{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:24:54Z","timestamp":1784823894726,"version":"3.55.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T00:00:00Z","timestamp":1636070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> In developed countries, the age structure of the population is currently undergoing an upward shift, resulting a decrease in general bone quality and surgical durability. Over the past decade, oblique lumbar interbody fusion (OLIF) has been globally accepted as a minimally invasive surgical technique. There are several stabilization options available for OLIF cage fixation such as self-anchored stand-alone (SSA), lateral plate-screw (LPS), and bilateral pedicle screw (BPS) systems. The constructs\u2019 stability are crucial for the immediate and long-term success of the surgery. The aim of this study is to investigate the biomechanical effect of the aforementioned constructs, using finite element analysis with different bone qualities (osteoporotic and normal).<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> A bi-segmental (L2\u2013L4) finite element (FE) model was created, using a CT scan of a 24-year-old healthy male. After the FE model validation, CAD geometries of the implants were inserted into the L3\u2013L4 motion segment during a virtual surgery. For the simulations, a 150\u00a0N follower load was applied on the models, then 10\u00a0Nm of torque was used in six general directions (flexion, extension, right\/left bending, and right\/left rotation), with different bone material properties.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The smallest segmental (L3\u2013L4) ROM (range of motion) was observed in the BPS system, except for right bending. Osteoporosis increased ROMs in all constructs, especially in the LPS system (right bending increase: 140.26%). Osteoporosis also increased the caudal displacement of the implanted cage in all models (healthy bone: 0.06 \u00b1 0.03\u00a0mm, osteoporosis: 0.106 \u00b1 0.07\u00a0mm), particularly with right bending, where the displacement doubled in SSA and LPS constructs. The displacement of the screws inside the L4 vertebra increased by 59% on average (59.33 \u00b1 21.53%) due to osteoporosis (100% in LPS, rotation). BPS-L4 screw displacements were the least affected by osteoporosis.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The investigated constructs provide different levels of stability to the spine depending on the quality of the bone, which can affect the outcome of the surgery. In our model, the BPS system was found to be the most stable construct in osteoporosis. The presented model, after further development, has the potential to help the surgeon in planning a particular spinal surgery by adjusting the stabilization type to the patient\u2019s bone quality.<\/jats:p>","DOI":"10.3389\/fbioe.2021.749914","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T06:38:25Z","timestamp":1636094305000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":47,"title":["Stability Evaluation of Different Oblique Lumbar Interbody Fusion Constructs in Normal and Osteoporotic Condition \u2013 A Finite Element Based Study"],"prefix":"10.3389","volume":"9","author":[{"given":"Ferenc","family":"Bereczki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mate","family":"Turbucz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Kiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Endre","family":"Eltes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron","family":"Lazary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2783","DOI":"10.1097\/01.brs.0000192281.53603.3f","article-title":"The Transmission of Stress to Grafted Bone inside a Titanium Mesh Cage Used in Anterior Column Reconstruction after Total Spondylectomy: A Finite-Element Analysis","volume":"30","author":"Akamaru","year":"2005","journal-title":"Spine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1016\/j.spinee.2014.06.015","article-title":"Bilateral Pedicle Screw Fixation Provides superior Biomechanical Stability in Transforaminal Lumbar Interbody Fusion: A Finite Element Study","volume":"15","author":"Ambati","year":"2015","journal-title":"Spine J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3685","DOI":"10.1007\/s00330-015-3794-0","article-title":"Free DICOM De-identification Tools in Clinical Research: Functioning and Safety of Patient Privacy","volume":"25","author":"Aryanto","year":"2015","journal-title":"Eur. Radiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2551","DOI":"10.1118\/1.1414009","article-title":"Evaluation of Three-Dimensional Finite Element-Based Deformable Registration of Pre- and Intraoperative Prostate Imaging","volume":"28","author":"Bharatha","year":"2001","journal-title":"Med. Phys."},{"key":"B5","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3109\/17453677208998949","article-title":"A New Method to Analyse the Mechanical Behaviour of Skeletal Parts","volume":"43","author":"Brekelmans","year":"1972","journal-title":"Acta Orthopaedica Scand."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1016\/j.jbiomech.2013.03.022","article-title":"Finite Element Modeling Mesh Quality, Energy Balance and Validation Methods: A Review with Recommendations Associated with the Modeling of Bone Tissue","volume":"46","author":"Burkhart","year":"2013","journal-title":"J. Biomech."