Biomechanical comparative analysis of conventional pedicle screws and cortical bone trajectory fixation in the lumbar spine: An in vitro and finite element study

Pei, Baoqing; Xu, Yangyang; Zhao, Yong; Wu, Xueqing; Lu, Da; Wang, Haiyan; Shu-qin, WU

doi:10.3389/fbioe.2023.1060059

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…The overall ROM of the PS group was further reduced compared to that of the intact group, while the CBT group showed an increasing trend, but the maximum value was 1.39˚, which was also considered stable. Compared with CBT, PS had better bending resistance, whereas PS had better anti-rotation performance than CBT, in agreement with Pei B et al [22]. Loss of spinal ROM in patients with AS is common and consistent with clinical knowledge.…”

Section: Discussionsupporting

confidence: 87%

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Comparative biomechanical analysis of pedicle screws versus cortical bone trajectory fixation in the treatment of ankylosing spondylitis

Zhang,

Kang,

Shi

et al. 2024

Preprint

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Background Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Patients with spinal deformities are typically treated with long-segment pedicle screw (PS) internal fixation after bone resection. However, issues with the operation, such as fracture and screw loosening or pulling out, might arise. Methods This study explore the biomechanical responses to PS and cortical bone trajectory (CBT) fixation. Using finite element analysis (FEA) on reconstructed preoperative and postoperative spine models under six conditions, it predicted stiffness, range of motion (ROM), and von Mises stress, comparing PS and CBT fixation effects. Results Stiffness was greater in the PS than CBT, while the PS performed better than the CBT under bending stiffness, except for the PS under extension conditions. In flexion, extension, and lateral bending, the PS sustained higher stress than CBT, while in axial rotation, CBT experienced greater stress than PS, with stress concentration at the level of bone resection. Furthermore, during spinal dynamics, calcified ligaments bore substantial stress. Biomechanically, PS demonstrated superior strength during flexion, extension, and lateral bending conditions. Whereas, under conditions of left and right rotation, the CBT technique provided better biomechanical strength. Conclusion Compared to PS, the current CBT technique was sufficiently effective in maintaining spinal fusion stability after bone resection for AS.

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Section: Discussionsupporting

confidence: 87%

“…Typically, a spinal model includes three components: vertebrae, intervertebral discs, and ligaments. Numerous scholars have created detailed models of vertebral bodies and intervertebral discs [22]. However, there are few studies on the effect of ligament modeling on the biomechanics of the spine.…”

Section: Introductionmentioning

confidence: 99%

Comparative biomechanical analysis of pedicle screws versus cortical bone trajectory fixation in the treatment of ankylosing spondylitis

Zhang,

Kang,

Shi

et al. 2024

Preprint

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“…The second variable was K, with the values used being 28, 57, and 85 N/mm. The values of the modulus of elasticity (E) and Poisson’s ratio (ν) for each of the tissues in the FE models are presented in Table 1 [ 22 , 25 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model

