Spinal Instrumentation

Haschtmann, Daniel; Ferguson, Stephen J.

doi:10.1007/978-3-540-69091-7_3

Cited by 2 publications

(3 citation statements)

References 91 publications

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“…One of the most common methods used for treating spinal instability is transpedicular stabilization. It enables correction and immediately fixation of any spinal deformity [2,18,19]. The thoracolumbar fixation systems used via the posterior approach are attached to vertebrae by means of screws, hooks or wires.…”

Section: Discussionmentioning

confidence: 99%

“…The thoracolumbar fixation systems used via the posterior approach are attached to vertebrae by means of screws, hooks or wires. Among the listed attachments, pedicle screws implemented through all three spinal columns present the highest pullout resistance when taking into account low bone density [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. However, in cases such as patients suffering from osteoporosis, low bone density affects their biomechanical resistance to pullout [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

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In vitro simulation of intraoperative vertebroplasty applied for pedicle screw augmentation. A biomechanical evaluation

Zapałowicz

Kierzkowska²,

Ciupik³

2018

Neurologia i Neurochirurgia Polska

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In vitro simulation of intraoperative vertebroplasty applied for pedicle screw augmentation. A biomechanical evaluation

Zapałowicz

Kierzkowska²,

Ciupik³

2018

Neurologia i Neurochirurgia Polska

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“…Pedicle screw and rod constructs are commonly used to provide posterior spine stabilization in a wide variety of spinal disorders [1]. Such constructs can involve the fixation of one spinal motion segment or more.…”

Section: Introductionmentioning

confidence: 99%

Misaligned spinal rods can induce high internal forces consistent with those observed to cause screw pullout and disc degeneration

et al. 2021

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BACKGROUND CONTEXT: Manual contouring of spinal rods is often required intraoperatively for proper alignment of the rods within the pedicle screw heads. Residual misalignments are frequently reduced by using dedicated reduction devices. The forces exerted by these devices, however, are uncontrolled and may lead to excessive reaction forces. As a consequence, screw pullout might be provoked and surrounding tissue may experience unfavorable biomechanical loads. The corresponding loads and induced tissue deformations are however not well identified. Additionally, whether the forced reduction alters the biomechanical behavior of the lumbar spine during physiological movements postoperatively, remains unexplored. PURPOSE: To predict whether the reduction of misaligned posterior instrumentation might result in clinical complications directly after reduction and during a subsequent physiological flexion movement. STUDY DESIGN: Finite element analysis. METHODS: A patient-specific, total lumbar (L1−S1) spine finite element model was available from previous research. The model consists of poro-elastic intervertebral discs with Pfirrmann grade-dependent material parameters, with linear elastic bone tissue with stiffness values related to the local bone density, and with the seven major ligaments per spinal motion segment described as nonlinear materials. Titanium instrumentation was implemented in this model to simulate a L4, L5, and S1 posterolateral fusion. Next, coronal and sagittal misalignments of 6 mm each were introduced between the rod and the screw head at L4. These misalignments were computationally reduced and a physiological flexion movement of 15˚was prescribed. Non-instrumented and wellaligned instrumented models were used as control groups. RESULTS: Pulling forces up to 1.0 kN were required to correct the induced misalignments of 6 mm. These forces affected the posture of the total lumbar spine, as motion segments were predicted to rotate up to 3 degrees and rotations propagated proximally to and even affect the L1−2 level.

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Spinal Instrumentation

Cited by 2 publications

References 91 publications

In vitro simulation of intraoperative vertebroplasty applied for pedicle screw augmentation. A biomechanical evaluation

In vitro simulation of intraoperative vertebroplasty applied for pedicle screw augmentation. A biomechanical evaluation

Misaligned spinal rods can induce high internal forces consistent with those observed to cause screw pullout and disc degeneration

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