Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study

Huang, Chen-Yi; Liu, Zongchao; Wei, Zhangchao; Fang, Zhongxin; Xi, Zhaodong; Cai, Ping; Li, Jingchi

doi:10.3389/fsurg.2022.1004642

Cited by 3 publications

(1 citation statement)

References 57 publications

(103 reference statements)

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“…To date, most studies have found that insertional screw positions affect surgical segment stiffness and local stress distribution, which are closely associated with the incidence of CS. 16 Newcomb et al suggested that angulations in both the sagittal and axial planes affected fixation strength during posterior spine fixation. 17 For OLIF‐AF, screw placement is not restricted by the pedicle; thus, theoretically, anterolateral screws can be placed in different trajectories.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Screw Positioning on Cage Subsidence in Patients with Oblique Lumbar Interbody Fusion Combined with Anterolateral Fixation

Wang,

et al. 2023

Orthopaedic Surgery

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ObjectivesCage subsidence (CS) has been reported to be one of the most common complications following oblique lumbar interbody fusion (OLIF). To reduce the incidence of CS and improve intervertebral fusion rates, anterolateral fixation (AF) has been gradually proposed. However, the incidence of CS in patients with oblique lumbar interbody fusion combined with anterolateral fixation (OLIF‐AF) is still controversial. Additionally, there is a lack of consensus regarding the optimal placement of screws for OLIF‐AF, and the impact of screw placement on the incidence of CS has yet to be thoroughly investigated and validated. The objective of this investigation was to examine the correlation between screw placements and CS and to establish an optimized approach for implantation in OLIF‐AF.MethodsA retrospective cohort study was undertaken. From October 2017 to December 2020, a total of 103 patients who received L4/5 OLIF‐AF for lumbar spinal stenosis or spondylolisthesis or degenerative instability in our department were followed up for more than 12 months. Demographic and radiographic data of these patients were collected. Additionally, screw placement related parameters, including trajectory and position, were measured by anterior–posterior X‐ray and axial CT. Analysis was done by chi‐square, independent t‐test, univariable and multivariable binary logistic regression to explore the correlation between screw placements and CS. Finally, the receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of screw placement‐related parameters.ResultsA total of 103 patients were included, and CS was found in 28 (27.18%) patients. Univariable analysis was firstly performed for each parameter. Next, variables with p‐value of <0.05, including bone mineral density (BMD), concave morphology, and screw placement‐related parameters were included in the multivariate logistic regression analysis. Significant predictor factors for subsidence were coronal plane angle (CPA) (OR 0.580 ± 0.208, 95% CI 1.187–2.684), implantation point (IP) (L4) (OR 5.732 ± 2.737, 95% CI 1.445–12.166), and IP (L5) (OR 7.160 ± 3.480, 95% CI 1.405–28.683). Furthermore, ROC curves showed that the predictive accuracy of CS was 88.1% for CPA, 77.6% for IP (L4) and 80.9% for IP (L5).ConclusionsWe demonstrate that the trajectory of vertebral screws, including angle and position, was closely related to CS. Inserting screws parallel to each other and as close to the endplate as possible while keeping the cage inside the range of the superior and inferior screws are an optimal implantation strategy for OLIF‐AF.

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Section: Introductionmentioning

confidence: 99%

The Influence of Screw Positioning on Cage Subsidence in Patients with Oblique Lumbar Interbody Fusion Combined with Anterolateral Fixation

Wang,

et al. 2023

Orthopaedic Surgery

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The Bony Density of the Pedicle Plays a More Significant Role in the Screw Anchorage Ability Than Other Regions of the Screw Trajectory

Chen,

Zhou

et al. 2024

Orthopaedic Surgery

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ObjectiveOsteoporosis is a crucial risk factor for screw loosening. Our studies indicate that the bone mineral density (BMD) in the screw trajectory is a better predictor of screw loosening than the BMD of the lumbar spine or the screw insertion position. Research has shown that anchorage on the screw tip is the most significant factor for screw anchorage ability, while others argue that decreased bony quality in the pedicle poses a significant risk for screw loosening. This study aimed to determine whether the bony quality of the screw tip, pedicle, or screw‐anchored vertebral body plays the most significant role in screw anchorage ability.MethodsA total of 73 patients who underwent single–segment bilateral pedicle screw fixation, along with posterior and transforaminal lumbar interbody fusion (PLIF and TLIF), from March 2019 to September 2020 were included in this retrospective study. The Hounsfield unit (HU) value of the fixed vertebral bodies, the entire screw trajectory, screw tip, screw–anchoraged vertebral body, and pedicles were measured separately. Data from patients with and without screw loosening were compared, and regression analyses were conducted to identify independent risk factors. Additionally, the area under the curve (AUC) values were computed to assess the predictive performance of different parameters. Furthermore, fixation strength was calculated in numerical models with varying bony densities in different regions.ResultsHU values were found to be significantly lower in the loosening group across most measuring methods (HU values in the pedicle, 148.79 ± 97.04, 33.06 ± 34.82, p < 0.001). Specifically, the AUC of screw loosening prediction was notably higher when using HU values of the pedicle compared to other methods (AUC in the pedicle > 0.9 and in the screw insertion position > 0.7). Additionally, computational results for fixation strength revealed a clear decline in screw anchorage ability in models with poor BMD in the pedicle region.ConclusionsPedicle bone quality plays a more significant role in screw anchorage ability than that in other regions. The innovation of bony augmentation strategies should pay more attention to this region to optimize the screw anchorage ability effectively.

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Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study

Huang,

Jia

et al. 2024

J Orthop Surg Res

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Background The capsule of the zygapophyseal joint plays an important role in motion segmental stability maintenance. Iatrogenic capsule injury is a common phenomenon in posterior approach lumbar interbody fusion operations, but whether this procedure will cause a higher risk of adjacent segment degeneration acceleration biomechanically has yet to be identified. Methods Posterior lumbar interbody fusion (PLIF) with different grades of iatrogenic capsule injury was simulated in our calibrated and validated numerical model. By adjusting the cross-sectional area of the capsule, different grades of capsule injury were simulated. The stress distribution on the cranial motion segment was computed under different loading conditions to judge the potential risk of adjacent segment degeneration acceleration. Results Compared to the PLIF model with an intact capsule, a stepwise increase in the stress value on the cranial motion segment can be observed with a step decrease in capsule cross-sectional areas. Moreover, compared to the difference between models with intact and slightly injured capsules, the difference in stress values was more evident between models with slight and severe iatrogenic capsule injury. Conclusion Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically, and iatrogenic capsule damage on the cranial motion segment should be reduced to optimize patients’ long-term prognosis.

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Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study

Cited by 3 publications

References 57 publications

The Influence of Screw Positioning on Cage Subsidence in Patients with Oblique Lumbar Interbody Fusion Combined with Anterolateral Fixation

The Influence of Screw Positioning on Cage Subsidence in Patients with Oblique Lumbar Interbody Fusion Combined with Anterolateral Fixation

The Bony Density of the Pedicle Plays a More Significant Role in the Screw Anchorage Ability Than Other Regions of the Screw Trajectory

Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study

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