Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

Abstract

Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system. The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary. Materials and Methods. DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method. Results. The values of stress and displacement fields for spine-hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153-161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine-hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws. Conclusion. The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.

Treatment Tactics for Patients with Isolated Injuries of the Fifth Lumbar Vertebra

“…The clinical efficiency of surgical reconstruction for injuries of the L 5 vertebra can be increased by supplementing TPF with anterior column support in combination (if necessary) with decompression of the spinal canal contents. The experience of using Mesh implants in the reconstruction of the resected vertebral body at the level of the thoracolumbar transitional spine [ 18 – 20 ] can be extrapolated to the lumbosacral transition. The practice of circular fixation and decompression in burst fractures of the L 5 vertebra is not sufficiently presented in the available literature [ 1 , 21 ].…”