Biomechanics of bone fusion

Robert J. Kowalski M.D., M.S., P.E., Lisa A. Ferrara M.S., and Edward C. Benzel M.D., F.A.C.S.
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  • Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Bone fusion can be achieved by one or more of three methods: in situ, onlay, and interbody fusion. Interbody implants provide the spine with the ability to bear an axial load. They function optimally when placed along the neutral axis and produce little, if any, significant bending moment. Interbody implants may be comprised of bone, non-bone materials such as acrylic, or a combination of both such as in interbody cages. In this report the authors' goal is to provide some insight into the theoretical, as well as practical, biomechanical factors that influence bone fusion, focusing on interbody implants. They review the concept of stress shielding and its impact on fusion. With the attendant biomechanical nuances of the different regions of the spine, they discuss region-specific strategies involved in successful fusion. Finally, they review intraoperative techniques that will improve the chance of achieving a successful arthrodesis.

Abbreviations used in this paper:

CSRS = Cervical Spine Research Society; NASS = North American Spine Society; PLIF = posterior lumbar interbody fusion; TIFC = threaded interbody fusion cage; VB = vertebral body.

Bone fusion can be achieved by one or more of three methods: in situ, onlay, and interbody fusion. Interbody implants provide the spine with the ability to bear an axial load. They function optimally when placed along the neutral axis and produce little, if any, significant bending moment. Interbody implants may be comprised of bone, non-bone materials such as acrylic, or a combination of both such as in interbody cages. In this report the authors' goal is to provide some insight into the theoretical, as well as practical, biomechanical factors that influence bone fusion, focusing on interbody implants. They review the concept of stress shielding and its impact on fusion. With the attendant biomechanical nuances of the different regions of the spine, they discuss region-specific strategies involved in successful fusion. Finally, they review intraoperative techniques that will improve the chance of achieving a successful arthrodesis.

Abbreviations used in this paper:

CSRS = Cervical Spine Research Society; NASS = North American Spine Society; PLIF = posterior lumbar interbody fusion; TIFC = threaded interbody fusion cage; VB = vertebral body.

Contributor Notes

Address reprint requests to: Edward C. Benzel, M.D., F.A.C.S., Spinal Disorders, Cleveland Clinic Foundation, Department of Neurosurgery/S80, 9500 Euclid Avenue, Cleveland, Ohio 44195. email: benzele@ccf.org.

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