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Ding Y, Zhang H, Jiang Q, Li T, Liu J, Lu Z, Yang G, Cui H, Lou F, Dong Z, Shuai M, Ding Y. Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases. Front Bioeng Biotechnol 2024; 12:1393005. [PMID: 38903190 PMCID: PMC11186988 DOI: 10.3389/fbioe.2024.1393005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction: For severe degenerative lumbar spinal stenosis (DLSS), the conventional percutaneous endoscopic translaminar decompression (PEID) has some limitations. The modified PEID, Cross-Overtop decompression, ensures sufficient decompression without excessive damage to the facet joints and posterior complex integrity. Objectives: To evaluate the biomechanical properties of Cross-Overtop and provide practical case validation for final decision-making in severe DLSS treatment. Methods: A finite element (FE) model of L4-L5 (M0) was established, and the validity was verified against prior studies. Endo-ULBD (M1), Endo-LOVE (M2), and Cross-Overtop (M3) models were derived from M0 using the experimental protocol. L4-L5 segments in each model were evaluated for the range of motion (ROM) and disc Von Mises stress extremum. The real clinical Cross-Overtop model was constructed based on clinical CT images, disregarding paraspinal muscle influence. Subsequent validation using actual FE analysis results enhances the credibility of the preceding virtual FE analysis. Results: Compared with M0, ROM in surgical models were less than 10°, and the growth rate of ROM ranged from 0.10% to 11.56%, while those of disc stress ranged from 0% to 15.75%. Compared with preoperative, the growth rate of ROM and disc stress were 2.66%-11.38% and 1.38%-9.51%, respectively. The ROM values in both virtual and actual models were less than 10°, verifying the affected segment stability after Cross-Overtop decompression. Conclusion: Cross-Overtop, designed for fully expanding the central canal and contralateral recess, maximizing the integrity of the facet joints and posterior complex, does no significant effect on the affected segmental biomechanics and can be recommended as an effective endoscopic treatment for severe DLSS.
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Affiliation(s)
- Yiwei Ding
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hanshuo Zhang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Qiang Jiang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Tusheng Li
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiang Liu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Zhengcao Lu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Guangnan Yang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongpeng Cui
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Fengtong Lou
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zhifeng Dong
- Mechanical and Electronic Engineering Department, China University of Mining and Technology, Beijing, China
| | - Mei Shuai
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yu Ding
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
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Liu G, Huang W, Leng N, He P, Li X, Lin M, Lian Z, Wang Y, Chen J, Cai W. Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study. Bioengineering (Basel) 2024; 11:519. [PMID: 38790385 PMCID: PMC11117612 DOI: 10.3390/bioengineering11050519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
A novel H-shaped miniplate (HSM) was specifically designed for restorative laminoplasties to restore patients' posterior elements after laminectomies. A validated finite element (FE) model of L2/4 was utilized to create a laminectomy model, as well as three restorative laminoplasty models based on the fixation of different miniplates after a laminectomy (the RL-HSM model, the RL-LSM model, and the RL-THM model). The biomechanical effects of motion and displacement on a laminectomy and restorative laminoplasty with three different shapes for the fixation of miniplates were compared under the same mechanical conditions. This study aimed to validate the biomechanical stability, efficacy, and feasibility of a restorative laminoplasty with the fixation of miniplates post laminectomy. The laminectomy model demonstrated the greatest increase in motion and displacement, especially in axial rotation, followed by extension, flexion, and lateral bending. The restorative laminoplasty was exceptional in preserving the motion and displacement of surgical segments when compared to the intact state. This preservation was particularly evident in lateral bending and flexion/extension, with a slight maintenance efficacy observed in axial rotation. Compared to the laminectomy model, the restorative laminoplasties with the investigated miniplates demonstrated a motion-limiting effect for all directions and resulted in excellent stability levels under axial rotation and flexion/extension. The greatest reduction in motion and displacement was observed in the RL-HSM model, followed by the RL-LSM model and then the RL-THM model. When comparing the fixation of different miniplates in restorative laminoplasties, the HSMs were found to be superior to the LSMs and THMs in maintaining postoperative stability, particularly in axial rotation. The evidence suggests that a restorative laminoplasty with the fixation of miniplates is more effective than a conventional laminectomy due to the biomechanical effects of restoring posterior elements, which helps patients regain motion and limit load displacement responses in the spine after surgery, especially in axial rotation and flexion/extension. Additionally, our evaluation in this research study could benefit from further research and provide a methodological and modeling basis for the design and optimization of restorative laminoplasties.
