Numerical Analysis of Multi-level Versus Short Instrumentation for the Treatment of Thoracolumbar Fractures

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2015 Mar 4

PMID 25733345

Citations 1

Authors

Andre Rafael Hubner

Daniel Gasparin

Agenor Dias de Meira Junior

Charles Leonardo Israel

Jean Marcel Dambros

Marcelo Ribeiro

Leandro de Freitas Spinelli

Affiliations

Soon will be listed here.

Abstract

Purpose: The research analyses the strength of metallic implants in posterior spinal instrumentation for the treatment of thoracolumbar fractures, considering extended and short fixation techniques on the immediate post-surgical load. Considering that short fixation may bring the advantage of a less invasive surgical procedure to the patient and may also result in lower costs, this evaluation becomes necessary.

Methods: Three-dimensional modelling of the thoracolumbar spine was initially performed. CT images were captured and converted for analysis with the ANSYS program. Both treatment techniques were analysed for stresses, and strains generated in the immediate postoperative period, when the fracture is still not healed.

Results: The maximum stress obtained for long fixation by the theory of Von Mises was 230 MPa, and it was located in the rod area next to the L2 vertebra. The maximum stress obtained for short fixation was 274.24 MPa, and it was located in the pedicle screw on the T12 vertebra.

Conclusions: There were no significant differences between the two techniques, since the observed stresses are well below the flow stress of the material, ensuring good safety factor (ranging from 3.5 to 4.1).

Citing Articles

Spinal Reconstruction Techniques for Traumatic Spinal Injuries: A Systematic Review of Biomechanical Studies.

Joaquim A, Maslak J, Patel A Global Spine J. 2019; 9(3):338-347.

PMID: 31192103 PMC: 6542174. DOI: 10.1177/2192568218767117.

References

Jansson K, Blomqvist P, Svedmark P, Granath F, Buskens E, Larsson M . Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital. Eur J Epidemiol. 2010; 25(6):431-7. PMC: 2896644. DOI: 10.1007/s10654-010-9461-5. View

Wang H, Li C, Liu T, Zhao W, Zhou Y . Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study. Indian J Orthop. 2012; 46(4):395-401. PMC: 3421928. DOI: 10.4103/0019-5413.98827. View

Gong Z, Chen Z, Feng Z, Cao Y, Jiang C, Jiang X . Finite element analysis of 3 posterior fixation techniques in the lumbar spine. Orthopedics. 2014; 37(5):e441-8. DOI: 10.3928/01477447-20140430-54. View

Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B . Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007; 32(14):1503-7. DOI: 10.1097/BRS.0b013e318067dd24. View

Robertson A, Branfoot T, Barlow I, Giannoudis P . Spinal injury patterns resulting from car and motorcycle accidents. Spine (Phila Pa 1976). 2002; 27(24):2825-30. DOI: 10.1097/00007632-200212150-00019. View

Xu G, Fu X, Du C, Ma J, Li Z, Tian P . Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: a finite element analysis. Proc Inst Mech Eng H. 2014; 228(10):1005-13. DOI: 10.1177/0954411914552308. View

Li C, Zhou Y, Wang H, Liu J, Xiang L . Treatment of unstable thoracolumbar fractures through short segment pedicle screw fixation techniques using pedicle fixation at the level of the fracture: a finite element analysis. PLoS One. 2014; 9(6):e99156. PMC: 4051693. DOI: 10.1371/journal.pone.0099156. View

Li Q, Li X, Liu Y, Zhang H, Shang P, Chu Z . Treatment of thoracolumbar fracture with pedicle screws at injury level: a biomechanical study based on three-dimensional finite element analysis. Eur J Orthop Surg Traumatol. 2013; 23(7):775-80. DOI: 10.1007/s00590-012-1076-y. View

Ouellet J, Richards C, Sardar Z, Giannitsios D, Noiseux N, Strydom W . Finite Element Analysis and Biomechanical Comparison of Short Posterior Spinal Instrumentation with Divergent Bridge Construct versus Parallel Tension Band Construct for Thoracolumbar Spine Fractures. Global Spine J. 2014; 3(2):85-94. PMC: 3854578. DOI: 10.1055/s-0033-1343073. View

10.

Park W, Park Y, Kim K, Kim Y . Biomechanical comparison of instrumentation techniques in treatment of thoracolumbar burst fractures: a finite element analysis. J Orthop Sci. 2009; 14(4):443-9. DOI: 10.1007/s00776-009-1341-z. View

11.

Alizadeh M, Rafiq Abdul Kadir M, Fadhli M, Fallahiarezoodar A, Azmi B, Raman Murali M . The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis. J Orthop Res. 2013; 31(9):1447-54. DOI: 10.1002/jor.22376. View

12.

Anekstein Y, Brosh T, Mirovsky Y . Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures: a biomechanical study. J Spinal Disord Tech. 2007; 20(1):72-7. DOI: 10.1097/01.bsd.0000211240.98963.f6. View

13.

Levine A, Edwards C . Low lumbar burst fractures. Reduction and stabilization using the modular spine fixation system. Orthopedics. 1988; 11(10):1427-32. DOI: 10.3928/0147-7447-19881001-11. View

14.

Tang S, Rebholz B . Does anterior lumbar interbody fusion promote adjacent degeneration in degenerative disc disease? A finite element study. J Orthop Sci. 2011; 16(2):221-8. DOI: 10.1007/s00776-011-0037-3. View

15.

Kannus P, Niemi S, Palvanen M, Parkkari J . Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons. Arch Intern Med. 2000; 160(14):2145-9. DOI: 10.1001/archinte.160.14.2145. View

16.

Kanis J, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A . Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int. 2000; 11(8):669-74. DOI: 10.1007/s001980070064. View

17.

Denis F, Armstrong G, Searls K, Matta L . Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res. 1984; (189):142-9. View

18.

Baaj A, Reyes P, Yaqoobi A, Uribe J, Vale F, Theodore N . Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures. J Neurosurg Spine. 2011; 14(2):192-7. DOI: 10.3171/2010.10.SPINE10222. View