Analysis and improvement of the three-column spinal theory

Su, Qihang; Li, Cong; Li, Yongchao; Zhou, Zifei; Zhang, Shuiqiang; Guo, Shuxiang; Feng, Xiaofei; Yan, Meijun; Zhang, Yan; Zhang, Jinbiao; Pan, Jie; Cheng, Biao; Tan, Jun

doi:10.1186/s12891-020-03550-5

Cited by 22 publications

(16 citation statements)

References 30 publications

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“…The mesh convergence of the intact L1-S model was tested, which contained 580,440 elements and 155,100 nodes. The material properties were defined according to the previously reported literature [18,24,25], as shown in Table 1.…”

Section: Intact Fe Modelmentioning

confidence: 99%

Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

Yang

Han

et al. 2022

J Orthop Surg Res

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Background Advancements in medicine and the popularity of lumbar fusion surgery have made lumbar adjacent segment disease (ASDz) increasingly common, but there is no mature plan for guiding its surgical treatment. Therefore, in this study, four different finite element (FE) ASDz models were designed and their biomechanical characteristics were analysed to provide a theoretical basis for clinical workers to choose the most appropriate revision scheme for ASDz. Methods According to whether internal fixation was retained, different FE models were created to simulate ASDz revision surgery, and flexion, extension, axial rotation and lateral bending were simulated by loading. The biomechanical characteristics of the adjacent segments of the intervertebral disc and the internal fixation system and the range of motion (ROM) of the lumbar vertebrae were analysed. Results The difference in the ROM of the fixed segment between FE models that did or did not retain the original internal fixation was less than 0.1°, and the difference was not significant. However, the stress of the screw–rod system when the original internal fixation was retained and prolonged fixation was performed with dual-trajectory screws was less than that when the original internal fixation was removed and prolonged fixation was performed with a long bar. Especially in axial rotation, the difference between models A and B is the largest, and the difference in peak stress reached 30 MPa. However, for the ASDz revision surgery segment, the endplate stress between the two models was the lowest, and the intradiscal pressure (IDP) of the adjacent segment was not significantly different between different models. Conclusion Although ASDz revision surgery by retaining the original internal fixation and prolonging fixation with dual-trajectory screws led to an increase in stress in the fusion segment endplate, it provides stability similar to ASDz revision surgery by removing the original internal fixation and prolonging fixation with a long bar and does not lead to a significant change in the IDP of the adjacent segment while avoiding a greater risk of rod fracture.

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Section: Intact Fe Modelmentioning

confidence: 99%

Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

Yang

Han

et al. 2022

J Orthop Surg Res

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“…One possible explanation was that the biomechanical properties of the middle column differed from the anterior or posterior elements. 26 Yet, it had not been investigated whether there was a pattern of lesion distribution in the SIJs in patients with axSpA. Our study was the first one to show that bone marrow edema and fat deposition were evenly distributed in the SIJs, while erosions were more likely to develop on the iliac sides.…”

Section: Discussionmentioning

confidence: 75%

Distribution of Acute and Chronic Lesions in the Sacroiliac Joints of Patients with Axial Spondyloarthritis

Lin¹,

Liu²,

Liu³

et al. 2022

IJGM

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In this study, we aimed to investigate whether there was a pattern of distribution of acute and chronic lesions in the sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA). Methods: A total of 96 patients diagnosed as axSpA were retrospectively included in this study. The Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score (SIS) and structural score (SSS) were used to evaluate the acute and chronic lesions in the SIJs. Scores representing the distribution of bone marrow edema, fatty lesions and erosions were extracted respectively. By dividing the SIJs into sacral or iliac sections, upper or lower sections, anterior and posterior levels, differences of scores representing acute and chronic lesions were analyzed by Kruskal Wallis' tests. Results: SIS scores were not significantly different in sacral or iliac sections, in upper or lower sections, on anterior or posterior levels. SSS scores were also not significantly different in different sections, except for higher occurrence rates of erosions in the iliac sections. Posthoc analysis showed that there was a higher erosion score in the left ilium than left sacrum, as well as in right ilium than left sacrum. Conclusion: There was no specific distribution pattern of acute or chronic lesions in the SIJs in patients with axSpA. A bigger study sample was needed to confirm the distribution of erosions in sacral or iliac sections.