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Affiliation(s)
- Guoyin Liu
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Weiqian Huang
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Nannan Leng
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Peng He
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Xin Li
- Department of Orthopedics, Central Military Commission Joint Logistics Support Force 904th Hospital, Wuxi 214044, China;
| | - Muliang Lin
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Zhonghua Lian
- Xiamen Medical Device Research and Testing Center, Xiamen 361022, China;
| | - Yong Wang
- Outpatient Department of The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China;
| | - Jianmin Chen
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Liu R, He T, Wu X, Tan W, Yan Z, Deng Y. Biomechanical response of decompression alone in lower grade lumbar degenerative spondylolisthesis--A finite element analysis. J Orthop Surg Res 2024; 19:209. [PMID: 38561837 PMCID: PMC10983632 DOI: 10.1186/s13018-024-04681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis. PURPOSE Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS). METHODS Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment. RESULTS The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models. CONCLUSION Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models.
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Affiliation(s)
- Renfeng Liu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Tao He
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Xin Wu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Wei Tan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Zuyun Yan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Youwen Deng
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China.
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Zhou C, Meng X, Huang S, Chen H, Zhou H, Liao Y, Tang Z, Zhang X, Li H, Sun W, Wang Y. Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis. Heliyon 2024; 10:e26726. [PMID: 38434291 PMCID: PMC10907677 DOI: 10.1016/j.heliyon.2024.e26726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This study aimed to compare the biomechanical effects of different bone cement distribution methods on osteoporotic vertebral compression fractures (OVCF). Patients and methods Raw CT data from a healthy male volunteer was used to create a finite element model of the T12-L2 vertebra using finite element software. A compression fracture was simulated in the L1 vertebra, and two forms of bone cement dispersion (integration group, IG, and separation group, SG) were also simulated. Six types of loading (flexion, extension, left/right bending, and left/right rotation) were applied to the models, and the stress distribution in the vertebra and intervertebral discs was observed. Additionally, the maximum displacement of the L1 vertebra was evaluated. Results Bone cement injection significantly reduced stress following L1 vertebral fractures. In the L1 vertebral body, the maximum stress of SG was lower than that of IG during flexion, left/right bending, and left/right rotation. In the T12 vertebral body, compared with IG, the maximum stress of SG decreased during flexion and right rotation. In the L2 vertebral body, the maximum stress of SG was the lowest under all loading conditions. In the T12-L1 intervertebral disc, compared with IG, the maximum stress of SG decreased during flexion, extension, and left/right bending and was basically the same during left/right rotation. However, in the L1-L2 intervertebral discs, the maximum stress of SG increased during left/right rotation compared with that of IG. Furthermore, the maximum displacement of SG was smaller than that of IG in the L1 vertebral bodies under all loading conditions. Conclusions SG can reduce the maximum stress in the vertebra and intervertebral discs, offering better biomechanical performance and improved stability than IG.
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Affiliation(s)
- Chengqiang Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao Meng
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaolong Huang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Han Chen
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haibin Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifeng Liao
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Li
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqing Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Huang F, Huang G, Jia J, Lu S, Li J. Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study. J Orthop Surg Res 2024; 19:143. [PMID: 38365801 PMCID: PMC10870541 DOI: 10.1186/s13018-024-04550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The capsule of the zygapophyseal joint plays an important role in motion segmental stability maintenance. Iatrogenic capsule injury is a common phenomenon in posterior approach lumbar interbody fusion operations, but whether this procedure will cause a higher risk of adjacent segment degeneration acceleration biomechanically has yet to be identified. METHODS Posterior lumbar interbody fusion (PLIF) with different grades of iatrogenic capsule injury was simulated in our calibrated and validated numerical model. By adjusting the cross-sectional area of the capsule, different grades of capsule injury were simulated. The stress distribution on the cranial motion segment was computed under different loading conditions to judge the potential risk of adjacent segment degeneration acceleration. RESULTS Compared to the PLIF model with an intact capsule, a stepwise increase in the stress value on the cranial motion segment can be observed with a step decrease in capsule cross-sectional areas. Moreover, compared to the difference between models with intact and slightly injured capsules, the difference in stress values was more evident between models with slight and severe iatrogenic capsule injury. CONCLUSION Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically, and iatrogenic capsule damage on the cranial motion segment should be reduced to optimize patients' long-term prognosis.
