Extent and location of fixation affects the biomechanical stability of short- or long-segment pedicle screw technique with screwing of fractured vertebra for the treatment of thoracolumbar burst fractures

Abstract

Intermediate screw fixation at the fracture level has been widely accepted to treat thoracolumbar burst fractures, but no study has shown the effect of the extent and location of fixation. The effect of the extent and location of fixation on short- or long-segment pedicle screw fixation through intermediate screw fixation at the fracture level in the treatment of thoracolumbar burst fractures is discussed.Posterior intermediate screw fixation techniques in treating T12 vertebral fracture models were simulated and compared using finite element methods; the fixation techniques included M3-L1 (bilateral 3 monoaxial pedicle screw fixation from L1 to T11), M3-L2, M4-L1 (bilateral 4 monoaxial pedicle screw fixation from L1 to T10), M4-L2, M4-L3, and M5-L2 (bilateral 5 monoaxial pedicle screw fixation from L2 to T10). Range of motion (ROM) and largest von Mises stress (LVMS) of the instrumentations were recorded and analyzed.No significant differences were observed in the mean ROM of all states of motion between the M3-L1 model and the other fixation models except for M5-L2. The LVMS of the pedicle screws and rods all occurred during flexion. The LVMS values of the pedicle screws were larger in the M3-L2 fixation model and M4-L3 fixation model than in the other fixation models. The M3-L1 model presented a significantly smaller mean LVMS of the pedicle screws in all states of motion than the M3-L2 model (P = .026). The LVMS values of the rods were larger in the M3-L2 fixation model, M4-L3 fixation model, and M4-L2 fixation model than in the other fixation models. No significant differences were observed in the mean LVMS of the rods in all states of motion among all the fixation models.When choosing short-segment pedicle screw fixation with the screwing of fractured vertebrae to treat thoracolumbar fractures, we suggest M3-L1 over M3-L2. More severe injuries can be considered to identify an alternative treatment to long-segment monoaxial pedicle fixation constructs such as the M4-L1 and M5-L2 techniques.

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

“…Therefore, the nonsignificant differences in the maximum stress among the groups in the present study suggest that the stress conduction does not change significantly with the change of the oblique angle. Similar to other studies [ 13 , 16 , 21 ], the maximum stress of screws in each group in this study was located in the upper screws during anterior flexion, which was mainly because the stress during anterior flexion was conducted from the upper pedicle screw to the lower pedicle screw across the injured vertebra and adjacent intervertebral disc.…”

Biomechanical Analysis of the External Fixation in a Lumbar Fracture Model: A Finite Element Study

“…Seven paraspinal ligaments, including the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinous ligament, supraspinous ligament, capsular ligament, and transverse interspinous ligament, were simulated. The materials and characteristics of the above correlation models were chosen based on previous studies [15,16], as shown in Table 1.…”

Biomechanical properties of a novel nonfusion artificial vertebral body for anterior lumbar vertebra resection and internal fixation

“…A total of seven ligaments were modeled, including the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, supraspinous ligament, and intertransverse ligament. The element types and material properties used in the FE model were defined according to previous reports [22][23][24][25] and are shown in Table 1.…”

“…Material properties assigned to the FE model[22][23][24][25] . UHMWPE Ultrahigh molecular weight polyethylene.…”