1
|
Jiang JH, Zhao CM, Zhang J, Xu RM, Chen L. Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement. World J Clin Cases 2024; 12:4108-4120. [PMID: 39015896 PMCID: PMC11235545 DOI: 10.12998/wjcc.v12.i20.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/24/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. AIM To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. METHODS Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. RESULTS At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). CONCLUSION The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.
Collapse
Affiliation(s)
- Ji-Hong Jiang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Chang-Ming Zhao
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Rong-Ming Xu
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lei Chen
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| |
Collapse
|
2
|
Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4826507. [PMID: 35388332 PMCID: PMC8979679 DOI: 10.1155/2022/4826507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 01/16/2023]
Abstract
There is no detailed biomechanical research about the hybrid CBT-TT (CBT screws at cranial level and TT screws at caudal level) and TT-CBT (TT screws at cranial level and CBT screws at caudal level) techniques with finite element (FE) method. Therefore, the purpose of this study was to evaluate and provide specific biomechanical data of the hybrid lumbar posterior fixation system and compare with traditional pedicle screw and cortical screw trajectories without fusion, in FE method. Specimens were from the anatomy laboratory of Xinjiang Medical University. Four FE models of the L4-L5 lumbar spine segment were generated. For each of these, four implanted models with the following instruments were created: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT fixation, and hybrid TT-CBT fixation. A 400 N compressive load with 7.5 Nm moments was applied so as to simulate flexion, extension, left lateral bending, right lateral bending, left rotation, and right rotation, respectively. The range of motion (ROM) of the L4-L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation in four implanted models were compared. CBT-TT displayed a lower ROM of the fixation segment (3.82 ± 0.633°) compared to TT-TT (4.78 ± 0.306°) and CBT-CBT (4.23 ± 0.396°). In addition, CBT-TT showed a lower ROM of the posterior fixation (0.595 ± 0.108°) compared to TT-TT (0.795 ± 0.103°) and CBT-CBT (0.758 ± 0.052°). The intervertebral disc stress of CBT-TT (4.435 ± 0.604 MPa) was lower than TT-TT (7.592 ± 0.387 MPa) and CBT-CBT (6.605 ± 0.600 MPa). CBT-TT (20.228 ± 3.044 MPa) and TT-CBT (12.548 ± 2.914 MPa) displayed a lower peak von Mises stress of the posterior fixation compared to TT-TT (25.480 ± 3.737 MPa). The hybrid CBT-TT and TT-CBT techniques offered superior fixation strength compared to the CBT-CBT and TT-TT techniques.
Collapse
|
3
|
Dexamethasone-Loaded Bioactive Coatings on Medical Grade Stainless Steel Promote Osteointegration. Pharmaceutics 2021; 13:pharmaceutics13040568. [PMID: 33923814 PMCID: PMC8073817 DOI: 10.3390/pharmaceutics13040568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
In this study, a multilayer bioactive coating based on carboxymethyl cellulose (CMC) and dexamethasone (DEX) was prepared on medical-grade stainless steel (AISI 316LVM). Its aim was the controlled drug delivery of the incorporated anti‑inflammatory drug, which at the same time promotes osteogenic differentiation of mesenchymal stem cells. Due to DEX’s limited solubility in physiological fluids, which limits the loading capacity of coatings, it was further combined with β-cyclodextrin to increase its concentration in the bioactive coating. Controlled release of DEX from the multilayer coating was achieved in four steps: a “burst”, i.e., very fast, release step (in an immersion interval of 0–10 min), a fast release step (10–30 min), a slow-release step (60–360 min), and a plateau step (360–4320 min), following a zero-order release or Higuchi model release mechanism. Successful layer-by-layer coating formation was confirmed using attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). It was shown that the application of the coating significantly increases the hydrophilic character of AISI 316LVM, and also significantly increases the surface roughness, which is known to promote cell growth. In addition, electrochemical measurements demonstrated that the coating application does not increase the susceptibility of medical-grade stainless steel to corrosion. In vitro cell testing using all cell types with which such coatings come into contact in the body (osteoblasts, chondrocytes, and mesenchymal stem cells (MSCs)) showed very good biocompatibility towards all of the mentioned cells. It further confirmed that the coatings promoted MSCs osteogenic differentiation, which is the desired mode of action for orthopedic implants.