},{"key":"B7","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/978-3-319-14148-0_22","article-title":"3D Vertebra Segmentation by Feature Selection Active Shape Model","volume-title":"Recent Advances in Computational Methods and Clinical Applications for Spine Imaging","author":"Castro-Mateos","year":"2015"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1007\/s00586-017-5176-6","article-title":"Preoperative Evaluation of Left Common Iliac Vein in Oblique Lateral Interbody Fusion at L5-S1","volume":"26","author":"Chung","year":"2017","journal-title":"Eur. Spine J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.jbiomech.2014.04.002","article-title":"Comparison of Eight Published Static Finite Element Models of the Intact Lumbar Spine: Predictive Power of Models Improves when Combined Together","volume":"47","author":"Dreischarf","year":"2014","journal-title":"J. Biomech."},{"key":"B10","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1243\/09544110260216568","article-title":"Finite Element Analysis in Spine Research","volume":"216","author":"Fagan","year":"2002","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"B11","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1227\/neu.0000000000000953","article-title":"The Aging of the Global Population","volume":"77","author":"Fehlings","year":"2015","journal-title":"Neurosurgery"},{"key":"B12","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1080\/10255842.2018.1478967","article-title":"FEBio Finite Element Models of the Human Lumbar Spine","volume":"21","author":"Finley","year":"2018","journal-title":"Comp. Methods Biomech. Biomed. Eng."},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2017.05.013","volume-title":"Changing Demographics: A New Approach to Global Health Care Due to the Aging Population","author":"Fuster","year":"2017"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e530","DOI":"10.1016\/j.wneu.2020.02.180","article-title":"Stability Evaluation of Oblique Lumbar Interbody Fusion Constructs with Various Fixation Options: A Finite Element Analysis Based on Three-Dimensional Scanning Models","volume":"138","author":"Guo","year":"2020","journal-title":"World Neurosurg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s12178-019-09562-6","article-title":"Lateral and Oblique Lumbar Interbody Fusion-Current Concepts and a Review of Recent Literature","volume":"12","author":"Hah","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s00586-010-1641-1","article-title":"Biomechanical Evaluation of Posterior Lumbar Dynamic Stabilization: An In Vitro Comparison between Universal Clamp and Wallis Systems","volume":"20","author":"Ilharreborde","year":"2011","journal-title":"Eur. Spine J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1111\/os.12625","article-title":"Development and Application of Oblique Lumbar Interbody Fusion","volume":"12","author":"Li","year":"2020","journal-title":"Orthop. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2570","DOI":"10.1097\/00007632-199611150-00006","article-title":"Do Bending, Twisting, and Diurnal Fluid Changes in the Disc Affect the Propensity to Prolapse? A Viscoelastic Finite Element Model","volume":"21","author":"Lu","year":"1996","journal-title":"Spine (Phila Pa 1976)"},{"key":"B19","volume-title":"Abaqus User Manual","author":"Manual","year":"2020"},{"key":"B20","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/00003086-199603000-00017","article-title":"The Relationship between Degenerative Changes and Osteoporosis in the Lumbar Spine","volume":"324","author":"Margulies","year":"1996","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1097\/00007632-199703150-00023","article-title":"A New Microsurgical Technique for Minimally Invasive Anterior Lumbar Interbody Fusion","volume":"22","author":"Mayer","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.medengphy.2010.04.006","article-title":"Development of a Multi-Scale Finite Element Model of the Osteoporotic Lumbar Vertebral Body for the Investigation of Apparent Level Vertebra Mechanics and Micro-level Trabecular Mechanics","volume":"32","author":"McDonald","year":"2010","journal-title":"Med. Eng. Phys."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1007\/s11999-016-4883-3","article-title":"The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine with Few Early Complications","volume":"474","author":"Mehren","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3978\/j.issn.2414-469X.2015.10.05","article-title":"Lumbar Interbody Fusion: Techniques, Indications and Comparison of Interbody Fusion Options Including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","journal-title":"J. Spine Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.jocn.2016.02.030","article-title":"Review of Early Clinical Results and Complications Associated with Oblique Lumbar Interbody Fusion (OLIF)","volume":"31","author":"Phan","year":"2016","journal-title":"J. Clin. Neurosci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1097\/01.BRS.0000061987.71624.17","article-title":"The Effect of Cement Augmentation on the Load Transfer in an Osteoporotic Functional Spinal Unit","volume":"28","author":"Polikeit","year":"2003","journal-title":"Spine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"101","DOI":"10.21037\/atm.2018.01.22","article-title":"Complications on Minimally Invasive Oblique Lumbar Interbody Fusion at L2-L5 Levels: a Review of the Literature and Surgical Strategies","volume":"6","author":"Quillo-Olvera","year":"2018","journal-title":"Ann. Transl Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"670","DOI":"10.3171\/spi.2005.2.6.0670","article-title":"Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine. Part 7: Intractable Low-Back Pain without Stenosis or Spondylolisthesis","volume":"2","author":"Resnick","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0200899","DOI":"10.1371\/journal.pone.0200899","article-title":"Comparison of Patient-specific Computational Models vs. Clinical Follow-Up, for Adjacent Segment Disc Degeneration and Bone Remodelling after Spinal Fusion","volume":"13","author":"Rijsbergen","year":"2018","journal-title":"PLoS One"},{"key":"B30","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/j.jbiomech.2005.02.019","article-title":"Determination of Trunk Muscle Forces for Flexion and Extension by Using a Validated Finite Element Model of the Lumbar Spine and Measured In Vivo Data","volume":"39","author":"Rohlmann","year":"2006","journal-title":"J. Biomech."