Biomechanical effects of vertebroplasty on thoracolumbar burst fracture with transpedicular fixation: A finite element model analysis

Xu, Ge‐Liang; Fu, Xin; Du, Chenxing; Ma, Jianxiong; Li, Z.; Ma, Xinlong

doi:10.1016/j.otsr.2014.03.016

Cited by 29 publications

(20 citation statements)

References 29 publications

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“…Since the aim of this study was to evaluate the overall biomechanical changes of the vertebral body, the overall von Mises stresses on the T12 vertical bodies were calculated to evaluate the effects of cement augmentation. These FEA models of the T11-L1 vertebral bodies under vertical flexion and right or left flexion load were verified similarly to those published in the literature [ 27 – 29 ]. The normal model was validated according to published FEA models of human cadaveric thoracolumbar spines by ANSYS [ 23 , 29 ].…”

Section: Methodssupporting

confidence: 77%

“…These FEA models of the T11-L1 vertebral bodies under vertical flexion and right or left flexion load were verified similarly to those published in the literature [ 27 – 29 ]. The normal model was validated according to published FEA models of human cadaveric thoracolumbar spines by ANSYS [ 23 , 29 ]. Results of stress on the T12 vertebral body and stress cloud images at the end of the analysis can be exported to a computer.…”

Section: Methodssupporting

confidence: 77%

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Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis

et al. 2018

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BackgroundClinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. However, no significant results regarding biomechanical effects post-augmentation have been found with different types of vertebral deformity or vertebral heights by biomechanical analysis. Therefore, the present study aimed to investigate the biomechanical effects between different vertebral heights of OVCFs before and after augmentation using three-dimensional finite element analysis.MethodsFour patients with OVCFs of T12 underwent computed tomography (CT) of the T11-L1 levels. The CT images were reconstructed as simulated three-dimensional finite-element models of the T11-L1 levels (before and after the T12 vertebra was augmented with cement). Four different kinds of vertebral height models included Genant semi-quantitative grades 0, 1, 2, and 3, which simulated unilateral augmentation. These models were assumed to represent vertical compression and flexion, left flexion, and right flexion loads, and the von Mises stresses of the T12 vertebral body were assessed under different vertebral heights before and after bone cement augmentation.ResultsData showed that the von Mises stresses significantly increased under four loads of OVCFs of the T12 vertebral body before the operation from grade 0 to grade 3 vertebral heights. The maximum stress of grade 3 vertebral height pre-augmentation was produced at approximately 200%, and at more than 200% for grade 0. The von Mises stresses were significantly different between different vertebral heights preoperatively. The von Mises stresses of the T12 vertebral body significantly decreased in four different loads and at different vertebral body heights (grades 0–3) after augmentation. There was no significant difference between the von Mises stresses of grade 0, 1, and 3 vertebral heights postoperatively. The von Mises stress significantly decreased between pre-augmentation and post-augmentation in T12 OVCF models of grade 0–3 vertebral heights.ConclusionVertebral augmentation can sufficiently reduce von Mises stresses at different heights of OVCFs of the vertebral body, although this technique does not completely restore vertebral height to the anatomical criteria.

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Section: Methodssupporting

confidence: 77%

Section: Methodssupporting

confidence: 77%

Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis

et al. 2018

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“…On the contrary, authors have also claimed that a fractured vertebra augmented by absorbable bone cement followed by a posterior short-segment construct can provide satisfactory clinical results, with a low implant failure rate of 0% to 5% [19, 20]. Xu et al [26] designed a FE model of a thoracolumbar burst fracture, and demonstrated that vertebroplasty inside the fractured vertebra can significantly reduce the stresses of the pedicle instrumentations and spine to prevent kyphotic correction loss and implant failure. In a clinical study, Liao et al [27] showed that two screws placed inside the fractured vertebra with short-segment instrumentation was associated with shorter surgical time and less implant failure as compared to augmentation with injectable calcium sulphate/phosphate cement following posterior short-segment instrumentation.…”

Section: Discussionmentioning

confidence: 99%

“…Orsini et al [34] demonstrated that calcium sulfate cement could promote new bone formation in a rabbit model of bone defects. Furthermore, Xu et al [26] used a FE model to show that cement augmentation of a fractured vertebra could decrease the von Mises stress on the rods by 50% and on the screws by 40%. In the current study, however, the initial stability provided by bone cement inside the fractured vertebra did not achieve the stability provided by two additional screws.…”

Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Liao

Chen

Wang

2017

BMC Musculoskelet Disord

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BackgroundTraditional one-above and one-below four-screw posterior short-segment instrumentation is used for unstable thoracolumbar burst fractures. However, this method has a high rate of implant failure and early loss of reduction. The purpose of this study was to use finite element (FE) analysis to determine the effect of treating thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture.MethodsAn intact T11-L1 spine FE model was created from the computed tomography images of a male subject. Four fixation models with posterior fusion devices (pedicle screws, rods, cross-link) were established to simulate an unstable thoracolumbar fracture with different fusion surgeries: short-segment fixation with: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). Different loading conditions (flexion, extension, lateral bending, and axial rotation) were applied on the models and analyzed with a FE package. The range of motion (ROM), and the maximum value and distribution of the implant stress, and the stress in the facet joint, were compared between the intact and fixation models.ResultsThe ROM in flexion, extension, axial rotation, and lateral bending was the smallest in the S-I-C model, followed by the S-I, S-L-C, and S-L models. Maximum von Mises stress values were larger under lateral bending and axial rotation loadings than under flexion and extension loading. High stress was concentrated at the crosslink and rod junctions. Maximal von Mises stress on the superior vertebral body for all loading conditions was larger than that on the inferior vertebral body. The maximal von Mises stress of the pedicle screws during all states of motion were 265.3 MPa in S-L fixation, 192.9 MPa in S-I fixation, 258.4 MPa in S-L-C fixation, and 162.3 MPa in S-I-C fixation.ConclusionsShort-segment fixation with two intermediate pedicle screws together with calcium sulfate cement at the fractured vertebrae may provide a stiffer construct and less von Mises stress of the pedicle screws and rods as compared to other types of short-segment fixation.

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“…The insufficient distribution of the bone cement increased the displacement of augmented vertebral body. Tschirhart et al[ 9 ] and Xu et al[ 10 ], both emphasized that in the case of severe fractures, cement augmentation could worsen the fracture, leading to the cement leakage with subsequent problems; this indicated the uncertainty in the results of VP. Baroud et al[ 11 ], emphasized that both experimental study and finite element modeling are often focused on the effect of type of bone cement and volume.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical assessment of new surgical method instead of kyphoplasty to improve the mechanical behavior of the vertebra: Micro finite element study

Faradonbeh

Jamshidi

2017

WJO

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AIMTo reduce post treatments of kyphoplasty, as a common treatment for osteoporotic vertebrae.METHODSThis study suggests a new method for treating vertebrae by setting the hexagonal porous structure instead of the rigid bone cement mass in the kyphoplasty (KP). The KP procedure was performed on the fresh ovine vertebra of the level L1. Micro finite element modeling was performed based on micro computed tomography of ovine trabecular cube. The hexagonal porous structure was set on one cube instead of the bone cement mass. For the implant designing, two geometrical parameters were considered: Spacing diameter and thickness.RESULTSThe results of micro finite element analyses indicated the improvement in the mechanical behavior of the vertebra treated by the hexagonal porous structures, as compared to those treated by vertebroplasty (VP) and KP under static loading. The improvement in the mechanical behavior of the vertebra, was observed as 54% decrease in the amount of maximum Von Misses stress (improvement of stress distribution), in trabecular cube with embedded hexagonal structure, as compared to VP and KP. This is comparable to the results of the experimental study already performed; it was shown that the improvement of mechanical behavior of the vertebra was observed as: 83% increase in the range of displacements before getting to the ultimate strength (increasing the toughness) after setting hexagonal pearls inside vertebrae. Both the material and geometry of implant influenced the amount of Von Mises stress in the structure.CONCLUSIONThe new proposed method can be offered as a substitute for the KP. The implant geometry had a more obvious effect on the amount of Von Mises stress, as compared to the implant material.

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Biomechanical effects of vertebroplasty on thoracolumbar burst fracture with transpedicular fixation: A finite element model analysis

Abstract: Level IV, biomechanical study.

Cited by 29 publications

References 29 publications

Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis

Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Biomechanical assessment of new surgical method instead of kyphoplasty to improve the mechanical behavior of the vertebra: Micro finite element study

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