{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:35:25Z","timestamp":1760150125323,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>A novel interlaminar elastic screw spacer technique was designed to maintain lumbar mobility in treating lumbar degenerative diseases. A validated finite element model of L4\/5 was used to establish an ISES-1\/2 model and an ISES-1\/3 model based on different insertion points, a unilateral fixation model and a bilateral fixed model based on different fixation methods, and a Coflex-F model based on different implants. The elastic rods were used to fix screws. Under the same mechanical conditions, we compared the biomechanical characteristics to investigate the optimal entry point for ISES technology, demonstrate the effectiveness of unilateral fixation, and validate the feasibility of the ISES technique. Compared to ISES-1\/3, the ISES-1\/2 model had lower intradiscal pressure, facet cartilage stress, and posterior structural stress. Compared to the ISES-BF model, the ISES-UF model had lower intervertebral pressure, larger mobility, and smaller stress on the posterior structures. The ISES model had a similar intervertebral pressure and limitation of extension as the Coflex-F model. The ISES model retained greater mobility and reduced the stress on the facet cartilage and posterior structure compared with the Coflex-F model. Our study suggests that the ISES technique is a promising treatment of lumbar degenerative diseases, especially those with osteoporosis.<\/jats:p>","DOI":"10.3390\/bioengineering10101204","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T05:43:49Z","timestamp":1697435029000},"page":"1204","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment of Lumbar Degenerative Disease with a Novel Interlaminar Screw Elastic Spacer Technique: A Finite Element Analysis"],"prefix":"10.3390","volume":"10","author":[{"given":"Zebin","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maodan","family":"Nie","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiabin","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xumiao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuerong","family":"Chu","sequence":"additional","affiliation":[{"name":"Daxing Hospital, Xi\u2019an 710082, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhicai","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00296-019-04273-0","article-title":"Real-world incidence and prevalence of low back pain using routinely collected data","volume":"39","author":"Fatoye","year":"2019","journal-title":"Rheumatol. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.bjpt.2019.01.012","article-title":"Low back pain and some associated factors: Is there any difference between genders?","volume":"24","author":"Bento","year":"2020","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_3","first-page":"e19956","article-title":"Inter Spinal Fixation and Stabilization Device for Lumbar Radiculopathy and Back Pain","volume":"13","author":"Raikar","year":"2021","journal-title":"Cureus"},{"key":"ref_4","first-page":"e13886","article-title":"Interspinous Process (ISP) Devices in Comparison to the Use of Traditional Posterior Spinal Instrumentation","volume":"13","author":"Faulkner","year":"2021","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s00264-018-4188-0","article-title":"Preliminary efficacy of inter-spinal distraction fusion which is a new technique for lumbar disc herniation","volume":"43","author":"Wei","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Li, K., Li, H., Chen, L., Xiang, J., Li, C., Weng, J., and Tian, N. (2023). Complications and radiographic changes after implantation of interspinous process devices: Average eight-year follow-up. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06798-9"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.spinee.2009.10.010","article-title":"Determination of the in vivo posterior loading environment of the Coflex interlaminar-interspinous implant","volume":"10","author":"Trautwein","year":"2010","journal-title":"Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Magerl, F. (1984). Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin. Orthop. Relat. Res., 125\u2013141.","DOI":"10.1097\/00003086-198410000-00014"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mulholland, R., and Sengupta, D. (2002). Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur. Spine J., S198\u2013S205.","DOI":"10.1007\/s00586-002-0422-x"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jia, L., Yu, Y., Khan, K., Li, F., Zhu, R., Zeng, Z., and Cheng, L. (2018). Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/6152769"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Oh, H., and Seo, H. (2021). The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132911"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1177\/2192568220962444","article-title":"Trajectory of Lumbar Translaminar Facet Screw Under Navigation: A Cadaveric Study","volume":"12","author":"Singhatanadgige","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_13","first-page":"550","article-title":"Translaminar facet screw placement: An anatomic study","volume":"27","author":"Lu","year":"1998","journal-title":"Am. J. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5082","DOI":"10.1177\/0300060519869719","article-title":"Anatomic study of the lumbar lamina for safe and effective placement of lumbar translaminar facet screws","volume":"47","author":"Hu","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.spinee.2015.03.038","article-title":"The influence of facet joint orientation and tropism on the stress at the adjacent segment after lumbar fusion surgery: A biomechanical analysis","volume":"15","author":"Kim","year":"2015","journal-title":"Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","doi-asserted-by":"crossref","unstructured":"Huang, Z.B., Nie, M.D., Zhang, N.Z., Liu, S., Yuan, J.B., Lin, X.M., Cheng, C.K., Shi, Z.C., and Mao, N.F. (2022). Biomechanical evaluation of a short-rod technique for lumbar fixation surgery. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.959210"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s007760200040","article-title":"Mechanical analysis of the lumbar vertebrae in a three-dimensional finite element method model in which intradiscal pressure in the nucleus pulposus was used to establish the model","volume":"7","author":"Goto","year":"2002","journal-title":"J. Orthop. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/00007632-199106000-00008","article-title":"Change of disc height, radial disc bulge, and intradiscal pressure from discectomy. An in vitro investigation on human lumbar discs","volume":"16","author":"Brinckmann","year":"1991","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/00007632-198507000-00008","article-title":"Kinematics of the whole lumbar spine. Effect of discectomy","volume":"10","author":"Goel","year":"1985","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3171\/2009.10.SPINE09305","article-title":"Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion","volume":"12","author":"Karahalios","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1097\/00007632-198911000-00020","article-title":"Three-dimensional movements of the whole lumbar spine and lumbosacral joint","volume":"14","author":"Yamamoto","year":"1989","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1080\/10255842.2010.502894","article-title":"Biomechanical effect after Coflex and Coflex rivet implantation for segmental instability at surgical and adjacent segments: A finite element analysis","volume":"14","author":"Lo","year":"2011","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_24","first-page":"395","article-title":"Do patients\u2019 expectations influence conservative treatment in Chronic Low Back Pain? A Narrative Review","volume":"46","author":"Ballestra","year":"2022","journal-title":"Retos-Nuevas Tend. Educ. Fis. Deport. Recreacion"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Far\u00ec, G., de Sire, A., Fallea, C., Albano, M., Grossi, G., Bettoni, E., Di Paolo, S., Agostini, F., Bernetti, A., and Puntillo, F. (2022). Efficacy of Radiofrequency as Therapy and Diagnostic Support in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12030600"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s40122-023-00489-y","article-title":"Low Back Pain and Radiofrequency Denervation of Facet Joint: Beyond Pain Control-A Video Recording","volume":"12","author":"Giglio","year":"2023","journal-title":"Pain Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1097\/BRS.0b013e3182a32208","article-title":"Re: Lumbar spine fusion for chronic low back pain due to degenerative disc disease. A systematic review","volume":"38","author":"Kovacs","year":"2013","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s13018-022-03015-6","article-title":"Effects of posterior lumbar nonfusion surgery with isobar devices versus posterior lumbar interbody fusion surgery on clinical and radiological features in patients with lumbar degenerative diseases: A meta-analysis","volume":"17","author":"Guan","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Fan, W., and Guo, L. (2020). The effect of non-fusion dynamic stabilization on biomechanical responses of the implanted lumbar spine during whole-body vibration. Comput. Methods Programs Biomed., 192.","DOI":"10.1016\/j.cmpb.2020.105441"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"629698","DOI":"10.1155\/2012\/629698","article-title":"A short history of posterior dynamic stabilization","volume":"2012","author":"Gomleksiz","year":"2012","journal-title":"Adv. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1007\/s00586-015-3850-0","article-title":"Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis","volume":"24","author":"Anekstein","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.clineuro.2018.06.030","article-title":"Comparative effectiveness and safety of posterior lumbar interbody fusion, Coflex, Wallis, and X-stop for lumbar degenerative diseases: A systematic review and network meta-analysis","volume":"172","author":"Mo","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_33","first-page":"7561","article-title":"Long term results of the use of a fusion-promoting, new generation interspinous processes device (IPD), Bacfuse (R): A monocentric prospective study","volume":"26","author":"Spallone","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1097\/01.brs.0000158971.74152.b6","article-title":"Stress shielding in box and cylinder cervical interbody fusion cage designs","volume":"30","author":"Epari","year":"2005","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.spinee.2005.03.016","article-title":"Percutaneous computer-assisted translaminar facet screw: An initial human cadaveric study","volume":"5","author":"Sasso","year":"2005","journal-title":"Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e516","DOI":"10.1016\/j.wneu.2018.04.085","article-title":"Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion for the Treatment of Low Lumbar Degenerative Disc Diseases: Analysis of Clinical and Radiographic Results","volume":"115","author":"Chen","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","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":"ref_38","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1097\/00007632-200007150-00017","article-title":"Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion","volume":"25","author":"Suk","year":"2000","journal-title":"Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/s13018-018-1004-x","article-title":"Is unilateral pedicle screw fixation superior than bilateral pedicle screw fixation for lumbar degenerative diseases: A meta-analysis","volume":"13","author":"Lu","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Newell, E., and Driscoll, M. (2021). Investigation of physiological stress shielding within lumbar spinal tissue as a contributor to unilateral low back pain: A finite element study. Comput. Biol. Med., 133.","DOI":"10.1016\/j.compbiomed.2021.104351"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"256","DOI":"10.4184\/asj.2018.12.2.256","article-title":"Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model","volume":"12","year":"2018","journal-title":"Asian Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/00007632-198409000-00005","article-title":"Mechanism of facet load transmission as a hypothesis for low-back pain","volume":"9","author":"Yang","year":"1984","journal-title":"Spine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s13018-020-01826-z","article-title":"Effect of facet-joint degeneration on the in vivo motion of the lower lumbar spine","volume":"15","author":"Yin","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e10192","DOI":"10.1002\/jbm4.10192","article-title":"Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States","volume":"3","author":"Lewiecki","year":"2019","journal-title":"JBMR Plus"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1759720X221083541","DOI":"10.1177\/1759720X221083541","article-title":"Osteoporosis in 10 years time: A glimpse into the future of osteoporosis","volume":"14","author":"Adami","year":"2022","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s00586-008-0825-4","article-title":"Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw","volume":"18","author":"Sethi","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13018-017-0606-z","article-title":"Minimally invasive unilateral pedicle screws and a translaminar facet screw fixation and interbody fusion for treatment of single-segment lower lumbar vertebral disease: Surgical technique and preliminary clinical results","volume":"12","author":"Huang","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Alonso P\u00e9rez, J., Mart\u00edn P\u00e9rez, S., Battaglino, A., Villafa\u00f1e, J., Alonso-Sal, A., and S\u00e1nchez Romero, E. (2021). An Up-Date of the Muscle Strengthening Exercise Effectiveness in Postmenopausal Women with Osteoporosis: A Qualitative Systematic Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112229"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/10\/1204\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:07:38Z","timestamp":1760130458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/10\/1204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["bioengineering10101204"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10101204","relation":{},"ISSN":["2306-5354"],"issn-type":[{"type":"electronic","value":"2306-5354"}],"subject":[],"published":{"date-parts":[[2023,10,16]]}}}