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1016\/j.jbiomech.2009.03.048","article-title":"Applying a Follower Load Delivers Realistic Results for Simulating Standing","volume":"42","author":"Rohlmann","year":"2009","journal-title":"J. Biomech."},{"key":"B32","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12891-018-1953-6","article-title":"Biomechanical Effects of Metastasis in the Osteoporotic Lumbar Spine: A Finite Element Analysis","volume":"19","author":"Salvatore","year":"2018","journal-title":"BMC Musculoskelet. Disord."},{"key":"B33","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1097\/01.brs.0000259059.90430.c2","article-title":"Intradiscal Pressure, Shear Strain, and Fiber Strain in the Intervertebral Disc under Combined Loading","volume":"32","author":"Schmidt","year":"2007","journal-title":"Spine"},{"key":"B34","doi-asserted-by":"publisher","first-page":"S108","DOI":"10.1227\/neu.0000000000000941","article-title":"Minimally Invasive Spinal Surgery in the Elderly","volume":"77","author":"Shamji","year":"2015","journal-title":"Neurosurgery"},{"key":"B35","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1097\/00007632-198611000-00012","article-title":"Mechanical Response of a Lumbar Motion Segment in Axial Torque Alone and Combined with Compression","volume":"11","author":"Shirazi-Adl","year":"1986","journal-title":"Spine"},{"key":"B36","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1097\/00007632-198403000-00003","article-title":"Stress Analysis of the Lumbar Disc-Body Unit in Compression A Three-Dimensional Nonlinear Finite Element Study","volume":"9","author":"Shirazi-adl","year":"1984","journal-title":"Spine"},{"key":"B37","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/00007632-199701150-00004","article-title":"Load Sharing between the Shell and Centrum in the Lumbar Vertebral Body","volume":"22","author":"Silva","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"B38","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4184\/asj.2012.6.2.89","article-title":"Complications and Morbidities of Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients","volume":"6","author":"Silvestre","year":"2012","journal-title":"Asian Spine J."},{"key":"B39","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1111\/os.12877","article-title":"Biomechanical Evaluation of Oblique Lumbar Interbody Fusion with Various Fixation Options: A Finite Element Analysis","volume":"13","author":"Song","year":"2021","journal-title":"Orthop. Surg."},{"key":"B40","doi-asserted-by":"publisher","first-page":"441","DOI":"10.2170\/physiolsci.RP009908","article-title":"The Virtual Physiological Human - a European Initiative for In Silico Human Modelling -","volume":"58","author":"Viceconti","year":"2008","journal-title":"J. Physiol. Sci."},{"key":"B41","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.compmedimag.2015.12.006","article-title":"A Multi-center Milestone Study of Clinical Vertebral CT Segmentation","volume":"49","author":"Yao","year":"2016","journal-title":"Comput. Med. Imaging Graphics"},{"key":"B42","volume-title":"The Comprehensive Treatment of the Aging Spine E-Book: Minimally Invasive and Advanced Techniques-Expert Consult","author":"Yue","year":"2010"},{"key":"B43","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.clinbiomech.2009.10.006","article-title":"The Biomechanical Effects of Osteoporosis Vertebral Augmentation with Cancellous Bone Granules or Bone Cement on Treated and Adjacent Non-treated Vertebral Bodies: A Finite Element Evaluation","volume":"25","author":"Zhang","year":"2010","journal-title":"Clin. Biomech."},{"key":"B44","doi-asserted-by":"publisher","first-page":"e1120","DOI":"10.1016\/j.wneu.2018.03.158","article-title":"Biomechanical Analysis of Lateral Lumbar Interbody Fusion Constructs with Various Fixation Options: Based on a Validated Finite Element Model","volume":"114","author":"Zhang","year":"2018","journal-title":"World Neurosurg."},{"key":"B45","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.clinbiomech.2016.11.007","article-title":"The Effects of Muscle Weakness on Degenerative Spondylolisthesis: A Finite Element Study","volume":"41","author":"Zhu","year":"2017","journal-title":"Clin. Biomech."},{"key":"B46","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/S1076-6332(03)00671-8","article-title":"Statistical Validation of Image Segmentation Quality Based on a Spatial Overlap index1","volume":"11","author":"Zou","year":"2004","journal-title":"Acad. Radiol."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2021.749914\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T06:38:32Z","timestamp":1636094312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2021.749914\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,5]]},"references-count":46,"alternative-id":["10.3389\/fbioe.2021.749914"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2021.749914","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,5]]},"article-number":"749914"}}