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Screws Fixation for Oblique Lateral Lumbar Interbody Fusion (OL-LIF): A Finite Element Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5542595. [PMID: 34055981 PMCID: PMC8147546 DOI: 10.1155/2021/5542595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
Background The combination of screw fixation and cage can provide stability in lumbar interbody fusion (LIF), which is an important technique to treat lumbar degeneration diseases. As the narrow surface cage is developed in oblique lateral lumbar interbody fusion (OL-LIF), screw fixation should be improved at the same time. We used the finite element (FE) method to investigate the biomechanics response by three different ways of screw fixation in OL-LIF. Methods Using a validated FE model, OL-LIF with 3 different screw fixations was simulated, including percutaneous transverterbral screw (PTVS) fixation, percutaneous cortical bone trajectory screw (PCBTS) fixation, and percutaneous transpedical screw (PPS) fixation. Range of motion (ROM), vertebral body displacement, cage displacement, cage stress, cortical bone stress, and screw stress were compared. Results ROM in FE models significantly decreased by 84-89% in flexion, 91-93% in extension, 78-89% in right and left lateral bending, and 73-82% in right and left axial rotation compared to the original model. The maximum displacement of the vertebral body and the cage in six motions except for the extension of model PTVS was the smallest among models. Meanwhile, the model PTVS had the higher stress of screw-rods system and also the lowest stress of cage. In all moments, the maximum stresses of the cages were lower than their yield stress. Conclusions Three screw fixations can highly restrict the surgical functional spinal unit (FSU). PTVS provided the better stability than the other two screw fixations. It may be a good choice for OL-LIF.
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Lv QB, Gao X, Pan XX, Jin HM, Lou XT, Li SM, Yan YZ, Wu CC, Lin Y, Ni WF, Wang XY, Wu AM. Biomechanical properties of novel transpedicular transdiscal screw fixation with interbody arthrodesis technique in lumbar spine: A finite element study. J Orthop Translat 2018; 15:50-58. [PMID: 30306045 PMCID: PMC6172361 DOI: 10.1016/j.jot.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to investigate finite element biomechanical properties of the novel transpedicular transdiscal (TPTD) screw fixation with interbody arthrodesis technique in lumbar spine. Methods An L4–L5 finite element model was established and validated. Then, two fixation models, TPTD screw system and bilateral pedicle screw system (BPSS), were established on the validated L4–L5 finite element model. The inferior surface of the L5 vertebra was set immobilised, and moment of 7.5 Nm was applied on the L4 vertebra to test the range of motion (ROM) and stress at flexion, extension, lateral bending and axial rotation. Results The intact model was validated for prediction accuracy by comparing two previously published studies. Both of TPTD and BPSS fixation models displayed decreased motion at L4–L5. The ROMs of six moments of flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation in TPTD model were 1.92, 2.12, 1.10, 1.11, 0.90 and 0.87°, respectively; in BPSS model, they were 1.48, 0.42, 0.35, 0.38, 0.74 and 0.75°, respectively. The screws' peak stress of above six moments in TPTD model was 182.58, 272.75, 133.01, 137.36, 155.48 and 150.50 MPa, respectively; and in BPSS model, it was 103.16, 129.74, 120.28, 134.62, 180.84 and 169.76 MPa, respectively. Conclusion Both BPSS and TPTD can provide stable biomechanical properties for lumbar spine. The decreased ROM of flexion, extension and lateral bending was slightly more in BPSS model than in TPTD model, but TPTD model had similar ROM of axial rotation with BPSS model. The screws' peak stress of TPTD screw focused on the L4–L5 intervertebral space region, and more caution should be put at this site for the fatigue breakage. The translational potential of this article Our finite element study provides the biomechanical properties of novel TPTD screw fixation, and promotes this novel transpedicular transdiscal screw fixation with interbody arthrodesis technique be used clinically.
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Affiliation(s)
- Qing-Bo Lv
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,Department of Orthopedics, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xiang Gao
- Department of Orthopedics, The Second Affiliated Hospital of Suzhou University, Suzhou University, Suzhou, China
| | - Xiang-Xiang Pan
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Hai-Ming Jin
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xiao-Ting Lou
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,Department of Orthopedics, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Shu-Min Li
- Department of Orthopedics, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Ying-Zhao Yan
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Cong-Cong Wu
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Yan Lin
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China
| | - Wen-Fei Ni
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,Department of Orthopedics, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Ai-Min Wu
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre, Wenzhou, Zhejiang, 325027, China.,Department of Orthopedics, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.,The Digital Orthopaedic Research Group, The Key Orthopaedic Laboratory in Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
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Duff J, Hussain MM, Klocke N, Harris JA, Yandamuri SS, Bobinski L, Daniel RT, Bucklen BS. Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? An in vitro biomechanical study. Clin Biomech (Bristol, Avon) 2018; 53:72-78. [PMID: 29455101 DOI: 10.1016/j.clinbiomech.2018.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical vertebral body fractures generally are treated through an anterior-posterior approach. Cervical pedicle screws offer an alternative to circumferential fixation. This biomechanical study quantifies whether cervical pedicle screws alone can restore the stability of a three-column vertebral body fracture, making standard 360° reconstruction unnecessary. METHODS Range of motion (2.0 Nm) in flexion-extension, lateral bending, and axial rotation was tested on 10 cadaveric specimens (five/group) at C2-T1 with a spine kinematics simulator. Specimens were tested for flexibility of intact when a fatigue protocol with instrumentation was used to evaluate construct longevity. For a C4-6 fracture, spines were instrumented with 360° reconstruction (corpectomy spacer + plate + lateral mass screws) (Group 1) or cervical pedicle screw reconstruction (C3 and C7 only) (Group 2). FINDINGS Results are expressed as percentage of intact (100%). In Group 1, 360° reconstruction resulted in decreased motion during flexion-extension, lateral bending, and axial rotation, to 21.5%, 14.1%, and 48.6%, respectively, following 18,000 cycles of flexion-extension testing. In Group 2, cervical pedicle screw reconstruction led to reduced motion after cyclic flexion-extension testing, to 38.4%, 12.3%, and 51.1% during flexion-extension, lateral bending, and axial rotation, respectively. INTERPRETATION The 360° stabilization procedure provided the greatest initial stability. Cervical pedicle screw reconstruction resulted in less change in motion following cyclic loading with less variation from specimen to specimen, possibly caused by loosening of the shorter lateral mass screws. Cervical pedicle screw stabilization may be a viable alternative to 360° reconstruction for restoring multilevel vertebral body fracture.
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Affiliation(s)
- John Duff
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Mir M Hussain
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Noelle Klocke
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Soumya S Yandamuri
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Lukas Bobinski
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Roy T Daniel
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
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