Finite Element Analysis of Long Posterior Transpedicular Instrumentation for Cervicothoracic Fractures Related to Ankylosing Spondylitis

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2018 Sep 12

PMID 30202710

Citations 6

Authors

Yohan Robinson

Viktor Lison Almkvist

Claes Olerud

Peter Halldin

Madelen Fahlstedt

Affiliations

Soon will be listed here.

Abstract

Study Design: Biomechanical finite element model analysis.

Objectives: Spinal fractures related to ankylosing spondylitis (AS) are often treated by long posterior stabilization. The objective of this study is to develop a finite element model (FEM) for spinal fractures related to AS and to establish a biomechanical foundation for long posterior stabilization of cervicothoracic fractures related to AS.

Methods: An existing FEM (consisting of 2 separately developed models) including the cervical and thoracic spine were adapted to the conditions of AS (all discs fused, C0-C1 and C1-C2 mobile). A fracture at the level C6-C7 was simulated. Besides a normal spine (no AS, no fracture) and the uninstrumented fractured spine 4 different posterior transpedicular instrumentations were tested. Three loads (1.5, 3.0, 4.5) were applied according to a specific load curve.

Results: All posterior stabilization methods could normalize the axial stability at the fracture site as measured with gap distance. The maximum stress at the cranial instrumentation end (C3-C4) was slightly greater if every level was instrumented, than in the skipped level model. The skipped level instrumentation achieved similar rotatory stability as the long multilevel instrumentation.

Conclusions: Skipping instrumentation levels without giving up instrumentation length reduced stresses in the ossified tissue within the range of the instrumentation and did not decrease the stability in a FEM of a cervicothoracic fracture related to AS. Considering the risks associated with every additional screw placed, the skipped level instrumentation has advantages regarding patient safety.

Citing Articles

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Application of vertebral body compression osteotomy in pedicle subtraction osteotomy on ankylosing spondylitis kyphosis: Finite element analysis and retrospective study.

Yang C, Zeng Z, Yan H, Wu J, Lv X, Zhang D Front Endocrinol (Lausanne). 2023; 14:1131880.

PMID: 37033224 PMC: 10076869. DOI: 10.3389/fendo.2023.1131880.

Biomechanical Evaluation of the Transcortical and Transpedicular Trajectories for Pedicle Screw Insertion in Thoracolumbar Fracture Fixation for Ankylosing Spondylitis.

Tong Z, Xiao B, Yan K, Xing Y, Zhang Y Front Surg. 2021; 8:706597.

PMID: 34568415 PMC: 8456994. DOI: 10.3389/fsurg.2021.706597.

Different fixation pattern for thoracolumbar fracture of ankylosing spondylitis: A finite element analysis.

Zhang T, Wang Y, Zhang P, Xue F, Zhang D, Jiang B PLoS One. 2021; 16(4):e0250009.

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A Contemporary View of the Diagnosis of Osteoporosis in Patients With Axial Spondyloarthritis.

Lim M, Kang K Front Med (Lausanne). 2020; 7:569449.

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