Future work - Conclusion and Future Work - 新型腰椎獨立式融合器的生物力學分析

Chapter 6 Conclusion and Future Work

6.3 Future work

The above studies are focused on single segment disease only. However, the disc degeneration disease occurs sometime in the multi-segment or adjacent segment after fusion surgery. Adjacent segment degeneration is the tendency for clinical symptomatic changes to occur following fusion surgery. It is widely believed that spinal fusion significantly alters the biomechanical environment of the adjacent spinal motion segments leading to an acceleration of the normal degenerative process. However, the outcomes of the combined use with pedicle screws and the multi-segment use of Latero device are unknown. The models instrumented with multiple levels can be a major topic in the further works.

In this study, the size of the implanted cages were decided by the surgeon. However, the lumbar geometry difference of every individual may lead to different analysis result. The size effect of the cages can be considered in the future works. Therefore, the surgeon can select

more appropriate cage size for each patient.

Topics can also be extended for new fusion surgery processes comparing with the Latero device. Ozqur et al. [118] described a minimally disruptive spine procedure called the Extreme Lateral Interbody Fusion or XLIF. The technique is used to gain access to the lumbar spine passing through the retroperitoneal fat and psoas major muscle. It is the other kind of lateral approach. The XLIF® cage (NuVasive Co., USA) is larger than Latero that it is can cross the whole vertebra (figure 6.1). The two-hole lateral plate has been used for clinical use for added stabilization after cage instrumentation. The two-hole lateral plate used here is not the same as the lateral plate in the Latero device. The two-hole lateral was not inserted into the vertebra. It attached on the lateral side of vertebra, and used the superior and inferior screws to stabilize the vertebras (see figure 6.1). The XLIF® device and Latero device are similar in some way. However, no finite element literature exists defining the stabilizing role of XLIF® by far. Therefore, the study of comparing the Latero device and XLIF® device can be investigated in the further.

Figure 6. 1: The XLIF® device (anterior view)

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1. Chen SH, Chiang MC, Lin JF, Lin SC, Hung CH.“Biomechanical comparison of three stand-alone lumbar cages --- a three-dimensional finite element analysis”, BMC Musculoskelet Disord 2013, 14(1):281. DOI: 10.1186/10.1186/1471-2474-14-281 [Epub ahead of print]

2. Chen SH, Chiang MC, Hung CH, Lin SC, Chang HW. “Finite element comparison of retrograde intramedullary nailing and locking plating fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty”, Knee 2013. DOI: 10.1016/j.knee.2013.03.006. [Epub ahead of print]

3. 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, Vol. 26 No. 4 p170-179.

4. Chien CY, Tan CH, Lin SC, Chuang WH, Chiang MC, Luh YP, Chen YJ. “Pretension Effects of the Dynesys Cord on the Tissue Responses and Screw-Spacer Behaviors of the Lumbosacral Construct With Hybrid Fixation”, Spine 2013, 1;38(13):E775-E782

Conference Papers

1. Chen SH, Zhong ZC, Chiang MC, Chen WJ, Hung C. “The load and displacement controlled finite element analyses on fusion and non-fusion spinal implants”, 53nd Congress of Taiwan Orthopaedic Association, Taoyuan, Taiwan, October 27-28 2007.

2. 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 2008.

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