Surgical anatomy of the pelvis, sacrum, and lumbar spine relevant to spinal surgery

Contribution to FE modeling for intraoperative pedicle screw strength prediction

Although the use of pedicle screws is considered safe, mechanical issues still often occur. Commonly reported issues are screw loosening, screw bending and screw fracture. The aim of this study was to develop a Finite Element (FE) model for the study of pedicle screw biomechanics and for the prediction of the intraoperative pullout strength. The model includes both a parameterized screw model and a patient-specific vertebra model. Pullout experiments were performed on 30 human cadaveric vertebrae from ten donors. The experimental force-displacement data served to evaluate the FE model performance. μCT images were taken before and after screw insertion, allowing the creation of an accurate 3D-model and a precise representation of the mechanical properties of the bone. The experimental results revealed a significant positive correlation between bone mineral density (BMD) and pullout strength (Spearman ρ = 0.59, p < 0.001) as well as between BMD and pullout stiffness (Spearman ρ = 0.59, p < 0.001). A high positive correlation was also found between the pullout strength and stiffness (Spearman ρ = 0.84, p < 0.0001). The FE model was able to reproduce the linear part of the experimental force-displacement curve. Moreover, a high positive correlation was found between numerical and experimental pullout stiffness (Pearson ρ = 0.96, p < 0.005) and strength (Pearson ρ = 0.90, p < 0.05). Once fully validated, this model opens the way for a detailed study of pedicle screw biomechanics and for future adjustments of the screw design.

Intrathecal magnetic drug targeting using gold-coated magnetite nanoparticles in a human spine model

AIM

We aimed to magnetically guide and locally confine nanoparticles in desired locations within the spinal canal to achieve effective drug administration for improved treatment of chronic pain, cancers, anesthesia and spasticity.

MATERIALS & METHODS

We developed a physiologically and anatomically consistent in vitro human spine model to test the feasibility of intrathecal magnetic drug targeting. Gold-coated magnetite nanoparticles were infused into the model and targeted to specific regions using external magnetic fields. Experiments and simulations aiming to determine the effect of key parameters, such as magnet strength, duration of magnetic field exposure, magnet location and ferrous implants, on the collection efficiency of superparamagnetic nanoparticles in targeted regions were performed.

RESULTS

An 891% increase in nanoparticle collection efficiency within the target region was achieved using intrathecal magnetic drug targeting when compared with the control. Nanoparticle collection efficiency at the target region increased with time and reached a steady value within 15 min. Ferrous epidural implants generated sufficiently high-gradient magnetic fields, even when magnets were placed at a distance equal to the space between a patient's epidermis and spinal canal.

CONCLUSION

Our experiments indicate that intrathecal magnetic drug targeting is a promising technique for concentrating and localizing drugs at targeted sites within the spinal canal for treating diseases affecting the CNS.