum von Mises stress in the annulus fibrosus of the fused model were much higher than those of
the normal one.
586 X. Peng et al.

Fig. 8 Predicted rotation displacement under three loading conditions

Fig. 9 Schematic drawing of model position (viewed from above)

Table 2 Stress distribution in annulus fibrosus under different loading cases (10◦ angular displacement)
Load type Model type Maximum von Mises stress value and position
in L2–L3 annulus fibrosus (MPa)
Extension Normal 13.01 I: 135◦ S: 90◦
Fusion 31.65 S: 45◦
Flexion Normal 23.66 S: 315◦
Fusion 35.90 S: 315◦
Axial rotation Normal 28.97 I: 45◦ S: 90◦
Fusion 54.27 I: 45◦ S: 90◦

The intradiscal pressures of the L2–L3 disc versus applied angular displacement under the three loading
cases are shown in Fig. 10. When the angular displacement was 10◦ , the intradiscal pressures of the fused
model reached 0.025, 1.69 and 1.30 MPa under extension, flexion and axial rotation, respectively, while the
intradiscal pressures of the normal model were only 59, 53 and 41 % of that of the fusion one under the same
angular displacement, respectively.
Figure 11 shows the intervertebral disc protrusion-axial compressive displacement relationships of the two
models under compression. The intervertebral disc protrusion of the fused model was much larger than that
of the normal one. When the axial compressive displacement was 2 mm, the intervertebral disc protrusion of
normal model was 0.76 mm, which was only 75 % of that of the fusion one.
Biomechanical analysis of lumbar interbody fusion 587

Fig. 10 Comparison of L2–L3 intradiscal pressure between two models

588 X. Peng et al.

Fig. 11 Intervertebral disc protrusion-axial compressive displacement relationships of two models under compression loading

4 Discussion

Guan et al. [27] compared the biomechanical responses of lumbar spine under flexion and extension between
intact and fusion spine with different fusion level. Their results showed nonlinear moment-rotation responses
under both loading conditions. In current study, the moment-angular displacements response was also nonlin-
ear. The results also showed that the fused model has a much smaller body motion range compared with that
of the normal one (see Fig. 8). Interbody fusion brought out obviously small spine motion range. This can be
attributed to the increased stiffness in the fusion spine segment resulting from the replacement of softer disc
with stiffer bone. In the normal model, both discs deformed under external loads, while in the fused model, the
fusion part was much stiffer than the original disc. Hence, the motion range of the fused model was determined
by the deformation of the nonfusion level’s annulus fibrosus. So under the same loading conditions, the motion
range of the fused model was much smaller than that of the normal one.
Many researches focused on the stress distribution on the spine after fusion. Adam et al. [16] studied
the stress in cage type interbody fusion system under compressive loading case. Their results suggested that
endplate stress was affected by implanted surface profiles. Ivanov et al. [28] found that lumbar spine motion
and stresses at sacroiliac joint increased due to fusion. Tsuang et al. [21] conducted a FE study to determine
the effect of cage applications on cage–endplate interface and facet joints, for example the change of the stress.
They compared the results of cage applications with different number and positions of the cages. The effect of
the cage applications with or without posterior instrumentation on cage–endplate interface and facet joints was
also investigated. They found that posterior instrumentation brings more efficient stability than an additional
cage. Stresses in disc adjacent to fusion level were often used as an important indicator for the evaluation of
interbody fusion [7,19]. The increase in intradiscal pressure would lead to degeneration of annulus fibrosis.
In order to effectively and correctly evaluate the effect of interbody fusion on the spine, it was necessary to
accurately determine the intradiscal pressure and stress distribution in the annulus fibrosus, which depends on
an appropriate constitutive model for the soft tissue. Due to its anatomical structure, the annulus fibrosus exhib-
its nonlinear, anisotropic biomechanical behaviours under loading. Hence, an anisotropic constitutive model
considering nonlinearity resulting from large deformations was necessary in the numerical simulation of the
lumber spine. Chen et al. [19] built a lumbar spine FE model with anterior interbody fusion in different level
to study stress distribution in adjacent disc. In the current study, the stress distribution was also investigated
using FE models with anisotropic constitutive model for annulus fibrosus.
Annulus fibrosus can withstand large bending and torsion load. It plays an important role in maintaining
the normal physiological function of the spine. Under the same angular displacement, the annulus fibrosus
withstood much more stress due to interbody fusion. The analysis results implied that lumbar interbody fusion
surgery brings much impact on stress distribution in adjacent intervertebral disc. This impact may accelerate
degeneration of intervertebral disc adjacent the fusion level.
Biomechanical analysis of lumbar interbody fusion 589

