Comparison of effects of four interbody fusion approaches on the fused and adjacent segments under vibration

Background: Which lumbar fusion approaches having fewer impacts on the lumbar spine, reducing the risk of complications and the most conducive to bone fusion under whole-body vibration is urgent to know. Objectives: This study researched the best approach under vibration by comparing the effects of four different approaches on the spine, especially regarding some significant indexes related to complications and outcomes. Methods: The L1-L5 finite element model was modified to simulate anterior, posterior, trans-foraminal and di-rect lateral lumbar interbody fusion approaches with bilateral pedicle screw fixation at L4-L5 level. Findings: Anterior lumbar interbody fusion decreased the corresponding vibration amplitude of the dynamic response at adjacent segments compared with the other three approaches. Direct lateral lumbar interbody fusion decreased the maximum stress in the cage, the endplates at the fused level, and the maximum compressive stress at the interface between the cage and endplates. The maximum disc height and segmental lordosis of Direct lateral lumbar interbody fusion model were the highest among these fusion approaches. Interpretation: Anterior lumbar interbody fusion may provide a more stable environment for the adjacent seg-ments under vibration. Direct lateral lumbar interbody fusion may reduce the risk of subsidence, cage failure, and adjacent segment disease. Direct lateral lumbar interbody fusion may provide a more stable and suitable environment for vertebral cell growth and lead to better fusion outcomes. The findings may help us understand the effect of various fusion approaches on lumbar and provide some references for choosing a fusion approach.