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Zhang G, Li J, Zhang L, Song J, Shao J, Lv C, Bai T, Du Y, Xi Y. Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis. Spine (Phila Pa 1976) 2024; 49:E229-E238. [PMID: 38721831 PMCID: PMC11232937 DOI: 10.1097/brs.0000000000005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/28/2024] [Indexed: 07/11/2024]
Abstract
STUDY DESIGN Finite element analysis. OBJECTIVE To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis. SUMMARY OF BACKGROUND DATA In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis. MATERIALS AND METHODS Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed. RESULTS Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease. CONCLUSION LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints.
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Affiliation(s)
- Guodong Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Spinal Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Li Zhang
- Department of Operation Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jie Song
- Department of Health Care, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiale Shao
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Changlin Lv
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tianyu Bai
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Feng D, Duan Y, Chen J, Wu Y, Li T, Wang Y, Jiang L, Huang Y. Posterior Pedicle Screw Fixation With Indirect Decompression Versus Direct Decompression in Treating Thoracolumbar Burst Fracture: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 186:27-34. [PMID: 38493890 DOI: 10.1016/j.wneu.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To compare the safety and efficacy between posterior pedicle screw fixation with direct versus indirect decompression in treating patients with thoracolumbar burst fracture. METHODS This study was conducted on the basis of PRISMA statement. We systematically searched the PubMed and Embase databases up to July 3, 2023. Relevant studies comparing indirect decompression and direct decompression were recruited. Weighted mean differences (WMDs), odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed for continuous and dichotomous data, respectively. P < 0.05 was considered statistically significant. RESULTS The operation time (WMD: -37.14, 95% CI: [-42.64, 31.64], P < 0.00001, I2 = 0%) and intraoperative blood loss (WMD: -316.82, 95% CI: [-469.80, -163.85], P < 0.0001, I2 = 99%) of indirect decompression group were significantly lower. Percentage of anterior vertebral body height (WMD: 3.98, 95% CI: [2.36, 5.60], P < 0.00001, I2 = 32%) and encroachment rate of the spinal canal (WMD: 1.48, 95% CI: [0.56, 2.40], P = 0.002, I2 = 35%) of indirect decompression group were significantly higher. No statistical difference was identified in grades of neurologic recovery and Cobb angle. CONCLUSIONS Posterior pedicle screw fixation with indirect decompression was safe and effective for thoracolumbar burst fracture with or without neurologic deficits when posterior longitudinal ligament was intact.
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Affiliation(s)
- Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jun Chen
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yamei Wu
- Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yiran Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Aydin E, Schenk P, Jacobi A, Mendel T, Klauke F, Ullrich BW. Percutaneous reduction of thoracolumbar fractures using monoaxial screws: Comparison of two instruments based on initial reduction and loss of reduction. BRAIN & SPINE 2024; 4:102778. [PMID: 38584864 PMCID: PMC10995800 DOI: 10.1016/j.bas.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024]
Abstract
Introduction Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results Both systems achieved equally good reduction (9° mean, 95%-CI: 8°-11°, p < 0.001). Anterior fused patients showed not significant (p = 0.057) less loss of reduction over time. Fracture severity had neither an influence on reduction or loss of reduction. Bone quality was positively correlated with greater amount of reduction and less loss of reduction. Early reduction within two days correlated with a greater amount of reduction (p = 0.006). Screw diameters and the patient's weight had no influence on loss of reduction. Complications occurred only in "V2" group. Discussion and conclusion Both systems are equivalent in reduction ability. The additional anterior fusion did not result in significantly lower reduction losses. The subsample being small, is a limitation. Good bone quality correlates with better initial reduction and less reduction loss. A preoperative bone density measurement can lead to optimization of surgical techniques.
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Affiliation(s)
- Esra Aydin
- Department of Internal Medicine – Cardiology, DRK Kliniken Köpenick, Berlin, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Arija Jacobi
- Department of Orthopedic and Trauma Surgery, DIAKO Ev. Diakonie-Krankenhaus gGmbH, 28239, Bremen, Germany
| | - Thomas Mendel
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
| | - Friederike Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Bernhard Wilhelm Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
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Fang Y, Zhang S, Ye Y, Chen K, Ling G, Wang Q, Chen W, Liu C. Analysis of factors influencing the intravertebral shell phenomenon after posterior reduction internal fixation of thoracolumbar fracture: a retrospective study. BMC Musculoskelet Disord 2024; 25:49. [PMID: 38200488 PMCID: PMC10777656 DOI: 10.1186/s12891-024-07168-9] [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: 10/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE The study objectives were as follows: 1) to analyze the factors influencing the occurrence of the intravertebral shell phenomenon (ISP) after thoracolumbar spinal fracture surgery and the evolutionary outcome of this phenomenon; and 2) to make recommendations for the clinical prevention and treatment of ISP. METHODS We retrospectively analyzed 331 patients with single-segment fractures of the thoracolumbar spine treated with internal fixation via a pedicle screw-rod system. Univariate and multivariate logistic regression were used to analyze factors influencing ISP. RESULTS A total of 260 patients (78.5%) developed ISP after surgery. Reduced bone mineral density, screw insertion depth, degree of vertebral body injury, and excessive vertebral body spreading were significantly associated with the occurrence of ISP (P < 0.05). A total of 166 of the 260 patients were reviewed via CT at 1 year postoperatively. Among them, 104 patients (62.6%) showed shrinkage or healed vertebral cavities, and 62 patients (37.4%) showed enlarged vertebral cavities or collapsed endplates. CONCLUSION In clinical management, surgeons need to focus on risk factors for ISP, which include decreased bone density, preoperative vertebral overcompression, intraoperative vertebral overextension, screw insertion depth, and the degree of vertebral repositioning. At the 1-year postoperative follow-up, some of the vertebrae with ISP failed to heal or even showed vertebral cleft enlargement, which would affect the stability of the internal fracture fixation device and the quality of the patient's daily life.
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Affiliation(s)
- Yao Fang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Sining Zhang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Yuchao Ye
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Kongning Chen
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Guangfeng Ling
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Qing Wang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Wugui Chen
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China.
| | - Chengzhao Liu
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China.
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