Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: a finite element analysis study of stress distribution

Abstract

BackgroundLateral mass screw fixation (LSF) techniques have been widely used for reconstructing and stabilizing the cervical spine; however, complications may result depending on the choice of surgeon. There are only a few reports related to LSF applications, even though fracture fixation has become a severe complication. This study establishes the three-dimensional finite element model of the lower cervical spine, and compares the stress distribution of the four LSF techniques (Magerl, Roy-Camille, Anderson, and An), following laminectomy -- to explore the risks of rupture after fixation.MethodCT scans were performed on a healthy adult female volunteer, and Digital imaging and communication in medicine (Dicom) data was obtained. Mimics 10.01, Geomagic Studio 12.0, Solidworks 2012, HyperMesh 10.1 and Abaqus 6.12 software programs were used to establish the intact model of the lower cervical spines (C3-C7), a postoperative model after laminectomy, and a reconstructive model after applying the LSF techniques. A compressive preload of 74 N combined with a pure moment of 1.8 Nm was applied to the intact and reconstructive model, simulating normal flexion, extension, lateral bending, and axial rotation. The stress distribution of the four LSF techniques was compared by analyzing the maximum von Mises stress.ResultThe three-dimensional finite element model of the intact C3-C7 vertebrae was successfully established. This model consists of 503,911 elements and 93,390 nodes. During flexion, extension, lateral bending, and axial rotation modes, the intact model’s angular intersegmental range of motion was in good agreement with the results reported from the literature. The postoperative model after the three-segment laminectomy and the reconstructive model after applying the four LSF techniques were established based on the validated intact model. The stress distribution for the Magerl and Roy-Camille groups were more dispersive, and the maximum von Mises stress levels were lower than the other two groups in various conditions.ConclusionThe LSF techniques of Magerl and Roy-Camille are safer methods for stabilizing the lower cervical spine. Therefore, these methods potentially have a lower risk of fixation fracture.

Results of Laminectomy With Lateral Masses Fixation in Treatment of Multilevel Cervical Degenerative Diseases

“…Инструментальная фиксация за боковые массы шейных позвонков после выполнения декомпрессивной ламинэктомии является частой операцией при субаксиальных дегенеративных заболеваниях. Наиболее частые периоперационные осложнения связаны с разрушением боковой массы винтом, повреждением позвоночной артерии и спинномозговых корешков погружными имплантатами [27]. Вышеупомянутые неблагоприятные последствия зависят преимущественно от способа введения винта в боковую массу и опыта спинального хирурга выполнения оперативных вмешательств.…”

Biomechanical Evaluation of Two Posterior Lumbar Intervertebral Fusion Surgical Scenarios Reinforced by a Rigid Posterior Fixation System in the Vertebral Column Analyzed by the Finite Element Method

“…The material properties of the INT model are listed in Table 1 and were chosen from previous studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. A ten-node solid element type (Solid187) was used for modeling the cortical bone, cancellous bone, endplate, and annulus fibrosus.…”

“…The intervertebral disc consisted of annulus ground substance and nucleus pulposus, which embeds collagen fibers in the ground substance. The non-linear annulus ground substance was simulated by using an isotropic and simulated by ten-node solid element, type (Solid187) [24][25][26][27][28][29][30] Ligament, Sacroiliac posterior Ligament, Interosseous Ligament) are simulated by tetrahedral elements, type (Solid187) conforming to defined parametric surfaces interfaces and they were arranged in the anatomical direction given by the text book [30]; the crosssectional area of each ligament was obtained from previous studies [36][37][38][39][40][41].…”

Outcome of Lateral Mass Fixation and Fusion – A Comprehensive Analytical Study of 205 Lateral Mass Screws in 35 Patients at Punjab Institute of Neurosciences

“…Most of the spinal surgeons believe that after standard cervical laminectomy and decompression of spinal cord, lateral mass fixation with polyaxial screws and rods is good option for stabilization of cervical spine. 3,4 It is very easy technically under fluoro guidance and gives enough stability with very few little complications ofnerve root or vertebral artery injuries and facet joint violations. 5,6 We operated all patients in prone position under fluoroscopic guidance.…”