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Affiliation(s)
- Fei Huang
- Department of Orthopedics, Meishan Hospital of Traditional Chinese Medicine, Meishan, China
| | - Gang Huang
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Junpengli Jia
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Shihao Lu
- Department of Orthopedics, Changzheng Hospital Affiliated to the Naval Medical University, Xiangyin Road, Shanghai, 200433, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Longmatan District, Luzhou, 646000, Sichuan Province, People's Republic of China.
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
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Xu G, Liang Z, Tian T, Meng Q, Bertin KM, Mo F. Development of a finite element full spine model with active muscles for quantitatively analyzing sarcopenia effects on lumbar load. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107709. [PMID: 37473587 DOI: 10.1016/j.cmpb.2023.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The musculoskeletal imbalance caused by disease is one of the most critical factors leading to spinal injuries, like sarcopenia. However, the effects of musculoskeletal imbalances on the spine are difficult to quantitatively investigate. Thus, a complete finite element spinal model was established to analyze the effects of musculoskeletal imbalance, especially concerning sarcopenia. METHODS A finite element spinal model with active muscles surrounding the vertebrae was established and validated from anatomic verification to the whole spine model in dynamic loading at multiple levels. It was then coupled with the previously developed neuromuscular model to quantitatively analyze the effects of erector spinae (ES) and multifidus (MF) sarcopenia on spinal tissues. The severity of the sarcopenia was classified into three levels by changing the physiological cross-sectional area (PCSA) of ES and MF, which were mild (60% PCSA of ES and MF), moderate (48% PCSA of ES and MF), and severe (36% PCSA of ES and MF). RESULTS The stress and strain levels of most lumbar tissues in the sarcopenia models were more significant than those of the normal model during spinal extension movement. The sarcopenia caused load concentration in several specific regions. The stress level of the L4-L5 intervertebral disc and L1 vertebra significantly increased with the severity of sarcopenia and showed relatively larger values than other segments. From the normal model to a severe sarcopenia model, the stress value of the L4-L5 intervertebral disc and L1 vertebra increased by 128% and 113%, respectively. The strain level of L5-S1 also inclined significantly with the severity of sarcopenia, and the relatively larger capsule strain values occurred at lower back segments from L3 to S1. CONCLUSIONS In summary, the validated spinal coupling model can be used for spinal injury risk analysis caused by musculoskeletal imbalance. The results suggested that sarcopenia can primarily lead to high injury risk of the L4-L5 intervertebral disc, L1 vertebrae, and L3-S1 joint capsule regarding significant stress or strain variance.
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Affiliation(s)
- Guangming Xu
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China; Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
| | - Ziyang Liang
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China; Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Tengfei Tian
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Qingnan Meng
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Komera Musoni Bertin
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Fuhao Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China.
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Yue J, Han Q, Chen H, Zhang A, Liu Y, Gong X, Wang Y, Wang J, Wu M. Artificial lamina after laminectomy: Progress, applications, and future perspectives. Front Surg 2023; 10:1019410. [PMID: 36816003 PMCID: PMC9932198 DOI: 10.3389/fsurg.2023.1019410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
In clinical practice, laminectomy is a commonly used procedure for spinal decompression in patients suffering from spinal disorders such as ossification of ligamentum flavum, lumbar stenosis, severe spinal fracture, and intraspinal tumors. However, the loss of posterior column bony support, the extensive proliferation of fibroblasts and scar formation after laminectomy, and other complications (such as postoperative epidural fibrosis and iatrogenic instability) may cause new symptoms requiring revision surgery. Implantation of an artificial lamina prosthesis is one of the most important methods to avoid post-laminectomy complications. Artificial lamina is a type of synthetic lamina tissue made of various materials and shapes designed to replace the resected autologous lamina. Artificial laminae can provide a barrier between the dural sac and posterior soft tissues to prevent postoperative epidural fibrosis and paravertebral muscle compression and provide mechanical support to maintain spinal alignment. In this paper, we briefly review the complications of laminectomy and the necessity of artificial lamina, then we review various artificial laminae from clinical practice and laboratory research perspectives. Based on a combination of additive manufacturing technology and finite element analysis for spine surgery, we propose a new designing perspective of artificial lamina for potential use in clinical practice.
