Restoration of the spinal canal volume in stenosis dependent on pedicle-lengthening distance in pedicle-lengthening osteotomy

Qian, Lei; Li, P.; Wu, Wei-Ting; Fang, Yongzheng; Zhang, J.; Ouyang, Jun

doi:10.1302/0301-620x.98b2.35644

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…They noted that a mean pedicle lengthening of 2.17 mm was enough to restore the spinal canal volume to its original disc free diameter. They concluded that the required increase in pedicle length to restore canal volume could be predicted related to the amount of disc protrusion [ 14 ]. No work is yet to be done on quantifying the ideal amount of distraction at the pedicles in other causes of spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

Hughes

Papadakos

Bishop

et al. 2018

SICOT-J

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Introduction: Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive.Methods: Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar spine underwent bilateral pedicle distraction at L4. A pedicle channel was drilled between the superior articular process and transverse process into the vertebral body. The pedicles underwent osteotomy at the midpoint. Screws were inserted bilaterally and fixated distraction of 0 mm, 2 mm, 4 mm and 6 mm. CT images were taken at each level of distraction. Foramen area was measured in the sagittal plane at L3/4. Spinal canal area was measured at L4 in the axial images. The cadaver was used to evaluate safety of osteotomy and soft tissue interactions preventing distraction. Statistical analysis was by student paired t-test and Pearson rank test.Results: Increasing distraction led to greater Spinal canal area. From 4.27 cm2 to 5.72 cm2 (p = 0.002) with 6 mm distraction. A Maximal increase of 34.1%. Vertebral foramen area also increased with increasing pedicle distraction. From 2.43 cm2 to 3.22 cm2 (p = 0.022) with 6 mm distraction. A maximal increase of 32.3%. The cadaver spinal canal increased in area by 21.7%. The vertebral foramen increased in area by 36.2% (left) and 22.6% (right).Discussion: For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction.

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Section: Discussionmentioning

confidence: 99%

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

Hughes

Papadakos

Bishop

et al. 2018

SICOT-J

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“…The accurate 3D reconstructed image also can be used for anatomic measurement. Qian et al (13) In the 3D printing realm, the accurate 3D reconstructed digital images reconstructed by Mimics software can further imported to a 3D printer to print accurate bony models (17,18), which may replace the specimen of human body for medical education (19,20), and surgeon training (21) and without the ethical problem of human body donation (22). Lu et al (4,23) used this method to design some novel rapid prototyping drill templates for cervical pedicle screw placement and C2 laminar screws, they suggest that these patient-specific templates are easy to use, fit the patient anatomy and can generate highly accurate screw placement.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images: a step by step approach by using Mimics software

Chen¹,

Chen²,

Tang³

et al. 2017

J. Spine Surg.

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There is a rapidly increasing amount of literature outlining the use of three-dimensional (3D) reconstruction and printing technologies in recent years. However, precise instructive articles which describe step-by-step methods of reconstructing 3D images from computed tomography (CT) or magnetic resonance imaging (MRI) remain limited. To address these issues, this article describes a detailed protocol which will allow the reader to easily perform the 3D reconstruction in their future research, to allow investigation of the appropriate surgical anatomy and allow innovative designs of novel screw fixation techniques or pre-operative surgical planning.

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“…The constructed IGES model was imported into HyperMesh software for secondary geometric cleaning, and the intervertebral disc model was constructed according to the morphology and structure of intervertebral disc: According to the characteristics of fibber ring, a structure model with three concentric circles arranged in inner, middle, and outer layers was established, and three concentric fibbers inserted into the annulus were established to simulate the elastic colloidal substance in each fibber-board layer [ 21 , 22 ]. The nucleus pulpous was modelled according to its position behind the disc and its proportion; the lower surface of L5 and the upper surface of S1 were normalized to construct the end plate with a thickness of 0.5 mm toward the corresponding vertebrae, and the complete intervertebral disc model was finally constructed.…”

Section: Construction Of 3d Modelmentioning

confidence: 99%

Three-Dimensional Biomechanical Finite Element Analysis of Lumbar Disc Herniation in Middle Aged and Elderly

Wan

Xue

Xiong

2022

Journal of Healthcare Engineering

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Lumbar intervertebral disc protrusion disease refers to the degeneration of intervertebral disc, rupture of fibrous ring, nucleus pulpous protrusion and stimulation or compression of nerve root. The import command in Mimics medical 3D reconstruction software was used to erase the irrelevant image data and obtain vertebral body images. The original 3D model of each vertebral body was built by 3D computing function. A three-dimensional finite element model was established to analyze the effect of different surgical methods on the mechanical distribution of the spine after disentomb. The stress distribution of the spine, intervertebral disc, and left and right articular cartilage at L4/L5 stage and the position shift of the fourth lumbar vertebra were analyzed under 7 working conditions of vertical, forward flexion, extension, left and right flexion, and left and right rotation. The results showed that the established model was effective, and the smaller the area of posterior laminar decompression was, the lesser the impact on spinal stability was. The PELD treatment of lumbar disc herniation had little impact on spinal biomechanics and could achieve good long-term biomechanical stability. Combining the clinical experiment method and finite element simulation, using the advantages of finite element software to optimize the design function can provide guidance for the design and improvement of medical devices and has important significance for the study of clinical mechanical properties and biomechanics.

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Restoration of the spinal canal volume in stenosis dependent on pedicle-lengthening distance in pedicle-lengthening osteotomy

Abstract: The predictive equation could help surgeons to decide the pedicle lengthening distance according to individual's condition and guide the surgery effectively.

Cited by 4 publications

References 30 publications

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images: a step by step approach by using Mimics software

Three-Dimensional Biomechanical Finite Element Analysis of Lumbar Disc Herniation in Middle Aged and Elderly

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