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Background <p>This study aimed to analyze and compare the biomechanical effects of four different minimally invasive surgical procedures for lumbar spinal stenosis complicated by degenerative spondylolisthesis.</p> Methods <p>A static finite element analysis was performed using data from a single healthy volunteer. A validated three-dimensional L1–S1 finite element model was constructed from CT scans of a 26‑year‑old healthy adult male. Based on the health model, the following finite element models were created: lumbar spinal stenosis with degenerative spondylolisthesis (LSS-DS), unilateral biportal endoscopy with ipsilateral decompression only (UBE‑IDO), unilateral biportal endoscopy lumbar interbody fusion (ULIF), minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF), and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF). Using the Hyperwork software, flexion-extension, lateral bending and lateral rotation loading conditions were simulated to compare the biomechanical effects among the models.</p> Results <p>Compared with the LSS-DS, the UBE‑IDO model showed changes in peak von Mises stress of the L4–L5 intervertebral disc and articular cartilage not exceeding 0.21 MPa. The ULIF model exhibited the highest bone graft stress among the fusion groups. Under the left lateral rotation, the Mis-TLIF demonstrated the highest peak von Mises stress in the internal fixation system(113.62 MPa). Under the right lateral bending, the Mis-TLIF showed the highest cage peak von Mises stress(25.12 MPa). Under the flexion, extension, and rotation, the peak von Mises stress of the L5-S1 articular cartilage in the Endo-TLIF group was the highest. Under the left bending and right rotation conditions, the Mis-TLIF had the highest peak von Mises stress at the L5-S1 articular cartilage.</p> Conclusions <p>From a biomechanical perspective, the UBE‑IDO surgery exerts a relatively minor impact on the lumbar spine. ULIF provides a more favorable biomechanical environment for intervertebral fusion. In the fusion model, Endo-TLIF provides a relatively favorable biomechanical environment for the internal fixation. Among the three fusion models, ULIF has the least impact on the biomechanics of adjacent segments. The absolute stress values presented herein are intended only for hypothesis generation, and inferences should be limited to relative trends among surgical models under identical assumptions.</p>

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Biomechanical comparative analysis of minimally invasive decompression and minimally invasive fusion with internal fixation in the treatment of lumbar spinal stenosis with degenerative spondylolisthesis: a finite element study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Hanqiang Liu,
  • Yuliang Xie,
  • Hongtao Hu,
  • Jianwei Sun,
  • Aijun Yang,
  • Sishun Zhao,
  • XiuRong Wang,
  • Hongbo Liu,
  • Changqing Wu,
  • Sheng Wang

摘要

Background

This study aimed to analyze and compare the biomechanical effects of four different minimally invasive surgical procedures for lumbar spinal stenosis complicated by degenerative spondylolisthesis.

Methods

A static finite element analysis was performed using data from a single healthy volunteer. A validated three-dimensional L1–S1 finite element model was constructed from CT scans of a 26‑year‑old healthy adult male. Based on the health model, the following finite element models were created: lumbar spinal stenosis with degenerative spondylolisthesis (LSS-DS), unilateral biportal endoscopy with ipsilateral decompression only (UBE‑IDO), unilateral biportal endoscopy lumbar interbody fusion (ULIF), minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF), and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF). Using the Hyperwork software, flexion-extension, lateral bending and lateral rotation loading conditions were simulated to compare the biomechanical effects among the models.

Results

Compared with the LSS-DS, the UBE‑IDO model showed changes in peak von Mises stress of the L4–L5 intervertebral disc and articular cartilage not exceeding 0.21 MPa. The ULIF model exhibited the highest bone graft stress among the fusion groups. Under the left lateral rotation, the Mis-TLIF demonstrated the highest peak von Mises stress in the internal fixation system(113.62 MPa). Under the right lateral bending, the Mis-TLIF showed the highest cage peak von Mises stress(25.12 MPa). Under the flexion, extension, and rotation, the peak von Mises stress of the L5-S1 articular cartilage in the Endo-TLIF group was the highest. Under the left bending and right rotation conditions, the Mis-TLIF had the highest peak von Mises stress at the L5-S1 articular cartilage.

Conclusions

From a biomechanical perspective, the UBE‑IDO surgery exerts a relatively minor impact on the lumbar spine. ULIF provides a more favorable biomechanical environment for intervertebral fusion. In the fusion model, Endo-TLIF provides a relatively favorable biomechanical environment for the internal fixation. Among the three fusion models, ULIF has the least impact on the biomechanics of adjacent segments. The absolute stress values presented herein are intended only for hypothesis generation, and inferences should be limited to relative trends among surgical models under identical assumptions.