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Affiliation(s)
- Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China,Correspondence: Minfei Wu Jincheng Wang
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China,Correspondence: Minfei Wu Jincheng Wang
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Complications of Unilateral Biportal Endoscopic Lumbar Discectomy: A Systematic Review. World Neurosurg 2022; 168:359-368.e2. [DOI: 10.1016/j.wneu.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
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Dai H, Liu Y, Han Q, Zhang A, Chen H, Qu Y, Wang J, Zhao J. Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis. Front Bioeng Biotechnol 2022; 10:978917. [PMID: 36159704 PMCID: PMC9495612 DOI: 10.3389/fbioe.2022.978917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis. Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated. Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions. Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.
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Affiliation(s)
| | | | | | | | | | - Yang Qu
- *Correspondence: Yang Qu, ; Jincheng Wang,
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Li L, Jiang S, Zhao J, Zhao M, Zhou X, Li K, Liu C, Zhang W, Chen J, Yu Q, Zhao Y, Wang J, Si H. Comparison of two internal fixation systems in lumbar spondylolysis by finite element methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 218:106713. [PMID: 35272148 DOI: 10.1016/j.cmpb.2022.106713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Internal fixation surgeries are currently the most effective treatments for lumbar spondylolysis, but the optimal fixation method is still on debate. This study was designed to compare the biomechanical characteristics of two fixation methods for lumbar spondylolysis, the pedicle screw-U shape rod (PSUSR) internal fixation system, and the pedicle screw-vertebral plate hook (PSVPH) internal fixation system, through three-dimensional finite element analysis, expecting to provide clinical guidance. METHODS Four finite element models (A, B, C, D) of L4-S1 vertebral body of a female patient were reconstructed by CT image segmentation. (A: intact model. B: spondylolysis model. C: spondylolysis model with PSUSR internal fixation. D: spondylolysis model with PSVPH internal fixation). Six physiological motion states were simulated by applying 500N concentrated force and 10Nm moment load to four models. The biomechanical advantages of the two internal fixation systems were evaluated by comparing the range of motion (ROM), maximum stress, maximum strain, and maximum displacement of the models. RESULTS Compared to model B, the ROM decreased by 35.7%-57.1% in model C and 39.7%-64.8% in model D. The maximum displacements of model C and D both decreased. The maximum stresses in both vertebral and the internal fixation system are greater in model C than those in model D. The maximum stress and strain reduction of L5-S1 intervertebral disc in model D was greater than that in model C. Model D restores the articular cartilage stresses to the normal levels of model A. The maximum stress and maximum displacement of the bone graft in model C are greater than those in model D. CONCLUSIONS The PSVPH internal fixation system has better biomechanical properties than PSUSR internal fixation system in several mechanical comparisons. Experimental results suggest that PSVPH internal fixation system can effectively treat lumbar spondylolysis while preserving segmental mobility, and can be the treatment of choice.
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Affiliation(s)
- Le Li
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Shuhao Jiang
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Junyong Zhao
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, People's Republic of China
| | - Mengmeng Zhao
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Xin Zhou
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Kunpeng Li
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Chen Liu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Junfei Chen
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Qun Yu
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Yuefeng Zhao
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Jingjing Wang
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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Low-Modulus PMMA Has the Potential to Reduce Stresses on Endplates after Cement Discoplasty. J Funct Biomater 2022; 13:jfb13010018. [PMID: 35225981 PMCID: PMC8883899 DOI: 10.3390/jfb13010018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022] Open
Abstract
Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady®, G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 °C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.