Nucleus is a nearly incompressible structure. Nucleus pressure would increase under external loads, and
too much pressure would lead to more intervertebral disc bulge and damage the disc. The intradiscal pressure–
angular displacement curve of the fused model showed much more rapid trend than that of the normal one
(Fig. 10). And the intervertebral disc posterior bulge showed the same trend (Fig. 11). The lumbar interbody
fusion increased the intradiscal pressure of adjacent intervertebral disc significantly. This may lead to accel-
erative degeneration of adjacent intervertebral disc.
Some factors, such as anisotropic characters of ligaments and muscle force, were not considered in the FE
model. Zander et al. [20] developed a nonlinear FE model of lumbar spine to investigate the effect of the muscle
force on the stress in the spine disc. Their work gave guidance on developing FE model with considering the
muscle force. It was helpful to improve the FE model used in this paper by including muscle forces in the
future work.

5 Conclusion

In this paper, detailed and anatomically accurate L2–L4 spine FE models with or without fusion were devel-
oped. A hyperelastic fibre-reinforced constitutive model was applied to characterize the nonlinear anisotropic
material behaviour of intervertebral disc annulus fibrosus. The biomechanical behaviour of two models under
extension, flexion and axial rotation was compared. The results suggested that the fused model has a much
smaller body motion range compared with that of the normal one. At the same time, interbody fusion brought
out obviously large stress in adjacent intervertebral disc annulus fibrosus. And it increased the intradiscal
pressure of adjacent intervertebral disc significantly.

Acknowledgments This work was supported by the National Natural Science Foundation of China (50975236, 11172171).

References

1. Vernon-Roberts, B.: Disc pathology and disease states. Biol. Intervertebr. Disc II, 73–119 (1988)
2. Denozière, G., Ku, D.N.: Biomechanical comparison between fusion of two vertebrae and implantation of an artificial
intervertebral disc. J. Biomech. 39(4), 766–775 (2006)
3. Fritzell, P., Hägg, O., Nordwall, A.: Complications in lumbar fusion surgery for chronic low back pain: comparison of three
surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar spine study group. Eur.
Spine J. 12(2), 178–189 (2003)
4. Hanley, E.N. Jr., David, S.M.: Lumbar arthrodesis for the treatment of back pain. J. Bone Joint Surg. 81(5), 716–730 (1999)
5. Lee, C.K.: Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13(3), 375–377 (1988)
6. Rahm, M.D., Hall, B.B.: Adjacent segment degeneration after lumbar fusion with instrumentation: a retrospective study.
J Spinal Disord. Tech. 9(5), 392–400 (1996)
7. Goto, K., Tajima, N., Chosa, E., Totoribe, K., Kubo, S., Kuroki, H., Arai, T.: Effects of lumbar spinal fusion on the other
lumbar intervertebral levels (three-dimensional finite element analysis). J. Orthop. Sci. 8(4), 577–584 (2003)
8. Penta, M., Sandhu, A., Fraser, R.D.: Magnetic resonance imaging assessment of disc degeneration 10 years after anterior
lumbar interbody fusion. Spine 20(6), 743–747 (1995)
9. Seitsalo, S., Schlenzka, D., Poussa, M., Österman, K.: Disc degeneration in young patients with isthmic spondylolisthesis
treated operatively or conservatively: a long-term follow up. Eur. Spine J. 6(6), 393–397 (1997)
10. Schmoelz, W., Huber, J.F., Nydegger, T., Claes, L., Wilke, H.J.: Dynamic stabilization of the lumbar spine and its effects
on adjacent segments-An in vitro experiment. J. Spinal Disord. Tech. 16(4), 418–423 (2003)
11. Gerber, M., Crawford, N.R., Chamberlain, R.H., Fifield, M.S, LeHuec, J.C., Dickman, C.A.: Biomechanical assessment
of anterior lumbar interbody fusion with an anterior lumbosacral fixation screw-plate: Comparison to stand-alone ante-
rior lumbar interbody fusion and anterior lumbar interbody fusion with pedicle screws in an unstable human cadaver
model. Spine 31(7), 762–768 (2006)
12. Fagan, M.J., Julian, S., Mohsen, A.M.: Finite element analysis in spine research. J. Eng. Med. 216(5), 281–298 (2002)
13. Zhang, Q.H., Teo, E.C.: Finite element application in implant research for treatment of lumbar degenerative disc disease. Med.
Eng. Phys. 30(10), 1246–1256 (2008)
14. Lee, K.K., Teo, E.C., Fuss, F.K., Vanneuville, V., Qiu, T.X., Ng, H.W., Yang, K., Sabitzer, R.J.: Finite-element analysis for
lumbar interbody fusion under axial loading. IEEE Trans. Biomed. Eng. 51(3), 393–400 (2004)
15. Steffen, T., Tsantrizos, A., Fruth, I., Aebi, M.: Cages: designs and concepts. Eur. Spine J. 9(1), S89–S94 (2000)
16. Adam, C., Pearcy, M., McCombe, P.: Stress analysis of interbody fusion-finite element modelling of intervertebral implant
and vertebral body. Clin. Biomech. 18(4), 265–272 (2003)
17. Chen, S.H., Tai, C.L., Lin, C.Y., Hsieh, P.H., Chen, W.P.: Biomechanical comparison of a new stand-alone anterior lumbar
interbody fusion cage with established fixation techniques-a three-dimensional finite element analysis. BMC Musculoskelet.
Disord. 9, 88 (2008)
18. Peng, X.Q., Guo, Z.Y., Moran, B.: An anisotropic hyperelastic constitutive model with fiber-matrix shear interaction for the
human annulus fibrosus. J. Appl. Mech. 73(5), 815–824 (2006)
 590 X. Peng et al.

