Biomechanical Assessment of Vertebroplasty Combined with Cement-Augmented Screw Fixation for Lumbar Burst Fractures: A Finite Element Analysis
Source abstract
Abstract
A hybrid fixation method, using a combination of vertebroplasty and cement-augmented screws, has been demonstrated as a useful technique for securing osteoporotic burst fractures. The purpose of this study was to assess changes in the range of motion (ROM) and stress in the spine after treating a lumbar burst fracture with this hybrid method. Five finite element models were developed: (a) intact lumbar spine (INT), (b) INT with vertebroplasty at L3 (AwC), (c) two-segment fixation of AwC (AwC-TSF), (d) AwC-TSF model with cement-augmented screws (AwC-TSF-S), and (e) INT with an L3 burst fracture treated with two-segment fixation (TSF). After loading, the models were evaluated in terms of the ROM of each motion segment, stiffness of fusion segments, and stresses on the endplates and screws. The results showed that the TSF model has a larger ROM at the instrumented segments than both the AwC-TSF and AwC-TSF-S models. The stiffness at L2–L4 under extension and lateral bending in AwC-TSF, AwC-TSF-S and TSF was approximately nine times greater than the INT model. In conclusion, the hybrid fixation method (AwC-TSF-S) results in a stiffer construct and lower ROM at instrumented segments, which may also reduce the risk of fracture of adjacent vertebrae.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Spinal Fractures and Fixation Techniques · Spine and Intervertebral Disc Pathology · Pelvic and Acetabular Injuries
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Department of Biomedical Engineering, National Yang-Ming University, 112 Taipei, Taiwan
Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, 235 New Taipei City, Taiwan
Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, 110 Taipei, Taiwan
Department of Orthopedic Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, 116 Taipei, Taiwan
Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 116 Taipei, Taiwan
References (33)
Show source-provided references
1. Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology10.1186/1749-799X-4-28 ↗
2. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures10.1007/s00586-007-0310-5 ↗
3. The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures10.1097/BSD.0b013e3181870385 ↗
4. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report10.2106/00004623-199302000-00002 ↗
5. Short-Segment Pedicle Instrumentation of Thoracolumbar Burst Fractures10.1097/00007632-200101150-00017 ↗
6. Complications in surgical treatment of thoracolumbar injuries10.1007/s00586-001-0382-6 ↗
7. Bone Cement-Augmented Short Segment Fixation with Percutaneous Screws for Thoracolumbar Burst Fractures Accompanied by Severe Osteoporosis10.3340/jkns.2012.52.4.353 ↗
8. Bone Cement Augmentation of Short Segment Fixation for Unstable Burst Fracture in Severe Osteoporosis10.3340/jkns.2008.44.1.8 ↗
9. Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia: A Comparative Study10.3340/jkns.2013.53.1.26 ↗
10. Wittenberg, R.H., Lee, K.-S., Shea, M., White, A.A., and Hayes, W.C. (1993). Effect of Screw Diameter, Insertion Technique, and Bone Cement Augmentation of Pedicular Screw Fixation Strength. Clin. Orthop. Relat. Res., 278–287.10.1097/00003086-199311000-00045 ↗
11. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty10.1093/rheumatology/39.12.1410 ↗
12. Occurrence of New Vertebral Body Fracture after Percutaneous Vertebroplasty in Patients with Osteoporosis110.1148/radiol.2261011911 ↗
13. Effect of Augmentation Material Stiffness on Adjacent Vertebrae after Osteoporotic Vertebroplasty Using Finite Element Analysis with Different Loading Methods10.36076/ppj.2015/18/E1101 ↗
14. Functional and Radiographic Outcome of Thoracolumbar and Lumbar Burst Fractures Managed by Closed Orthopaedic Reduction and Casting10.1097/01.BRS.0000090834.36061.DD ↗
15. Wu, Y., Chen, C.-H., Tsuang, F.-Y., Lin, Y.-C., Chiang, C.-J., and Kuo, Y.-J. (2019). The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone: A finite element analysis. PLoS ONE, 14.10.1371/journal.pone.0211676 ↗
16. Effect of Spacer Diameter of the Dynesys Dynamic Stabilization System on the Biomechanics of the Lumbar Spine10.1097/BSD.0b013e31824e5e10 ↗
17. Shih, S.-L., Liu, C.-L., Huang, L.-Y., Huang, C.-H., and Chen, C.-S. (2013). Effects of cord pretension and stiffness of the Dynesys system spacer on the biomechanics of spinal decompression- a finite element study. BMC Musculoskelet. Disord., 14.10.1186/1471-2474-14-191 ↗
18. Comparison of eight published static finite element models of the intact lumbar spine: Predictive power of models improves when combined together10.1016/j.jbiomech.2014.04.002 ↗
19. Jamari, J., Saputra, E., Anwar, I.B., and Van Der Heide, E. (2019). Study of an Additional Layer of Cement Mantle Hip Joints for Reducing Cracks. J. Funct. Biomater., 10.10.3390/jfb10030040 ↗
20. Biomechanical evaluation of a novel pedicle screw-based interspinous spacer: A finite element analysis10.1016/j.medengphy.2017.05.004 ↗
21. Hybrid multidirectional test method to evaluate spinal adjacent-level effects10.1016/j.clinbiomech.2006.08.006 ↗
22. Failure analysis of broken pedicle screws on spinal instrumentation10.1016/j.medengphy.2004.12.007 ↗
23. Reinforcement of thoracolumbar burst fractures with calcium phosphate cement: A biomechanical study10.1097/00007632-199803150-00004 ↗
24. Effect of augmentation techniques on the failure of pedicle screws under cranio-caudal cyclic loading10.1007/s00586-015-3904-3 ↗
25. The biomechanical effect of pedicle screw hubbing on pullout resistance in the thoracic spine10.1016/j.spinee.2012.03.020 ↗
26. Stress analysis of the disc adjacent to interbody fusion in lumbar spine10.1016/S1350-4533(01)00076-5 ↗
27. Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions10.1097/00007632-199604150-00013 ↗
28. Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature10.1097/01.brs.0000137069.88904.03 ↗
29. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis10.1016/j.clinbiomech.2017.02.011 ↗
30. Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: A three-dimensional finite element analysis10.1186/s13018-018-0733-1 ↗
31. Does Bone Cement In Percutaneous Vertebroplasty Act as a Stress Riser?10.1097/01.brs.0000435029.88434.97 ↗
32. Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality10.1016/j.spinee.2017.04.029 ↗
33. Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement