Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: A finite element analysis

Xu, Ge‐Liang; Fu, Xin; Du, Chenxing; Ma, Jianxiong; Li, Zhijun; Tian, Peng; Zhang, Tao

doi:10.1177/0954411914552308

Cited by 24 publications

(18 citation statements)

References 33 publications

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“…Further augmentation with bone cement at the fractured level can further reduce the stress around the pedicle screw root, and further decrease the probability of screw failure. In addition, we found the pedicle screw root under lateral bending and axial rotation load sustained higher von Mises stresses, as finding similar to that of Xu et al [32]. …”

Section: Discussionsupporting

confidence: 91%

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Liao

Chen

Wang

2017

BMC Musculoskelet Disord

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BackgroundTraditional one-above and one-below four-screw posterior short-segment instrumentation is used for unstable thoracolumbar burst fractures. However, this method has a high rate of implant failure and early loss of reduction. The purpose of this study was to use finite element (FE) analysis to determine the effect of treating thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture.MethodsAn intact T11-L1 spine FE model was created from the computed tomography images of a male subject. Four fixation models with posterior fusion devices (pedicle screws, rods, cross-link) were established to simulate an unstable thoracolumbar fracture with different fusion surgeries: short-segment fixation with: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). Different loading conditions (flexion, extension, lateral bending, and axial rotation) were applied on the models and analyzed with a FE package. The range of motion (ROM), and the maximum value and distribution of the implant stress, and the stress in the facet joint, were compared between the intact and fixation models.ResultsThe ROM in flexion, extension, axial rotation, and lateral bending was the smallest in the S-I-C model, followed by the S-I, S-L-C, and S-L models. Maximum von Mises stress values were larger under lateral bending and axial rotation loadings than under flexion and extension loading. High stress was concentrated at the crosslink and rod junctions. Maximal von Mises stress on the superior vertebral body for all loading conditions was larger than that on the inferior vertebral body. The maximal von Mises stress of the pedicle screws during all states of motion were 265.3 MPa in S-L fixation, 192.9 MPa in S-I fixation, 258.4 MPa in S-L-C fixation, and 162.3 MPa in S-I-C fixation.ConclusionsShort-segment fixation with two intermediate pedicle screws together with calcium sulfate cement at the fractured vertebrae may provide a stiffer construct and less von Mises stress of the pedicle screws and rods as compared to other types of short-segment fixation.

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Section: Discussionsupporting

confidence: 91%

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Liao

Chen

Wang

2017

BMC Musculoskelet Disord

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“…The above-mentioned biomechanical study provides a strong theoretical basis for clinical implementation of affected-vertebrae fixation. In clinical studies, Xu et al [ 22 ] and Liu et al [ 23 ] treated thoracolumbar fractures with single-segment fixation and obtained satisfactory outcomes without complications such as internal fixation breakage or loosening. These studies provide the biomechanical and clinical bases for affected-vertebrae fixation in the treatment of spinal TB.…”

Section: Discussionmentioning

confidence: 99%

Five-year outcomes of posterior affected-vertebrae fixation in lumbar tuberculosis patients

et al. 2018

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BackgroundPosterior instrumentation after deformity correction is an important method for reconstruction of spinal stability in the management of lumbar tuberculosis (TB). However, the commonly used methods include both long- and short-segment fixation of normal motor units. There has been no report regarding affected-vertebrae fixation of lumbar TB.MethodsData from 135 patients with lumbar TB who underwent posterior instrumentation and either affected-vertebrae fixation or short-segment fixation using a combined posterior and anterior approach were retrospectively reviewed. Among these patients, 71 cases were treated with affected-vertebrae fixation, and 64 cases were treated with short-segment fixation. Debridement, bone grafting, deformity correction, and decompression were performed within all affected segments. Operative times, intra-operative blood loss, TB cure rates, bone graft fusion rates, degree of deformity correction, neurological function, pain recovery, and complications were analyzed.ResultsComparing affected-vertebrae fixation vs. short-segment fixation groups, respectively, the number of the affected segments was 107 vs. 98; average number of affected segments was 1.51 vs. 1.53; total number of fixed segments was 107 vs. 226; average number of fixed segments was 1.51 vs. 3.53; average blood loss was 726.2 ml vs. 948.5 ml; average operative time was 210.4 min vs. 270.3 min; and average hospitalization costs were 29,000 RMB vs. 42,000 RMB (all p values < 0.05). In the affected-vertebrae fixation vs. short-segment fixation groups, respectively, TB cure rates were 82.61% vs. 84.62% at 6 months after operation and 97.83% vs. 97.44% at 5 years after operation; bone fusion rates were 86.96% vs. 87.18% at 6 months after operation and 97.83% vs. 97.66% at 5 years after operation; average number of degrees of Cobb’s angle correction were 13.1° vs. 13.7°; average correction losses were 1.9° vs. 1.4°; and complication rates were 12.04% vs. 12.97% (all p values > 0.05).ConclusionUnder strict surgical indications, posterior instrumentation on affected-vertebrae is a safe, effective, and feasible fixation method in the treatment of lumber TB.

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“…Previous finite element simulation of the fracture models is not widely accepted and is different from clinical practice due to the removal of the part of the cortical or cancellous bone, which is not suitable for comparative analysis of various finite element studies [ 11 , 16 , 17 ]. LSC is a widely accepted vertebral body load scoring standard for the treatment of thoracolumbar fractures.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

et al. 2020

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Background To evaluate the biomechanical properties of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture using a finite element analysis. Methods The Universal Spine System (USS) fixation model for adjacent upper and lower vertebrae (T12 and L2) of lumbar 1 vertebra burst fracture was established. During flexion/extension, lateral bending, and rotation, the screw stress and the displacement of bone defect area of the injured vertebrae were evaluated when the downward inserted angle between the long axis of the screws and superior endplate of the adjacent vertebrae was set to 0° (group A), 5° (group B), 10° (group C), and 15°(group D). There were 6 models in each group. Results There were no significant differences in the maximum screw stress among all the groups during flexion/extension, lateral bending, and rotation (P > 0.05). There were no significant differences in the maximum displacement of the bone defect area of the injured vertebrae among all the groups during flexion/extension, lateral bending, and rotation (P > 0.05). Conclusion Short-segment Schanz screw implanted in an oblique downward direction with different angles (0°/parellel, 5°, 10°, and 15°) did not change the maximum stress of the screws, and there was a lower risk of screw breakage in all groups during flexion/extension, lateral bending, and rotation. In addition, the displacement of the injured vertebra defect area had no significant changes with the change of angles.

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Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: A finite element analysis

Cited by 24 publications

References 33 publications

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Five-year outcomes of posterior affected-vertebrae fixation in lumbar tuberculosis patients

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

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