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However, the procedure still faces a high incidence of non\u2010unions. A key factor contributing to non\u2010union is stress shielding effects related to unfavorable mechanical signals at the fusion site. Mechanical conditions at the fusion site are determined by the loading conditions that result from daily activities. Recent studies have reported that humans spend most of the day with their spine in a flexed position. The role of flexion loading in the progression of bone fusion remains poorly understood. This study explores the influence of habitual flexion loading on the spinal fusion process using a computational modeling framework that integrates finite element analysis with bone healing algorithms to simulate bone regeneration following fusion surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A finite element model of the lumbar spine based on a healthy subject was developed and validated with in\u00a0vitro experimental data. Thereafter, a virtual posterior lumbar interbody fusion was performed where 2 intervertebral cages were inserted at the L4\u2010L5 level together with posterior fixation. The influence of two loading conditions on the predicted fusion process were investigated: (1) A compression load (2) A hybrid (compression + flexion) loading protocol simulating habitual flexion encountered during daily living.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Bone bridging was predicted to occur 14\u2009weeks after surgery. At week 14, for the hybrid loading, the model predicted a bone volume of 70%, whereas for compression load, the bone volume prediction was 59%. Computer model predictions showed that habitual flexion loading can promote bone formation in the anterior and peripheral regions by inducing a mechanical environment favorable for bone formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Flexion loading may enhance bone healing by promoting mechanically advantageous conditions. The computational framework could guide the development of optimized rehabilitation protocols to improve fusion outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jsp2.70075","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T15:49:12Z","timestamp":1752508152000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of Habitual Flexion on Bone Formation After Spinal Fusion Surgery: An In Silico Study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4150-5680","authenticated-orcid":false,"given":"Siddarth","family":"Ananth Swaminathan","sequence":"first","affiliation":[{"name":"Julius Wolff Institute Berlin Institute of Health, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima","family":"Taheri","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9\u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Becker","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9\u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Pumberger","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9\u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute Berlin Institute of Health, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Checa","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute Berlin Institute of Health, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Institute of Biomechanics Hamburg University of Technology  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-020-06596-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2020.06.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2019.03.001"},{"issue":"4","key":"e_1_2_7_5_1","first-page":"E118","article-title":"Biomechanical Analysis of Various Footprints of Transforaminal Lumbar Interbody Fusion Devices","volume":"27","author":"Faizan A.","year":"2014","journal-title":"Clinical Spine Surgery"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199903150-00010"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199712150-00003"},{"issue":"6","key":"e_1_2_7_8_1","first-page":"461","article-title":"The Role of Fusion and Instrumentation in the Treatment of Degenerative Spondylolisthesis With Spinal Stenosis","volume":"6","author":"Bridwell K. 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