{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T14:28:00Z","timestamp":1768746480088,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The occurrence of ALL rupture during posterior correction of adult spinal deformity (ASD) was rare before the introduction of lateral lumbar interbody fusion (LLIF) but has become more frequent recently. It remains unclear whether this phenomenon is unique to LLIF-combined procedures or primarily related to enhanced corrective ability. Methods: The research method used in this study is finite element analysis (FEA). Using preoperative computed tomography images, LLIF cage (L group) or posterior lumbar interbody fusion (PLIF) cage (P group) were placed in the disc space with identical lordotic angles and distances from the anterior vertebral body edge for the same patients\u2019 samples. Finite element simulations of corrective procedures were conducted. A spring simulating the ALL was introduced into the FEA, and the load on the ALL was evaluated with either LLIF or PLIF cage placement. Spring elongation directly measured the load on the ALL, while the location of the rotation center served as an indirect evaluation. Two different types of corrective procedures were created, one of which is mimicking ASD correction. For both procedures, the load to ALL was measured using abovementioned parameters when either LLIF cage (L group) or PLIF cage (P group) was used. The load to ALL was compared between L group and P group. Results: The degree of spring elongation during the simulation of a corrective procedure significantly decreased in the L group compared to the P group only in the model which is mimicking ASD correction (p = 0.006, Cohen\u2019s d = 2.33, Power (1\u2212\u03b2) = 0.956). The rotation center was significantly more posteriorly located in the P group than that in the L group in both models. These differences were more obvious in the model mimicking ASD correction (p = 0.0013, Cohen\u2019s d = 2.00, Power (1\u2212\u03b2) = 0.891). Conclusions: Our findings suggest that the use of a PLIF cage, which has a longer anterior\u2013posterior cage length, caused the posterior edge of the cage to act as a pivot point. This configuration places greater leverage on the ALL, potentially leading to rupture during posterior correction procedures. This phenomenon, ALL rupture during posterior correction for ASD, is thought to be associated with increased corrective capabilities rather than being specific to the geometry of the LLIF cage.<\/jats:p>","DOI":"10.3390\/jcm14217460","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:20:44Z","timestamp":1761196844000},"page":"7460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Anterior Longitudinal Ligament Rupture During Posterior Corrective Surgery for Adult Spinal Deformity a Phenomenon Unique to When Combined with Lateral Lumbar Interbody Fusion? -Finite Element Analysis with Comparison to When Combined with Posterior Lumbar Interbody Fusion-"],"prefix":"10.3390","volume":"14","author":[{"given":"Takaya","family":"Imai","sequence":"first","affiliation":[{"name":"Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichiro","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koutaro","family":"Kageshima","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Akaike","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soya","family":"Kawabata","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8658-2088","authenticated-orcid":false,"given":"Nobuyuki","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinjiro","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3171\/2014.7.SPINE13564","article-title":"Retroperitoneal oblique corridor to the L2-S1 intervertebral discs in the lateral position: An anatomic study","volume":"21","author":"Davis","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","journal-title":"Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/BSD.0b013e3181ecf995","article-title":"Lateral lumbar interbody fusion: Clinical and radiographic outcomes at 1 year: A preliminary report","volume":"24","author":"Sharma","year":"2011","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"246989","DOI":"10.1100\/2012\/246989","article-title":"Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions","volume":"2012","author":"Malham","year":"2012","journal-title":"Sci. World J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1007\/s11999-013-3263-5","article-title":"Is the lateral transpsoas approach feasible for the treatment of adult degenerative scoliosis?","volume":"472","author":"Castro","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/j.jocn.2015.03.050","article-title":"Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity","volume":"22","author":"Phan","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","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":"ref_8","first-page":"543","article-title":"Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates","volume":"17","author":"Kamal","year":"2017","journal-title":"Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s12178-017-9444-1","article-title":"Lateral lumbar interbody fusion outcomes and complications","volume":"10","author":"Salzmann","year":"2017","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"738","DOI":"10.31616\/asj.2018.0275","article-title":"Factors affecting postoperative sagittal alignment after lateral lumbar interbody fusion in adult spinal deformity: Posterior osteotomy, anterior longitudinal ligament rupture, and endplate injury","volume":"13","author":"Nakashima","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1227\/NEU.0000000000000182o","article-title":"The comprehensive anatomical spinal osteotomy classification","volume":"74","author":"Schwab","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"697","DOI":"10.3171\/2016.4.SPINE16157","article-title":"Lateral interbody fusion combined with open posterior surgery for adult spinal deformity","volume":"25","author":"Strom","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1177\/21925682211069936","article-title":"Circumferential bone fusion in adult spinal deformity via combination of