{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:23:26Z","timestamp":1761218606606,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic cages were available and ALL rupture was more frequently experienced compared with later periods when more lordotic cages were available. We performed finite element analysis (FEA) regarding the mechanism of ALL rupture during a posterior correction procedure. Methods: A spring (which mimics ALL) was introduced at the location of ALL in the FEA and an LLIF cage with two different lordotic angles, 6 and 12 degrees (6DC\/12DC), was employed. To assess the extent of burden on the ALL, the extension length of the spring during the correction procedure was measured and the location of the rotation center was examined. Results: We observed a significantly higher degree of length extension of the spring during the correction procedure in the FEA model with 6DC compared with that of 12DC. We also observed that the location of the rotation center was shifted posteriorly in the FEA model with 6DC compared with that of 12DC. Conclusions: It is considered that the posterior and rostral edge of the less lordotic angle cage became a hinge, and the longer lever arm increased the burden on ALL as the principle of leverage. It is important to use an LLIF cage with a sufficient lordotic angle, that is compatible with the degree of posterior osteotomy in ASD correction.<\/jats:p>","DOI":"10.3390\/medicina59091569","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T10:46:00Z","timestamp":1693305960000},"page":"1569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Elucidation of the Mechanism of Occasional Anterior Longitudinal Ligament Rupture with Posterior Correction Procedure for Adult Spinal Deformity Using LLIF\u2013Finite Element Analysis of the Impact of the Lordotic Angle of Intervertebral LLIF Cage"],"prefix":"10.3390","volume":"59","author":[{"given":"Hiroki","family":"Takeda","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, 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, Japan"},{"name":"Department of Orthopedic Surgery, Eniwa Hospital, Eniwa 061-1373, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takaya","family":"Imai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9074-5556","authenticated-orcid":false,"given":"Mohd Zaim Mohd","family":"Rashid","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, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, 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, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6782-1725","authenticated-orcid":false,"given":"Sota","family":"Nagai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurenai","family":"Hachiya","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, 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, 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, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,29]]},"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","unstructured":"Zakaria, A.F., Kaneko, S., Takeda, H., Nagai, S., Kawabata, S., Ikeda, D., Fujita, N., Yato, Y., and Asazuma, T. (2022). Circumferential bone fusion in adult spinal deformity via combination of oblique lateral interbody fusion and grade 2 posterior column osteotomy. Glob. Spine J., 21925682211069936.","DOI":"10.1177\/21925682211069936"},{"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":"60","DOI":"10.5935\/0004-2749.20140016","article-title":"Finite element modelling of cornea mechanics: A review","volume":"77","author":"Nejad","year":"2014","journal-title":"Arq. Bras. Oftalmol."},{"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":"8","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","first-page":"104122","DOI":"10.1016\/j.compbiomed.2020.104122","article-title":"Does oblique lumbar interbody fusion promote adjacent degeneration in degenerative disc disease: A finite element analysis","volume":"128","author":"Du","year":"2021","journal-title":"Comput. Biol. Med."},{"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","unstructured":"Kozaki, T., Lundberg, H.J., Mell, S.P., Samartzis, D., Kawakami, M., Yamada, H., Inoue, N., and An, H.S. (2023). Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress: A Finite Element Analysis. Spine.","DOI":"10.1097\/BRS.0000000000004791"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"746902","DOI":"10.3389\/fbioe.2021.746902","article-title":"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","volume":"9","author":"Tachi","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"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"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:41:38Z","timestamp":1760128898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,29]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["medicina59091569"],"URL":"https:\/\/doi.org\/10.3390\/medicina59091569","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,8,29]]}}}