Collapse
|
4
|
Functionalization of Ceramic Coatings for Enhancing Integration in Osteoporotic Bone: A Systematic Review. COATINGS 2019. [DOI: 10.3390/coatings9050312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The success of reconstructive orthopaedic surgery strongly depends on the mechanical and biological integration between the prosthesis and the host bone tissue. Progressive population ageing with increased frequency of altered bone metabolism conditions requires new strategies for ensuring an early implant fixation and long-term stability. Ceramic materials and ceramic-based coatings, owing to the release of calcium phosphate and to the precipitation of a biological apatite at the bone-implant interface, are able to promote a strong bonding between the host bone and the implant. Methods: The aim of the present systematic review is the analysis of the existing literature on the functionalization strategies for improving the implant osteointegration in osteoporotic bone and their relative translation into the clinical practice. The review process, conducted on two electronic databases, identified 47 eligible preclinical studies and 5 clinical trials. Results: Preclinical data analysis showed that functionalization with both organic and inorganic molecules usually improves osseointegration in the osteoporotic condition, assessed mainly in rodent models. Clinical studies, mainly retrospective, have tested no functionalization strategies. Registered trademarks materials have been investigated and there is lack of information about the micro- or nano- topography of ceramics. Conclusions: Ceramic materials/coatings functionalization obtained promising results in improving implant osseointegration even in osteoporotic conditions but preclinical evidence has not been fully translated to clinical applications.
Collapse
|
5
|
Pang J, Gao Z, Zhang L, Wang H, Hu X. Synthesis and Characterization of Photoresponsive Macromolecule for Biomedical Application. Front Chem 2018; 6:217. [PMID: 30013963 PMCID: PMC6036227 DOI: 10.3389/fchem.2018.00217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/25/2018] [Indexed: 01/28/2023] Open
Abstract
Azobenzene, a photo switcher, has attracted increasing interest due to its structural response to photo stimulus in the field of information science and chemical sensing in the recent decades. However, limited water solubility and cytotoxicity restrained their applications in the biomedical field. In research, HA-AZO has been designed as a water soluble photo switcher in biomedical application. Synthesized HA-AZO had good water-solubility and a stable π-π* transition absorbance peak trans-isomer. With exposure to UV, transformation from trans-isomer to cis-isomer of HA-AZO could be realized according to UV spectra. Reversely, trans-isomer could be gradually recovered from cis-isomer in the dark. Simultaneously, quick response and slow recovery could be detected in the process of structural change. Moreover, repeated illumination was further used to detect the antifatigue property of HA-AZO, which showed no sign of fatigue during 20 circles. The influence of pH value on UV spectrum for HA-AZO was investigated in the work. Importantly, in acid solution, HA-AZO no longer showed any photoresponsive property. Additionally, the status of HA-AZO under the effect of UV light was investigated by DLS results and TEM image. Finally, in vitro cytotoxicity evaluations were performed to show the effects of photoresponsive macromolecule on cells.
Collapse
Affiliation(s)
- Juan Pang
- School of Material Engineering, Jinling Institute of Technology, Nanjing, China
| | - Ziyu Gao
- School of Material Engineering, Jinling Institute of Technology, Nanjing, China
| | - Long Zhang
- School of Material Engineering, Jinling Institute of Technology, Nanjing, China
| | - Huiming Wang
- School of Material Engineering, Jinling Institute of Technology, Nanjing, China
| | - Xiaohong Hu
- School of Material Engineering, Jinling Institute of Technology, Nanjing, China
| |
Collapse
|
6
|
Dias IR, Camassa JA, Bordelo JA, Babo PS, Viegas CA, Dourado N, Reis RL, Gomes ME. Preclinical and Translational Studies in Small Ruminants (Sheep and Goat) as Models for Osteoporosis Research. Curr Osteoporos Rep 2018; 16:182-197. [PMID: 29460175 DOI: 10.1007/s11914-018-0431-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW This review summarizes research on the use of sheep and goats as large animal models of human osteoporosis for preclinical and translational studies. RECENT FINDINGS The most frequent osteoporotic sheep model used is the ovariectomized sheep with 12 months post-operatively or more and the combined treatment of ovariectomized sheep associated to calcium/vitamin D-deficient diet and glucocorticoid applications for 6 months, but other methods are also described, like pinealectomy or hypothalamic-pituitary disconnection in ovariectomized sheep. The goat model for osteoporosis research has been used in a very limited number of studies in osteoporosis research relative to sheep. These osteoporotic small ruminant models are applied for biomaterial research, bone augmentation, efficacy of implant fixation, fragility fracture-healing process improvement, or bone-defect repair studies in the osteopenic or osteoporotic bone. Sheep are a recognized large animal model for preclinical and translational studies in osteoporosis research and the goat to a lesser extent. Recently, the pathophysiological mechanism underlying induction of osteoporosis in glucocorticoid-treated ovariectomized aged sheep was clarified, being similar to what occurs in postmenopausal women with glucocorticoid-induced osteoporosis. It was also concluded that the receptor activator of NF-κB ligand was stimulated in the late progressive phase of the osteoporosis induced by steroids in sheep. The knowledge of the pathophysiological mechanisms at the cellular and molecular levels of the induction of osteoporosis in small ruminants, if identical to humans, will allow in the future, the use of these animal models with greater confidence in the preclinical and translational studies for osteoporosis research.
Collapse
Affiliation(s)
- Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal.
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal.
| | - José A Camassa
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - João A Bordelo
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - Pedro S Babo
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Nuno Dourado
- CMEMS-UMinho, Department of Mechanical Engineering, University of Minho, Campus de Azurém, 4804-533, Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Manuela E Gomes
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| |
Collapse
|