Biomechanical Evaluation of Spinal Column After Percutaneous Cement Discoplasty: A Finite Element Analysis

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2022 Jul 12

PMID 35818350

Authors

Shuang Li

Baoshan Xu

Yancheng Liu

Jingyu Zhang

Guijun Xu

Pengfei Shao

Xiaoye Li

Yongcheng Hu

Xinlong Ma

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the biomechanical properties of percutaneous cement discoplasty (PCD) in the spinal column between different implant-endplate friction.

Methods: A validated L3-Scarumfinite element (FE) model was modified for simulation. In the PCD model, the L4/5 level was modified based on model 1 (M1) and model 2 (M2). In M1, the interaction between bone cement and endplate was defined as face-to-face contact with a friction coefficient of 0.3; in M2, the contact was defined as a Tie constraint. 7.5 N m moments of four physiological motions and axial load of 15, 100 and 400 N preload were imposed at the top of L3. The range of motion (ROM) and interface stress analysis of endplates, annulus fibrosus and bone cement of the operated level were calculated for comparisons among the three models.

Results: The ROM of M1 and M2 increased when compared with the intact model during flexion (FL) (17.5% vs 10.0%), extension (EX) (8.8% vs -8.8%), left bending (LB) (19.0% vs -17.2%) and left axial rotation (LR) (34.6% vs -3.8%). The stress of annulus fibrosus in M1 and M2 decreased in FL (-48.4% vs -57.5%), EX (-25.7% vs -14.7%), LB (-47.5% vs -52.4%), LR (-61.4% vs -68.7%) and axis loading of 100 N (-41.5% vs -15.3%), and 400 N (-27.9% vs -27.3%). The stress of upper endplate of M1 and M2 increased in FL (24.6% vs 24.7%), LB (82.2% vs 89.5%), LR (119% vs 62.4%) and axis loading of 100 N (64.6% vs 45.5%), and 400 N (58.2% vs 24.3%), but was similar in EX (2.9% vs 0.3%). The stress of lower endplate of M1 and M2 increased in FL (170.9% vs 175.0%), EX (180.8% vs 207.7%), LB (302.6% vs 274.7%), LR (332.4% vs 132.8%) and axis loading of 100 N (350.7% vs 168.6%), and 400 N (165.2% vs 106.7%).

Conclusion: Percutaneous cement discoplasty procedure could make effect on the mobility or stiffness. The fusion of bone cement and endplate might have more biomechanical advantages, including of the decreasing rate of implant subsidence and dislocation, and the increase spine stability.

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References

Kiss L, Varga P, Szoverfi Z, Jakab G, Eltes P, Lazary A . Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty. Eur Spine J. 2019; 28(6):1441-1447. DOI: 10.1007/s00586-019-05966-7. View

Janssen D, Mann K, Verdonschot N . Finite element simulation of cement-bone interface micromechanics: a comparison to experimental results. J Orthop Res. 2009; 27(10):1312-8. PMC: 2802538. DOI: 10.1002/jor.20882. View

Zhang Z, Fogel G, Liao Z, Sun Y, Liu W . Biomechanical analysis of lumbar interbody fusion cages with various lordotic angles: a finite element study. Comput Methods Biomech Biomed Engin. 2018; 21(3):247-254. DOI: 10.1080/10255842.2018.1442443. View

Tschugg A, Kavakebi P, Hartmann S, Lener S, Wipplinger C, Loscher W . Clinical and radiological effect of medialized cortical bone trajectory for lumbar pedicle screw fixation in patients with degenerative lumbar spondylolisthesis: study protocol for a randomized controlled trial (mPACT). Trials. 2018; 19(1):129. PMC: 5819638. DOI: 10.1186/s13063-018-2504-z. View

Denoziere G, Ku D . Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc. J Biomech. 2006; 39(4):766-75. DOI: 10.1016/j.jbiomech.2004.07.039. View

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

Grant J, Oxland T, Dvorak M . Mapping the structural properties of the lumbosacral vertebral endplates. Spine (Phila Pa 1976). 2001; 26(8):889-96. DOI: 10.1097/00007632-200104150-00012. View

