Chapter 5: Conclusion and Future Work
5.2. Future Work
This study suggests several avenues for future research. The five-level lumbar spine model derived in this study can be used in parameter analysis for creating a design guide which could include the effects of implant height, position, material, size, and shape. The results are useful for engineers in the design and development of new spinal implants. It also serves as a reference resource for surgeons in selecting implants for the patients. To avoid accelerative disc degeneration after treatment by spinal fusion, several pedicle-based non-fusion dynamic stabilization systems have been developed.
Differences between dynamic stabilization systems and traditional pedicle screw instrumentation systems can be considered in future studies. In addition, patients who had accelerative disc degeneration at adjacent levels could be treated with various non-fusion spinal implants to prevent another surgery for extended fusion to the adjacent levels. The function of hybrid use of these spinal implants can be investigated through further study. In addition, the advantage of non-fusion spinal implants is to preserve a mildly to moderately degenerative disc. Therefore, the various grades of degeneration in the disc could be considered through change of material properties, disc height, or disc geometry.
Recently, Patwardhan et al. [113] proposed a “follower load” to mimic the more realistic physiological compressive loads seen in vivo. This consists of a compressive load applied along a “follower load” path that approximates the tangent to the curve of the lumbar spine, thus subjecting the whole lumbar spine to nearly pure compression. Besides the “follower load”, there are several methods that have been presented for mimicking the role of muscles.
Differences among them are still not known. Therefore, comparison of these loading conditions is another topic for future work.
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Publication List
Journal Papers:
1. Liu CL, Zhong ZC, Shih SL, Hung C, Lee YE, Chen CS. Influence of Dynesys system screw profile on adjacent segment and screw. Journal of Spinal Disorders &
Techniques 2008. (Accepted)
2. Zhong ZC, Chen SH, Hung C. Load- and displacement- controlled finite element analyses on fusion and non-fusion spinal implants. Proceedings of the Institution of Mechanical Engineers, Part H - Journal of Engineering in Medicine 2009 Feb;
223(2):143-157.
3. Chen SH, Zhong ZC, Chen CS, Chen WJ, Hung C. Biomechanical comparison between lumbar disc arthroplasty and fusion. Medical Engineering & Physics 2009 Mar; 31(2):244-253.
4. Chiang MF, Zhong ZC, Chen CS, Cheng CK, Shih SL. Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two cages by finite element analysis. Spine 2006 Sep; 31(19): E682-E689.
5. Wang JP, Zhong ZC, Cheng CK, Chen CS, Yu Ch, Chang TK, Wei SH. Finite element analysis of the spondylolysis in lumbar spine. Bio-Medical Materials &
Engineering 2006 Oct; 16(5):301-308.
6. Zhong ZC, Wei SH, Wang JP, Feng CK, Chen CS, Yu Ch. Finite element analysis of the lumbar spine with a new cage using topology optimization method. Medical Engineering & Physics 2006 Jan; 18(1):90-98.
7. Chen SH, Chiang MC, Zhong ZC, Hung C. The finite element analysis using a follower load on fusion and non-fusion spinal implants. Journal of Orthopaedic Surgery Taiwan 2009. (Accepted)
8. Chen SH, Chao SH, Zhong ZC, Hung C. Biomechanical comparison of two new stand-alone anterior lumbar interbody fusion cages (SynFix and Stabilis) with established fixation techniques – a three-dimensional finite element analysis. Journal of Orthopaedic Surgery Taiwan 2009. (Accepted)
Conference Papers:
1. Chen SH, Chao SH, Zhong ZC, Hung C, Chen WJ. Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody interbody fusion after decompressive surgery - A finite element analysis.
Orthopaedic Research Society 55th Annual Meeting (ORS 55th), No. 1725, Las Vegas, Nevada, US (February 22-25, 2009)
2. Zhong ZC, Chen SH, Chen WJ, Hung C. Comparison of the load and displacement controlled finite element analyses on fusion and non-fusion spinal implants.
International Society of Biomechanics XXI Congress (21st ISB 2007), Taipei, Taiwan (July 1-5, 2007) Published in Journal of Biomechanics 2007;40(S2):S353.
3. Zhong ZC, Chiang MF, Hung C, Chen CS, Cheng CK. Biomechanical comparison of instrumented lumbar interbody fusion with one or two cages by finite element analysis. The 2nd Asian Pacific Conference On Biomechanics (APB2005), Taipei, Taiwan (November 23-25, 2005)
4. 陳世豪、江銘傑、鍾政成、陳文哲、洪景華，應用伴隨負荷之有限元素模型對
6. Chen SH, Zhong ZC, Chiang MC, Chen WJ, Hung C. The load and displacement controlled finite element analyses with follower load on fusion and non-fusion spinal implants. 55th Congress of Taiwan Orthopaedic Association, Taoyuan, Taiwan (October 25-26, 2008)
7. Chen SH, Chao SH, Zhong ZC, Lo CC, Hung C. Biomechanical comparison of two new stand-alone anterior lumbar interbody fusion cages (SynFix and Stabilis) with estabilished fixation techniques – a three-dimensional finite element analysis. 55th Congress of Taiwan Orthopaedic Association, Taoyuan, Taiwan (October 25-26, 2008)
8. Chen SH, Lo CC, Tsai KJ, Zhong ZC, Hung C. Biomechanical effect of interspinous
8. Chen SH, Lo CC, Tsai KJ, Zhong ZC, Hung C. Biomechanical effect of interspinous