Investigation into the Biomechanics of Lumbar Spine Micro-dynamic Pedicle Screw

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2018 Jul 20

PMID 30021549

Citations 8

Authors

Chuang Liu

Allieu Kamara

Yunhui Yan

Affiliations

Soon will be listed here.

Abstract

Background: Numerous reports have shown that rigid spinal fixation contributes to a series of unwanted complications in lumbar fusion procedure. This innovative micro-dynamic pedicle screw study was designed to investigate the biomechanical performance of lumbar implants using numerical simulation technique and biomechanical experiment.

Methods: Instrumented finite element models of three configurations (dynamic fixation, rigid fixation and hybrid fixation) using a functional L3-L4 lumbar unit were developed, to compare the range of motion of the lumbar spine and stress values on the endplate and implants. An in vitro experiment was simultaneously conducted using 18 intact porcine lumbar spines and segmental motion analyses were performed as well.

Results: Simulation results indicated that the dynamic fixation and the hybrid fixation models respectively increased the range of motion of the lumbar spine by 95 and 60% in flexion and by 83 and 55% in extension, compared with the rigid fixation model. The use of micro-dynamic pedicle screw led to higher stress on endplates and lower stress on pedicle screws. The outcome of the in vitro experiment demonstrated that the micro-dynamic pedicle screw could provide better range of motion at the instrumented segments than a rigid fixation.

Conclusion: The micro-dynamic pedicle screw has the advantage of providing better range of motion than conventional pedicle screw in flexion-extension, without compromising stabilization, and has the potential of bringing the load transfer behavior of fusional segment closer to normal and also lowers the stress values of pedicle screws.

Citing Articles

Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases?.

Ozer A, Akgun M, Ucar E, Hekimoglu M, Basak A, Gunerbuyuk C Int J Spine Surg. 2024; 18(2):152-163.

PMID: 38561203 PMC: 11287803. DOI: 10.14444/8588.

Perpendicular probing and screwing technique: A simple method for accurate pedicle screw placement based on the human internal reference frame for angle estimation.

Kato G, Baba S, Kawaguchi K, Watanabe T, Mae T, Tomari S PLoS One. 2022; 17(11):e0277229.

PMID: 36441680 PMC: 9704603. DOI: 10.1371/journal.pone.0277229.

The influence of pelvic tilt on stress distribution in the acetabulum: finite element analysis.

Hasegawa K, Kabata T, Kajino Y, Inoue D, Sakamoto J, Tsuchiya H BMC Musculoskelet Disord. 2021; 22(1):764.

PMID: 34488684 PMC: 8422778. DOI: 10.1186/s12891-021-04500-5.

Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis.

Kweh B, Tan T, Lee H, Hunn M, Liew S, Tee J Global Spine J. 2021; 12(4):700-718.

PMID: 33926307 PMC: 9109574. DOI: 10.1177/21925682211005411.

Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy.

Baba S, Kawaguchi K, Itamoto K, Watanabe T, Hayashida M, Mae T PLoS One. 2020; 15(11):e0242512.

PMID: 33196657 PMC: 7668595. DOI: 10.1371/journal.pone.0242512.

References

Ito M, Fay L, Ito Y, Yuan M, Edwards W, Yuan H . The effect of pulsed electromagnetic fields on instrumented posterolateral spinal fusion and device-related stress shielding. Spine (Phila Pa 1976). 1997; 22(4):382-8. DOI: 10.1097/00007632-199702150-00005. View

Wilke H, Geppert J, Kienle A . Biomechanical in vitro evaluation of the complete porcine spine in comparison with data of the human spine. Eur Spine J. 2011; 20(11):1859-68. PMC: 3207338. DOI: 10.1007/s00586-011-1822-6. View

Bono C, Lee C . Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine (Phila Pa 1976). 2004; 29(4):455-63. DOI: 10.1097/01.brs.0000090825.94611.28. View

Ahn Y, Chen W, Lee K, Park K, Lee S . Comparison of the load-sharing characteristics between pedicle-based dynamic and rigid rod devices. Biomed Mater. 2008; 3(4):044101. DOI: 10.1088/1748-6041/3/4/044101. View

