Background: Interbody discs play a major role in maintaining the spine and skeleton structures which may undergo damage. If damage is so severe that the disc cannot be repaired, implants, known as “interbody cages”, should be used.
Objectives: The present study aimed to propose a novel design with proper strength and resistance against axial disc torques.
Methods: The design and analysis of innovative anatomical cages comprised two stages, namely, cage design according to three different models and finite element analysis (FEA). The designs were based on the spine of a 15-year-old teenager without lumbar disc disease. To model the vertebrae, computed tomography )CT( scans and Digital Imaging and Communications in Medicine (DICOM) files were entered into Mimics Version 10.01 (Materialise Inc., Leuven, Belgium); then, the L4 and L5 spinal segments were modeled.
Results: The implants were fixed to the bottom level and subjected to a net force of 1000 N. Additionally, a moment load of 7.5 Nm in flexion, extension, axial rotation, and lateral bending was applied in these three cage models. Considering the application of 1000-N force, maximum and minimum stress and strain distribution rates were presented in three honeycomb, Islamic architecture, and porous gyroid cages.
Conclusion: Novel designs for lumbar cages were considered to achieve damping capacity, light weight, and high resistance. Considering the characteristics of the honeycomb, Islamic architecture, and gyroid structures, optimal designs were proposed for lumbar cages to achieve adequate strength and resistance against axial disc torques under normal conditions.
Cao L, Li X, Zhou X, Li Y, Vecchio KS, Yang L, et al. Lightweight open-cell scaffolds from sea urchin spines with superior material properties for bone defect repair. ACS Appl Mater Interfaces. 2017;9(11):9862-70. doi: 10.1021/acsami.7b01645. [PubMed: 28252933].
Figueroa O, Rodríguez CA, Siller HR, Martinez-Romero O, Flores-Villalba E, Díaz-Elizondo J, et al. Lumbar cage design concepts based on additive manufacturing. Virtual and Rapi. 2013;102:1-6.
Lee YH, Chung CJ, Wang CW, Peng YT, Chang CH, Chen CH, et al. Computational comparison of three posterior lumbar interbody fusion techniques by using porous titanium interbody cages with 50% porosity. Comput Biol Med. 2016;71:35-45. doi: 10.1016/j.compbiomed.2016.01.024. [PubMed: 26874064].
Basgul C, MacDonald DW, Siskey R, Kurtz SM. Thermal localization improves the interlayer adhesion and structural integrity of 3D printed PEEK lumbar spinal cages. Materialia. 2020;10:100650. doi: 10.1016/j.mtla.2020.100650. [PubMed: 32318685].
Brandão RA, da Silva Martins WC, Arantes Jr AA, Gusmão SN, Perrin G, Barrey C. Titanium versus polyetheretherketone implants for vertebral body replacement in the treatment of 77 thoracolumbar spinal fractures. Surg Neurol Int. 2017;8:191. doi: 10.4103/sni.sni_113_17. [PubMed: 28868203].
Distefano F, Epasto G, Guglielmino E, Amata A, Mineo R. Subsidence of a partially porous titanium lumbar cage produced by electron beam melting technology. J Biomed Mater Res. 2023;111(3):590-8. doi: 10.1002/jbm.b.35176.
Naoum S, Vasiliadis AV, Koutserimpas C, Mylonakis N, Kotsapas M, Katakalos K. Finite element method for the evaluation of the human spine: A Literature Overview. J
Funct Biomater. 2021;12(3):43. doi: 10.3390/jfb12030043. [PubMed: 34449646].
Serra T, Capelli C, Toumpaniari R, Orriss IR, Leong JJ, Dalgarno K, et al. Design and fabrication of 3D-printed anatomically shaped lumbar cage for intervertebral disc (IVD) degeneration treatment. Biofabrication. 2016;8(3):
doi: 10.1088/1758-5090/8/3/035001. [PubMed: 27431399].
Abueidda DW, Elhebeary M, Shiang CS, Pang S, Al-Rub RK, Jasiuk IM. Mechanical properties of 3D printed polymeric Gyroid cellular structures: Experimental and finite element study. Mater Des. 2019;165:107597.
Zhang Q, Yang X, Li P, Huang G, Feng S, Shen C, et al. Bioinspired engineering of honeycomb structure–Using nature to inspire human innovation. Prog Mater Sci. 2015;74:332-400. doi: 10.1016/j.pmatsci.2015.05.001. [PubMed: 29501735].
Zhang Z, Li H, Fogel GR, Xiang D, Liao Z, Liu W. Finite element model predicts the biomechanical performance of transforaminal lumbar interbody fusion with various porous additive manufactured cages. Comput Biol Med. 2018;95:167-74. doi: 10.1016/j.compbiomed.2018.02.016.
Phan K, Mobbs RJ. Evolution of design of interbody cages for anterior lumbar interbody fusion. Orthop Surg. 2016;8(3):270-7. doi: 10.1111/os.12259. [PubMed: 27627708].
Zhu H, Zhong W, Zhang P, Liu X, Huang J, Liu F, et al. Biomechanical evaluation of autologous bone-cage in posterior lumbar interbody fusion: a finite element analysis. BMC Musculoskelet Disord. 2020;21(1):379.doi: 10.1186/s12891-020-03411-1. [PubMed: 32534573].
Zhang Z, Li H, Fogel GR, Liao Z, Li Y, Liu W. Biomechanical analysis of porous additive manufactured cages for lateral lumbar interbody fusion: a finite element analysis. World Neurosurg. 2018;111:581-91. doi: 10.1016/j.wneu.2017.12.127. [PubMed: 29288855].
Piple AS, Ungurean Jr V, Raji OR, Rowland A, Schlauch A, Kondrashov DG, et al. An Analysis of a decade of
lumbar interbody cage failures in the United States: A MAUDE database study. Spine. 2023:10-97. doi: 10.1097/BRS.0000000000004583. [PubMed: 36727830].