oblique lateral interbody fusion and grade 2 posterior column osteotomy","volume":"13","author":"Zakaria","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E26","DOI":"10.1097\/BSD.0000000000001000","article-title":"Incidence and risk factors of anterior longitudinal ligament rupture after posterior corrective surgery using lateral lumbar interbody fusion for adult spinal deformity","volume":"34","author":"Maruo","year":"2021","journal-title":"Clin. Spine Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2185\/jrm.2020-057","article-title":"Accidental anterior longitudinal ligament rupture during lateral lumbar interbody fusion disclosed after posterior corrective fusion surgery resulting in local hyper-lordosis","volume":"16","author":"Shibao","year":"2021","journal-title":"J. Rural Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"87","DOI":"10.22603\/ssrr.2018-0097","article-title":"Anterior column reconstruction performed for complete anterior longitudinal ligament rupture caused by surgical correction with lateral interbody fusion for kyphosis","volume":"4","author":"Yamamura","year":"2019","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S1350-4533(03)00138-3","article-title":"An improved method for the automatic mapping of computed tomography numbers onto finite element models","volume":"26","author":"Taddei","year":"2004","journal-title":"Med. Eng. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1177\/0954411911423346","article-title":"Mechanical characterization of fourth generation composite humerus","volume":"225","author":"Grover","year":"2011","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jbiomech.2011.11.038","article-title":"Considerations for reporting finite element analysis studies in biomechanics","volume":"45","author":"Erdemir","year":"2012","journal-title":"J. Biomech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1016\/S0020-1383(13)70200-6","article-title":"Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model","volume":"44","author":"Sabalic","year":"2013","journal-title":"Injury"},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1055\/s-0035-1570114","article-title":"The use of finite element analysis to enhance research and clinical practice in orthopedics","volume":"29","author":"Pfeiffer","year":"2016","journal-title":"J. Knee Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"125","DOI":"10.3171\/2016.6.SPINE151477","article-title":"The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: A finite element analysis","volume":"26","author":"Bess","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1016\/j.wneu.2018.02.073","article-title":"Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: A finite element analysis","volume":"114","author":"Zhao","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"574","DOI":"10.3171\/2018.10.SPINE18429","article-title":"Optimal tether configurations and preload tensioning to prevent proximal junctional kyphosis: A finite element analysis","volume":"30","author":"Buell","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13018-019-1150-9","article-title":"Biomechanical study of proximal adjacent segment degeneration after posterior lumbar interbody fusion and fixation: A finite element analysis","volume":"14","author":"Jiang","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Du, C.F., Cai, X.Y., Gui, W., Sun, M.S., Liu, Z.X., Liu, C.J., Zhang, C.Q., and Huang, Y.P. (2021). Does oblique lumbar interbody fusion promote adjacent degeneration in degenerative disc disease: A finite element analysis. Comput. Biol. Med., 128.","DOI":"10.1016\/j.compbiomed.2020.104122"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, X.H., She, L.J., Zhang, W., Cheng, X.D., and Fan, J.P. (2022). Biomechanics of extreme lateral interbody fusion with different internal fixation methods: A finite element analysis. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05049-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E355","DOI":"10.1097\/BRS.0000000000004791","article-title":"Effect of lumbar fusion and pelvic fixation rigidity on hip joint stress: A finite element analysis","volume":"48","author":"Kozaki","year":"2023","journal-title":"Spine"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tachi, H., Kato, K., Abe, Y., Kokabu, T., Yamada, K., Iwasaki, N., and Sudo, H. (2021). Surgical outcome prediction using a four-dimensional planning simulation system with finite element analysis incorporating pre-bent rods in adolescent idiopathic scoliosis: Simulation for spatiotemporal anatomical correction technique. Front. Bioeng. Biotechnol., 9.","DOI":"10.3389\/fbioe.2021.746902"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1177\/09544119221128467","article-title":"Optimization of cervical cage and analysis of its base material: A finite element study","volume":"236","author":"Jalilvand","year":"2022","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Takeda, H., Abe, Y., Imai, T., Rashid, M.Z.M., Ikeda, D., Kawabata, S., Nagai, S., Hachiya, K., Fujita, N., and Kaneko, S. (2023). Elucidation of the mechanism of occasional anterior longitudinal ligament rupture with posterior correction procedure for adult spinal deformity using LLIF-finite element analysis of the impact of the lordotic angle of intervertebral LLIF cage. Medicina, 59.","DOI":"10.3390\/medicina59091569"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav. Res. Methods"},{"key":"ref_35","first-page":"656","article-title":"Advancements in biomaterials and bioactive solutions for lumbar spine fusion cages: Current trends and future perspectives","volume":"53","author":"Antoniac","year":"2025","journal-title":"Bioact. Mater."}],"updated-by":[{"DOI":"10.3390\/jcm15020728","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000}}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7460\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:37:27Z","timestamp":1768552647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":35,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217460"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217460","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]}}}