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Lu T, Ren J, Sun Z, Zhang J, Xu K, Sun L, Yang P, Wang D, Lian Y, Zhai J, Gou Y, Ma Y, Ji S, He X, Yang B. Relationship between the elastic modulus of the cage material and the biomechanical properties of transforaminal lumbar interbody fusion: A logarithmic regression analysis based on parametric finite element simulations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106570. [PMID: 34896688 DOI: 10.1016/j.cmpb.2021.106570] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Conventional method for evaluating the biomechanical effects of a specific elastic modulus of cage (cage-E) on spinal fusions requires establishing a "one-on-one" biomechanical model, which seems laborious and inefficient when dealing with the emergence of numerous cage materials with various cage-Es. We aim to offer a much convenient method to instantly predicting the biomechanical effects of any targeted cage-E on transforaminal lumbar interbody fusion (TLIF) by using a parametric finite element (FE) analysis to determining the regression relationship between cage-E and biomechanical properties of TLIF. MATERIALS AND METHODS A L4/5 FE TLIF construct was modeled. Cage-E was linearly increased from 0.1 GPa (cancellous bone) to 110 GPa (titanium alloy). The function equations for assessing the influence of cage-E on the biomechanical indexes of TLIF were established using a logarithmic regression analysis. EXPERIMENTAL RESULTS As cage-E increased from 0.1 GPa to 110 GPa, all the biomechanical indexes initially increased or decayed rapidly, and then slowed over time. Logarithmic regression models and functional equations were successfully established between cage-E and these indexes (P<0.0001). Their determination coefficients ranged from 0.72 to 0.99. The range of motions decreased from 0.37-1.10° to 0.20-1.07°. The mean stresses of the central and peripheral grafts reduced from 0.10-0.41 and 0.25-0.42 MPa to 0.03-0.04 and 0.19-0.27 MPa, respectively. In addition, the maximum stresses of the screw-bone interface and posterior instrumentation reduced from 11.76-25.04 and 8.91-84.68 MPa to 9.71-18.92 and 6.99-70.59 MPa, respectively. Finally, the maximum stresses of the cage and endplate increased from 0.28-1.35 MPa and 3.90-8.63 MPa to 14.86-36.16 MPa and 11.01-36.55 MPa, respectively. CONCLUSIONS The decrease of cage-E reduces the risks of cage subsidence, cage breakage, and pseudarthrosis, while increasing the risk of instrumentation failure. The logarithmic regression models optimally demonstrate the relationship between cage-E and biomechanical properties of TLIF. The functional equations based on these models can be adopted to predict the biomechanical effects of any targeted cage-Es on TLIF, which effectively simplifies the procedures for the biomechanical assessments of cage materials.
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Affiliation(s)
- Teng Lu
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jiakun Ren
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhongwei Sun
- Department of Engineering Mechanics, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, China
| | - Jing Zhang
- Department of Research and Development, ZSFab, Inc., Boston, Massachusetts, United States
| | - Kai Xu
- Department of Research and Development, ZSFab, Inc., Boston, Massachusetts, United States
| | - Lu Sun
- Department of Research and Development, ZSFab, Inc., Boston, Massachusetts, United States
| | - Pinglin Yang
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Dong Wang
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yueyun Lian
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jingjing Zhai
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yali Gou
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yanbing Ma
- Department of Human Anatomy and Tissue Embryology, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Shengfeng Ji
- Department of Human Anatomy and Tissue Embryology, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Baohui Yang
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Yuan X, Li Y, Chen Q, Zeng Q, Pou K, Wong H, Tang S. Effect of pedicle screw fixation on adjacent segments in osteoporotic spine following transforaminal lumbar interbody fusion under whole body vibration. World Neurosurg 2022; 161:e523-e530. [DOI: 10.1016/j.wneu.2022.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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Gierig M, Liu F, Weiser L, Lehmann W, Wriggers P, Marino M, Saul D. Biomechanical Effects of a Cross Connector in Sacral Fractures - A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:669321. [PMID: 34124023 PMCID: PMC8188498 DOI: 10.3389/fbioe.2021.669321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Fangrui Liu
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Lukas Weiser
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, United States
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