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Ethics in Biology, Engineering and Medicine: An International Journal
SJR: 0.123

ISSN Print: 2151-805X
ISSN Online: 2151-8068

Ethics in Biology, Engineering and Medicine: An International Journal

DOI: 10.1615/EthicsBiologyEngMed.2015013776
pages 313-322

CAE-Driven Evaluations of Surgical Fixations on Lumbar Spine: An Option for Aiding Ethics in Orthopedics

Gunti Ranga Srinivas
Center for Product Design and Manufacturing, Indian Institute of Science, Bangalore, India
Malhar N. Kumar
HOSMAT Hospital, Bangalore, India
Anindya Deb
Center for Product Design and Manufacturing, Indian Institute of Science, Bangalore, India
Subrata Saha
University of Washington, Department of Restorative Dentistry Affiliated Faculty, Department of Oral & Maxillofacial Surgery School of Dentistry, University of Washington, Seattle, WA

ABSTRACT

Segmental spinal fusion−posterior, anterior, and combined−has been widely employed in the management of degenerative disc disease of the lumbar spine and for surgical stabilization of spine during vertebral body fractures. The surgeon may often resort to more invasive and expensive procedures that have long-term negative effects on the patient. Commercial motivations may also drive the propensity to extend the use of instrumentation as much as possible. The surgeon should inform the patients of the possible long-term effects of surgical fixations. However, due to the lack of long-term controlled studies proving the efficacy of various surgical spinal fixations, the treating surgeon may face ethical challenges in selecting the best treatment for the patient. In the present study, a computer-aided engineering (CAE)−based approach was followed using explicit finite element analysis (FEA) to predict the maximum stresses in the adjacent lumbar discs during the following conditions: intervertebral disc without fusion and disc adjacent to instrumented circumferential fusion at one-, two-, and three-level fusions. The insights obtained from the numerical simulations could be useful in avoiding unnecessary extension of the instrumentation to healthy disc segments. The study provides quantitative data which would be useful for clinicians to understand the effects of their choice of surgical intervention.


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