Biomechanics of artificial pedicle fixation in a 3D-printed prosthesis after total en bloc spondylectomy: a finite element analysis

Wang, Xiaodong; Xu, Haibo; Han, Yang; Wu, Jincheng; Song, Yang; Jiang, Yuanyuan; Wang, Jianzhong

doi:10.1186/s13018-021-02354-0

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…The rotational stiffness increased notably in all three loading directions compared to the intact model for all models. However, it increased least in axial rotation, consistently with previous in vitro and in silico results 11 , 21 , 48 , 49 . There was no significant difference in stiffness between the individual replacements, meaning that all devices provide similar adequate construct stability, although, PMMA-C demonstrated the greatest stiffness in all directions.…”

Section: Discussionsupporting

confidence: 91%

“…The stability of the structures was determined by their rotational stiffness, similar to Wang et al 48 . The rotational stiffness increased notably in all three loading directions compared to the intact model for all models.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that only combined antero-posterior instrumentation has sufficient axial rotational stability. Wang et al 48 investigated a new type of one-level VBR, and found that artificial pedicles increase the rotational stability of the device. This could be the reason for the better rotational stability of PMMA-C, since the screw connecting the anterior replacement to the posterior fixation acts like an artificial pedicle, not only preventing the dislocation of the device but also increasing rotational stability.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study

Pokorni,

Turbucz,

Kiss

et al. 2023

Sci Rep

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Total en bloc spondylectomy (TES) effectively treats spinal tumors. The surgery requires a vertebral body replacement (VBR), for which several solutions were developed, whereas the biomechanical differences between these devices still need to be completely understood. This study aimed to compare a femur graft, a polyetheretherketone implant (PEEK-IMP-C), a titan mesh cage (MESH-C), and a polymethylmethacrylate replacement (PMMA-C) using a finite element model of the lumbar spine after a TES of L3. Several biomechanical parameters (rotational stiffness, segmental range of motion (ROM), and von Mises stress) were assessed to compare the VBRs. All models provided adequate initial stability by increasing the rotational stiffness and decreasing the ROM between L2 and L4. The PMMA-C had the highest stiffness for flexion–extension, lateral bending, and axial rotation (215%, 216%, and 170% of intact model), and it had the lowest segmental ROM in the instrumented segment (0.2°, 0.5°, and 0.7°, respectively). Maximum endplate stress was similar for PMMA-C and PEEK-IMP-C but lower for both compared to MESH-C across all loading directions. These results suggest that PMMA-C had similar or better primary spinal stability than other VBRs, which may be related to the larger contact surface and the potential to adapt to the patient’s anatomy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study

Pokorni,

Turbucz,

Kiss

et al. 2023

Sci Rep

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“…The thickness of cortical bone was 1 mm. The thickness of upper and lower endplates was 0.5 mm [ 17 , 18 ]. The intervertebral disk is composed of the nucleus pulposus, stroma and annulus fibers, which are embedded into the annulus matrix in the form of truss units.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical differences between two different shapes of oblique lumbar interbody fusion cages on whether to add posterior internal fixation system: a finite element analysis

Liu,

Geng,

Wang

et al. 2023

J Orthop Surg Res

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Background Oblique lateral lumbar fusion (OLIF) is widely used in spinal degeneration, deformity and other diseases. The purpose of this study was to investigate the biomechanical differences between two different shapes of OLIF cages on whether to add posterior internal fixation system, using finite element analysis. Methods A complete three-dimensional finite element model is established and verified for L3–L5. Surgical simulation was performed on the verified model, and the L4–L5 was the surgical segment. A total of the stand-alone group (Model A1, Model B1) and the BPSF group (Model A2, Model B2) were constructed. The four OLIF surgical models were: A1. Stand-alone OLIF with a kidney-shaped Cage; B1. Stand-alone OLIF with a straight cage; A2. OLIF with a kidney-shaped cage + BPSF; B2. Stand-alone OLIF with a straight cage + BPSF, respectively. The differences in the range of motion of the surgical segment (ROM), equivalent stress peak of the cage (ESPC), the maximum equivalent stress of the endplate (MESE) and the maximum stress of the internal fixation (MSIF) were compared between different models. Results All OLIF surgical models showed that ROM declines between 74.87 and 96.77% at L4–L5 operative levels. The decreasing order of ROM was Model A2 > Model B2 > Model A1 > Model A2. In addition, the ESPC and MESE of Model A2 are smaller than those of other OLIF models. Except for the left-bending position, the MSIF of Model B2 increased by 1.51–16.69% compared with Model A2 in each position. The maximum value of MESE was 124.4 Mpa for Model B1 in the backward extension position, and the minimum value was 7.91 Mpa for Model A2 in the right rotation. Stand-alone group showed significantly higher ROMs and ESPCs than the BPSF group, with maximum values of 66.66% and 70.59%. For MESE, the BPSF group model can be reduced by 89.88% compared to the stand-alone group model. Conclusions Compared with the traditional straight OLIF cage, the kidney-shaped OLIF cage can further improve the stability of the surgical segment, reduce ESPC, MESE and MSIF, and help to reduce the risk of cage subsidence.

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“…Images of three vertebrae and two intervertebral discs between T12 and L2 were obtained using a 64-slice spiral computed tomography scanner (Siemens, Erlangen, Germany) with 0.625 mm interlayer spacing. DICOM images were imported into Mimics 20.0(Materialise Inc., Leuven, Belgium) to create a 3D vertebral body surface model T12—L2 [ 6 ]. 3-Matic 12.0 software (Materialise Inc.) was used to construct facet joints and annulus fibrosus stroma and nucleus pulposus.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease: a finite element study

Xu,

Feng,

et al. 2023

BMC Musculoskelet Disord

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Objective To investigate and evaluate the biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease (KD) by finite element (FE) analysis. Methods A validated finite element model of healthy adult thoracolumbar vertebrae T12-L2 was given the osteoporotic material properties and the part of the middle bone tissue of the L1 vertebral body was removed to make it wedge-shaped. Based on these, FE model of KD was established. The FE model of KD was repaired and treated with three options: pure percutaneous vertebroplasty (Model A), novel unilateral cement screw placement (Model B), novel bilateral cement screw placement (Model C). Range of motion (ROM), maximum Von-Mises stress of T12 inferior endplate and bone cement, relative displacement of bone cement, and stress distribution of bone cement screws of three postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. Results The relative displacements of bone cement of Model B and C were similar in all actions studied, and both were smaller than that of Model A. The minimum value of relative displacement of bone cement is 0.0733 mm in the right axial rotation of Model B. The maximum Von-Mises stress in T12 lower endplate and bone cement was in Model C. The maximum Von-Mises stress of bone cement screws in Model C was less than that in Model B, and it was the most substantial in right axial rotation, which is 34%. There was no substantial difference in ROM of the three models. Conclusion The novel bone cement screw can effectively reduce the relative displacement of bone cement by improving the stability of local cement. Among them, novel unilateral cement screw placement can obtain better fixation effect, and the impact on the biomechanical environment of vertebral body is less than that of novel bilateral cement screw placement, which provides a reference for minimally invasive treatment of KD in clinical practice.

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Biomechanics of artificial pedicle fixation in a 3D-printed prosthesis after total en bloc spondylectomy: a finite element analysis

Cited by 8 publications

References 37 publications

Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study

Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study

Biomechanical differences between two different shapes of oblique lumbar interbody fusion cages on whether to add posterior internal fixation system: a finite element analysis

Biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease: a finite element study

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