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. 2022 Apr 12;6(6):681-688.
doi: 10.22603/ssrr.2021-0231. eCollection 2022 Nov 27.

Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study

Takuhei Kozaki  1 , Hiroshi Hashizume  1 , Hiroyuki Oka  2 , Satoru Ohashi  3 , Yoh Kumano  4 , Ei Yamamoto  5 , Akihito Minamide  1 , Yasutsugu Yukawa  1 , Hiroshi Iwasaki  1 , Shunji Tsutsui  1 , Masanari Takami  1 , Keiji Nakata  1 , Takaya Taniguchi  1 , Daisuke Fukui  1 , Daisuke Nishiyama  1 , Manabu Yamanaka  1 , Hidenobu Tamai  1 , Ryo Taiji  1 , Shizumasa Murata  1 , Akimasa Murata  1 , Hiroshi Yamada  1
Affiliations

Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study

Takuhei Kozaki et al. Spine Surg Relat Res. .

Erratum in

Abstract

Introduction: Adult spinal fusion surgery improves lumbar alignment and patient satisfaction. Adult spinal deformity surgery improves saggital balance not only lumbar lesion, but also at hip joint coverage. It was expected that hip joint coverage rate was improved and joint stress decreased. However, it was reported that adjacent joint disease at hip joint was induced by adult spinal fusion surgery including sacroiliac joint fixation on an X-ray study. The mechanism is still unclear. We aimed to investigate the association between lumbosacral fusion including sacroiliac joint fixation and contact stress of the hip joint.

Methods: A 40-year-old woman with intact lumbar vertebrae underwent computed tomography. A three-dimensional nonlinear finite element model was constructed from the L4 vertebra to the femoral bone with triangular shell elements (thickness, 2 mm; size, 3 mm) for the cortical bone's outer surface and 2-mm (lumbar spine) or 3-mm (femoral bone) tetrahedral solid elements for the remaining bone. We constructed the following four models: a non-fusion model (NF), a L4-5 fusion model (L5F), a L4-S1 fusion model (S1F), and a L4-S2 alar iliac screw fixation model (S2F). A compressive load of 400 N was applied vertically to the L4 vertebra and a 10-Nm bending moment was additionally applied to the L4 vertebra to stimulate flexion, extension, left lateral bending, and axial rotation. Each model's hip joint's von Mises stress and angular motion were analyzed.

Results: The hip joint's angular motion in NF, L5F, S1F, and S2F gradually increased; the S2F model presented the greatest angular motion.

Conclusions: The average and maximum contact stress of the hip joint was the highest in the S2F model. Thus, lumbosacral fusion surgery with sacroiliac joint fixation placed added stress on the hip joint. We propose that this was a consequence of adjacent joint spinopelvic fixation. Lumbar-to-pelvic fixation increases the angular motion and stress at the hip joint.

Keywords: adjacent joint disease; adjacent segment disease on hip joint; adult spinal deformity surgery; finite element analysis; hip pathology; sacroiliac joint fixation.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Finite element model from the L4 vertebra to the femoral bone.
Figure 2.
Figure 2.
(a) The range of motion of the lumbar and sacrum of our model were validated with a previous cadaveric study ). (b) The range of motion of the sacroiliac joint of our model was validated with a previous cadaveric study ).
Figure 3.
Figure 3.
Mean of the average von Mises stress at both sides of the hip joint cartilage. NF: non-fusion model, L5F: L4-5 fusion model, S1F: L4-S1 fusion model, S2F: L4-S2 alar screw fixation model
Figure 4.
Figure 4.
Mean of the peak von Mises stress at both sides of the hip joint cartilage. NF: non-fusion model, L5F: L4-5 fusion model, S1F: L4-S1 fusion model, S2F: L4-S2 alar screw fixation model
Figure 5.
Figure 5.
Mean of the average angular motion at both sides of the hip joint cartilage. NF: non-fusion model, L5F: L4-5 fusion model, S1F: L4-S1 fusion model, S2F: L4-S2 alar screw fixation model
Figure 6.
Figure 6.
Stress contours at the left hip cartilage in the L4-S2 fixation model (a), L4-S1 fixation model (b), L4-L5 fixation model (c), and non-fixation model (d) at flexion, extension, bending, and rotation.
See this image and copyright information in PMC

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