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“…Wang et al ( 9 ) believed that the defect of anterior cortex may increase the probability of cement displacement under weight-bearing conditions. According to Denis’s three-column theory, the anterior margin of the vertebral body is an important part of the anterior column of the spine, and the anterior 1/3 of the vertebral body is the area that bears the highest pressure ( 17 ). We also indirectly confirm this result by establishing a three-dimensional finite element model.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for bone cement displacement after percutaneous vertebral augmentation for osteoporotic vertebral compression fractures

Gao

Hao²,

Lin³

et al. 2022

Front. Surg.

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PurposeTo explore the risk factors of bone cement displacement after percutaneous vertebral augmentation (PVA) in patients with osteoporotic vertebral compression fracture (OVCF).MethodsWe retrospectively reviewed the records of 1,538 patients with OVCF treated with percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) from January 2016 to June 2021. Patients were divided into bone cement displacement group (n = 78) and bone cement non-displacement group (n = 1,460) according to the radiographic images. Possible risk factors for bone cement displacement were noted, including age, gender, body mass index (BMI), bone mineral density (BMD), underlying disease, number of fractured vertebrae, involved vertebral segment, surgical method, surgical approach, vertebral height, Cobb angle, cement leakage, the viscosity of bone cement, bone cement diffuse ratio, degree of bone cement interweaving, sagittal bone cement placement, targeted location of bone cement, the distance between the bone cement and the upper and lower endplates, the time of wearing brace and postoperative osteoporosis treatment. Risk factors were identified with univariate and multivariate logistic regressions and the discrimination ability of the predictive indicators was evaluated using area under the curve (AUC) of the receiver operating characteristic (ROC).ResultsIn multivariate regression, independent risk factors for bone cement displacement included: high restoration of Cobb angle (OR = 2.019, 95%[CI] 1.545–4.852, P < 0.001), cement leakage (anterior edge) (OR = 1.727, 95%[CI] 1.05–2.20, P < 0.001), small degree of bone cement interweaving (OR = 1.917, 95%[CI] 1.129–2.747, P < 0.001), non-targeted location of bone cement (OR = 2.323, 95%[CI] 1.645–4.134, P < 0.001), short duration of brace wearing (OR = 3.207, 95%[CI] 2.036–4.348, P < 0.001) and postoperative osteoporosis treatment (OR = 0.422, 95% CI = 0.323–0.547, P < 0.001). The AUCs for the high restoration of Cobb angle, cement leakage (anterior edge), small degree of bone cement interweaving, non-targeted location of bone cement, short duration of brace wearing and non-postoperative osteoporosis treatment were 0.784 (95% CI, 0.747–0.821), 0.811 (95% CI 0.764–0.859), 0.917 (95%CI 0.864–0.970), 0.610 (95%CI 0.552–0.669), 0.854 (95%CI 0.816–0.892) and 0.756 (95% CI, 0.712–0.800), respectively.ConclusionHigh restoration of Cobb angle, cement leakage (anterior edge), small degree of bone cement interweaving, non-targeted location of bone cement, short duration of brace wearing and non-postoperative osteoporosis treatment were the independent risk factors of bone cement displacement after PVA.

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Analysis and improvement of the three-column spinal theory

Cited by 22 publications

References 30 publications

Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

Distribution of Acute and Chronic Lesions in the Sacroiliac Joints of Patients with Axial Spondyloarthritis

Risk factors for bone cement displacement after percutaneous vertebral augmentation for osteoporotic vertebral compression fractures

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