19. Chen, C.S., Cheng, C.K., Liu, C.L., Lo, W.H.: Stress analysis of the disc adjacent to interbody fusion in lumbar spine. Med.
Eng. Phys. 23(7), 483–491 (2001)
20. Zander, T., Rohlmann, A., Calisse, J., Bergmann, G.: Estimation of muscle forces in the lumbar spine during upper-body
inclination. Clin. Biomech. 16(1), S73–S80 (2001)
21. Tsuang, Y.H., Chiang, Y.F., Hung, C.Y., Wei, H.W., Huang, C.H., Cheng, C.K.: Comparison of cage application modal-
ity in posterior lumbar interbody fusion with posterior instrumentation-A finite element study. Med. Eng. Phys. 31(5),
565–570 (2009)
22. Holzapfel, G.A., Schulze-Bauer, C.A.J., Feigl, G., Regitnig, P.: Single lamellar mechanics of the human lumbar annulus
fibrosus. Biomech. Model. Mechanobiol. 3(3), 125–140 (2005)
23. Virgin, W.J.: Experimental investigations into the physical properties of intervertebral disc. J. Bone Joint Surg. 33(4),
607–611 (1951)
24. Markolf, K.L., Morris, J.M.: The structural components of the intervertebral disc: a study of their contributions to the ability
of the disc to withstand compressive forces. J. Bone Joint Surg. 56, 675–687 (1974)
25. Gay, R.E., Ilharreborde, B., Zhao, K.D., Berglund, L.J., Bronfort, G., An, K.N.: Stress in lumbar intervertebral discs during
distraction: a cadaveric study. Spine J. 8(6), 982–990 (2008)
26. Steffen, T.: Three-dimensional Spine Biomechanics. A Combined In-vivo and Ex-vivo Approach. McGill University, Mon-
treal (1998)
27. Guan, Y., Yoganandan, N., Maiman, D.J., Pintar, F.A.: Internal and external responses of anterior lumbar/lumbosacral fusion:
Nonlinear finite element analysis. J. Spinal Disord. Tech. 21(4), 299–304 (2008)
28. Ivanov, A.A., Kiapour, A., Ebraheim, N.A., Goel, V.: Lumbar fusion leads to increases in angular motion and stress across
sacroiliac joint a finite element study. Spine 34(5), E162–E169 (2009)
29. Kumaresan, S., Yoganandan, N., Pintar, F.A., Maiman, D.J.: Finite element modelling of the cervical spine: role of inter-
vertebral disc under axial and eccentric loads. Med. Eng. Phys. 21(10), 689–700 (1999)
30. White, A.A., Panjabi, M.M.: Clinical Biomechanics of the Spine. Lippincott Williams & Wilkins, New York (1990)

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