Hsiao,

Tsai

et al. 2023

Bioengineering

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Spinal fusion surgery leads to the restriction of mobility in the vertebral segments postoperatively, thereby causing stress to rise at the adjacent levels, resulting in early degeneration and a high risk of adjacent vertebral fractures. Thus, to address this issue, non-fusion surgery applies some pedicle screw-based dynamic stabilisation systems to provide stability and micromotion, thereby reducing stress in the fusion segments. Among these systems, the hybrid performance stabilisation system (HPSS) combines a rigid rod, transfer screw, and coupler design to offer a semi-rigid fixation method that preserves some mobility near the fusion site and reduces the adjacent segment compensatory effects. However, further research and confirmation are needed regarding the biomechanical effects of the dynamic coupler stiffness of the HPSS on the intrinsic degenerated adjacent segment. Therefore, this study utilised the finite element method to investigate the impact of the coupler stiffness of the HPSS on the mobility of the lumbar vertebral segments and the stress distribution in the intervertebral discs under flexion, extension, and lateral bending, as well as the clinical applicability of the HPSS on the discs with intrinsic moderate and severe degeneration at the adjacent level. The analytical results indicated that, regardless of the degree of disc degeneration, the use of a dynamic coupler stiffness of 57 N/mm in the HPSS may reduce the stress concentrations at the adjacent levels. However, for severely degenerated discs, the postoperative stress on the adjacent segments with the HPSS was still higher compared with that of the discs with moderate degeneration. We conclude that, when the discs had moderate degeneration, increasing the coupler stiffness led to a decrease in disc mobility. In the case of severe disc degeneration, the effect on disc mobility by coupler stiffness was less pronounced. Increasing the coupler stiffness ked to higher stress on intervertebral discs with moderate degeneration, while its effect on stress was less pronounced for discs with severe degeneration. It is recommended that patients with severe degeneration who undergo spinal dynamic stabilisation should remain mindful of the risk of accelerated adjacent segment degeneration.

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“…The accuracy and safety of screws were well established, 3–5 while complications were also indicated intraoperatively or postoperatively. The common complications of internal fixation include deep wound infection, screw loosening, breakage, and so on 6,7 . These complications result in the increasing likelihood of negative outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…The common complications of internal fixation include deep wound infection, screw loosening, breakage, and so on. 6 , 7 These complications result in the increasing likelihood of negative outcomes. Screw loosening is one of severe complications which may occur postoperatively in patients, leading to adverse consequences like back pain, deformity and disability.…”

Section: Introductionmentioning

confidence: 99%

Diabetes‐related Screw Loosening: The Distinction of Surgical Sites and the Relationship among Diabetes, Implant Stabilization and Clinical Outcomes

Wang,

et al. 2023

Orthopaedic Surgery

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ObjectivesDiabetes mellitus (DM) is correlated with poor clinical outcomes in spinal surgery. However, the effect of it on screw stabilization has not been investigated. The aim of this study was to evaluate the screw loosening rate and postoperative outcomes in diabetic patients and to identify potential risk factors associated with loosening.MethodsThis was a retrospective study. Two hundred and forty‐three patients who received cervical or lumbar internal fixation between 2015 and 2019 were enrolled. Screw loosening was assessed on radiography, and clinical outcomes were evaluated by the improvement of visual analogue scale (VAS), Oswestry disability index (ODI) or Japanese Orthopaedic Association (JOA) scores. The relationship of DM, screw loosening and clinical outcomes were analyzed with chi‐square tests and regression analyses.ResultsOne hundred and twenty‐two patients (50.2%) with diabetes were included in this study. Diabetes led to the increase of the rate of screw loosening in the lumbar spine, while the loosening rate did not vary significantly in the cervical spine. The occurrence of screw loosening in the lumbar spine was more likely to be associated with clinical outcomes for motor performance including walking and sitting. However, no significant effect on JOA and VAS scores in the cervical spine of screw loosening was found. Moreover, the history of DM affected the outcomes of the patients who underwent spinal surgery.ConclusionDM had an adverse effect on screw stabilization. The impaired improvement of clinical outcomes in diabetics after spinal surgery was related to screw loosening. In addition to the direct effects on operative wounds and neural function, the impact on the screws due to DM was also worth noting.

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Biomechanical comparative analysis of conventional pedicle screws and cortical bone trajectory fixation in the lumbar spine: An in vitro and finite element study

Cited by 6 publications

References 42 publications

Comparative biomechanical analysis of pedicle screws versus cortical bone trajectory fixation in the treatment of ankylosing spondylitis

Comparative biomechanical analysis of pedicle screws versus cortical bone trajectory fixation in the treatment of ankylosing spondylitis

Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model

Diabetes‐related Screw Loosening: The Distinction of Surgical Sites and the Relationship among Diabetes, Implant Stabilization and Clinical Outcomes

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