Kim H, Lim D, Oh H, Lee K, Lee S . Effects of nonlinearity in the materials used for the semi-rigid pedicle screw systems on biomechanical behaviors of the lumbar spine after surgery. Biomed Mater. 2011; 6(5):055005. DOI: 10.1088/1748-6041/6/5/055005. View

Huang R, Girardi F, Lim M, Cammisa Jr F . Advantages and disadvantages of nonfusion technology in spine surgery. Orthop Clin North Am. 2005; 36(3):263-9. DOI: 10.1016/j.ocl.2005.02.006. View

Huang R, Wright T, Panjabi M, Lipman J . Biomechanics of nonfusion implants. Orthop Clin North Am. 2005; 36(3):271-80. DOI: 10.1016/j.ocl.2005.02.010. View

Cripton P, Jain G, Wittenberg R, Nolte L . Load-sharing characteristics of stabilized lumbar spine segments. Spine (Phila Pa 1976). 2000; 25(2):170-9. DOI: 10.1097/00007632-200001150-00006. View

Cakir B, Schmidt R, Mattes T, Fraitzl C, Reichel H, Kafer W . Index level mobility after total lumbar disc replacement: is it beneficial or detrimental?. Spine (Phila Pa 1976). 2009; 34(9):917-23. DOI: 10.1097/BRS.0b013e31819b213c. View

10.

Scifert J, Sairyo K, Goel V, Grobler L, Grosland N, Spratt K . Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model. Spine (Phila Pa 1976). 1999; 24(21):2206-13. DOI: 10.1097/00007632-199911010-00006. View

11.

Sangiorgio S, Sheikh H, Borkowski S, Khoo L, Warren C, Ebramzadeh E . Comparison of three posterior dynamic stabilization devices. Spine (Phila Pa 1976). 2011; 36(19):E1251-8. DOI: 10.1097/BRS.0b013e318206cd84. View

12.

Schmoelz W, Onder U, Martin A, von Strempel A . Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment. Eur Spine J. 2009; 18(10):1478-85. PMC: 2899377. DOI: 10.1007/s00586-009-1052-3. View

13.

Ruberte L, Natarajan R, Andersson G . Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments--a finite element model study. J Biomech. 2009; 42(3):341-8. DOI: 10.1016/j.jbiomech.2008.11.024. View

14.

Sengupta D . Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am. 2004; 35(1):43-56. DOI: 10.1016/S0030-5898(03)00087-7. View

15.

Vadapalli S, Sairyo K, Goel V, Robon M, Biyani A, Khandha A . Biomechanical rationale for using polyetheretherketone (PEEK) spacers for lumbar interbody fusion-A finite element study. Spine (Phila Pa 1976). 2006; 31(26):E992-8. DOI: 10.1097/01.brs.0000250177.84168.ba. View

16.

Oda I, Cunningham B, Lee G, Abumi K, Kaneda K, McAfee P . Biomechanical properties of anterior thoracolumbar multisegmental fixation: an analysis of construct stiffness and screw-rod strain. Spine (Phila Pa 1976). 2000; 25(18):2303-11. DOI: 10.1097/00007632-200009150-00007. View

17.

Fogel G, Reitman C, Liu W, Esses S . Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure. Spine (Phila Pa 1976). 2003; 28(5):470-3. DOI: 10.1097/01.BRS.0000048652.45964.2E. View

18.

Yamamoto I, Panjabi M, Crisco T, Oxland T . Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine (Phila Pa 1976). 1989; 14(11):1256-60. DOI: 10.1097/00007632-198911000-00020. View

19.

Park P, Garton H, Gala V, Hoff J, McGillicuddy J . Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004; 29(17):1938-44. DOI: 10.1097/01.brs.0000137069.88904.03. View

20.

Goto K, Tajima N, Chosa E, Totoribe K, Kuroki H, Arizumi Y . Mechanical analysis of the lumbar vertebrae in a three-dimensional finite element method model in which intradiscal pressure in the nucleus pulposus was used to establish the model. J Orthop Sci. 2002; 7(2):243-6. DOI: 10.1007/s007760200040. View