Bone cement is a crucial material to treat bone metastases defects, and can fill the bone defect and provide mechanical support simultaneously, but the antitumor effect is very limited. Magnetic bone cement not only supports bone metastasis defects but can also achieve magnetic hyperthermia to eliminate tumor cells around the bone defect. However, the physicochemical properties of the bone cement matrix will change if the weight ratio of the magnetic nanoparticles in the cement is too high. We mixed 1 weight percent Zn0.3Fe2.7O4 with good biocompatibility and high heating efficiency into a polymethyl methacrylate matrix to prepare magnetic bone cement, which minimized the affection for physicochemical properties and satisfied the hyperthermia requirement of the alternating magnetic field.
Objective: Providing the biomechanical evidences to the surgeons on the internal fixation strategy and Cage implantation method in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by the finite element analysis (FEA).Methods: Firstly, based on the common MIS-TLIF surgical methods, three surgical models with different internal fixation strategies and Cage implantation methods were established. The surgical models simulated the physiological activities of the lumbar spine to evaluate the range of motion (ROM) of lumbar spine, the peak stress and the overall stress of the internal fixation system and Cage.Results: The results of the study show that the ROM of the surgical model has decreased significantly under all working conditions, and the decrease range is between 71.07-97.53%. The peak stress of the internal fixation system range was 48.56 to 100.09 MPa in Model-A, 58.10 to 136.05 MPa in Model-B, and 83.26 to 189.81 MPa in Model-C. Especially in the three working conditions of left lateral bending (LLB), left rotation (LR), and right rotation (RR), the peak stress of the internal fixation system of Model-C is 1.80 , 2.07, 1.79 times of Model-A and 2.05 , 1.64, 2.28 times of Model-B. The peak stress of Model-C Cage is significantly lower than Model-A and Model-B under all working conditions.Conclusion: Although the strategy of unilateral pedicle screw + lamina articular process screw + Cage horizontal implantation has the least Cage stress, there is a higher risk of internal fixation fail. Comprehensive evaluation, the surgical strategy of bilateral pedicle screw + Cage horizontal implantation has the best performance, and has the potential to become the standard implantation strategy of MIS-TLIF.
Case:A 68-year-old woman developed symptoms of acute paraplegia due to an occult cervical dural arteriovenous fistula (DAVF) after a minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). She was subsequently diagnosed by angiography and treated with vascular embolization. A 2-year follow-up showed that the patient's upper limb muscle strength returned to normal, and the lower limb muscle strength partially improved with remnant motor dysfunction.Conclusion:For patients with symptoms of nerve injury inconsistent with the spinal surgery site, a possibility of DAVF should be considered, and related investigations should be performed. Once diagnosed, active treatment is required.
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