Hayakawa K, Kurano M, Ohya J, Oichi T, Kano K, Nishikawa M . Lysophosphatidic acids and their substrate lysophospholipids in cerebrospinal fluid as objective biomarkers for evaluating the severity of lumbar spinal stenosis. Sci Rep. 2019; 9(1):9144. PMC: 6591408. DOI: 10.1038/s41598-019-45742-7. View

Wang L, Malone K, Huang H, Zhang Z, Zhang Z, Zhang L . Biomechanical Evaluation of a Novel Autogenous Bone Interbody Fusion Cage for Posterior Lumbar Interbody Fusion in a Cadaveric Model. Spine (Phila Pa 1976). 2014; 39(11):E684-E692. DOI: 10.1097/BRS.0000000000000291. View

10.

Lin B, Yu H, Chen Z, Huang Z, Zhang W . Comparison of the PEEK cage and an autologous cage made from the lumbar spinous process and laminae in posterior lumbar interbody fusion. BMC Musculoskelet Disord. 2016; 17(1):374. PMC: 5004315. DOI: 10.1186/s12891-016-1237-y. View

11.

Polikeit A, Ferguson S, Nolte L, Orr T . Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis. Eur Spine J. 2003; 12(4):413-20. PMC: 3467788. DOI: 10.1007/s00586-002-0505-8. View

12.

Wang H, Lv B . Comparison of Clinical and Radiographic Results Between Posterior Pedicle-Based Dynamic Stabilization and Posterior Lumbar Intervertebral Fusion for Lumbar Degenerative Disease: A 2-Year Retrospective Study. World Neurosurg. 2018; 114:e403-e411. DOI: 10.1016/j.wneu.2018.02.192. View

13.

Zhang Z, Zhao L, Qu D, Jin D . Artificial nucleus replacement: surgical and clinical experience. Orthop Surg. 2011; 1(1):52-7. PMC: 6734642. DOI: 10.1111/j.1757-7861.2008.00010.x. View

14.

Varga P, Jakab G, Bors I, Lazary A, Szoverfi Z . Experiences with PMMA cement as a stand-alone intervertebral spacer: Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. Orthopade. 2015; 44 Suppl 1:S1-7. DOI: 10.1007/s00132-014-3060-1. View

15.

Jenis L, Banco R, Kwon B . A prospective study of Autologous Growth Factors (AGF) in lumbar interbody fusion. Spine J. 2006; 6(1):14-20. DOI: 10.1016/j.spinee.2005.08.014. View

16.

Zhu H, Zhong W, Zhang P, Liu X, Huang J, Liu F . Biomechanical evaluation of autologous bone-cage in posterior lumbar interbody fusion: a finite element analysis. BMC Musculoskelet Disord. 2020; 21(1):379. PMC: 7293772. DOI: 10.1186/s12891-020-03411-1. View

17.

Ottardi C, La Barbera L, Pietrogrande L, Villa T . Vertebroplasty and kyphoplasty for the treatment of thoracic fractures in osteoporotic patients: a finite element comparative analysis. J Appl Biomater Funct Mater. 2016; 14(2):e197-204. DOI: 10.5301/jabfm.5000287. View

18.

Ekstrom L, Zhang Q, Abrahamson J, Beck J, Johansson C, Westin O . A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients. J Orthop Surg Res. 2020; 15(1):155. PMC: 7165389. DOI: 10.1186/s13018-020-01652-3. View

19.

Panjabi M, Brand Jr R, White 3rd A . Mechanical properties of the human thoracic spine as shown by three-dimensional load-displacement curves. J Bone Joint Surg Am. 1976; 58(5):642-52. View

20.

Zhang Z, Li H, Fogel G, Liao Z, Li Y, Liu W . Biomechanical Analysis of Porous Additive Manufactured Cages for Lateral Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurg. 2017; 111:e581-e591. DOI: 10.1016/j.wneu.2017.12.127. View