Open laminectomy plus posterolateral fusion versus open laminectomy plus transforaminal lumbar interbody fusion surgical approaches for fusing degenerated L4-L5 segment: A comparative finite element study

Various finite element (FE) studies reported the biomechanical effects of fusion surgeries in the lumbar spine. However, a comparative study on Open laminectomy plus Posterolateral Fusion (OL-PLF) and Open Laminectomy plus Transforaminal Lumbar Interbody Fusion (OL-TLIF) for fusing an L4-L5 segment has not been reported in the literature. The present comparative FE study evaluates the biomechanical variations in an L4-L5 segment fused using OL-PLF and OL-TLIF surgical approaches. The three-dimensional implanted models were constructed from a computed-tomography scan dataset using image processing software. The models were simulated for the physiological movements such as lateral bending, flexion and extension. The OL-TLIF model had a considerably larger peak equivalent strain than the OL-PLF model under extension (126 %), lateral bending (88 %) and flexion (13 %). However, in both implanted models, a peak equivalent strain above the compressive yield strain limit of the vertebra (0.007) was observed over 60 % of the L4-L5 fused segment, indicating an imminent post-operative bone failure under the imposed loading conditions. The maximum equivalent strain observed in the disc and endplates of the L3-L4 segment was substantially larger to initiate the adjacent segment degeneration. No discernible biomechanical benefits were observed for the OL-TLIF or OL-PLF approaches in fusing the L4-L5 segment.