Finite Element Study on Three Osteotomy Methods for Treating Thoracolumbar Osteoporotic Fracture Vertebral Collapse Complicated with Neurological Dysfunction

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2024 Feb 16

PMID 38363921

Authors

Zhisheng Long

Jingyu Zhou

Long Xiong

Gang Chen

Jiabin Wen

Affiliations

Soon will be listed here.

Abstract

Background: Surgical methods for patients with osteoporotic fracture vertebral collapse complicated with neurological dysfunction are still a topic of debate. We designed an improved osteotomy for the treatment of osteoporotic compression fracture patients with neurological dysfunction. Compared with traditional osteotomy methods such as pedicle subtraction osteotomy (PSO) and bone-disc-bone osteotomy (BDBO), the osteotomy range is reduced. Therefore, we use a finite element method to analyze the biomechanical conditions of these three osteotomy methods and provide a mechanical theoretical basis for the surgical treatment of these three osteotomy methods.

Methods: Based on the CT scan of a patient with L1 osteoporotic fracture vertebral collapse and neurological dysfunction, the finite element model was constructed by importing Mimics software, and three different osteotomy models were established. The forces and displacements of internal fixation device, T1-L5 whole segment, T10 vertebral body, and T10/11 intervertebral disc were recorded under different working conditions.

Results: The displacement levels of internal fixation device, T1-L5 spine, T10 vertebral body, and T10/11 intervertebral disc in the modified osteotomy group were between BDBO group and PSO group. The stress in BDBO group was concentrated in titanium mesh and its maximum stress was much higher than that in PSO group and modified osteotomy group. The mechanical distribution of T10/11 intervertebral disc showed that the maximum stress distribution of the three osteotomy methods was similar.

Conclusion: The relatively simple modified osteotomy has certain advantages in stress and displacement. In contrast, the stability of BDBO group was poor, especially in the lumbar intervertebral disc and lumbar body. For this type of osteotomy patients, it is recommended to avoid postoperative flexion so as not to increase the load.

References

Schulze M, Gehweiler D, Riesenbeck O, Wahnert D, Raschke M, Hartensuer R . Biomechanical characteristics of pedicle screws in osteoporotic vertebrae-comparing a new cadaver corpectomy model and pure pull-out testing. J Orthop Res. 2016; 35(1):167-174. DOI: 10.1002/jor.23237. View

Zhang X, Liu X, Yan Z, Cai J, Kang F, Shan S . Spatiotemporal characterization of microdamage accumulation in rat ulnae in response to uniaxial compressive fatigue loading. Bone. 2018; 108:156-164. DOI: 10.1016/j.bone.2018.01.011. View

Wang D, Li Y, Yin H, Li J, Qu J, Jiang M . [Three dimensional finite element analysis of optimal distribution model of fillers in vertebroplasty]. Zhongguo Gu Shang. 2021; 34(1):26-33. DOI: 10.12200/j.issn.1003-0034.2021.01.006. View

Fan H, Zhang R, Shen C, Dong F, Li Y, Song P . The Biomechanical Properties of Pedicle Screw Fixation Combined With Trajectory Bone Cement Augmentation in Osteoporotic Vertebrae. Clin Spine Surg. 2016; 29(2):78-85. DOI: 10.1097/BSD.0b013e3182a14870. View

Li Y, Feng X, Pan J, Yang M, Li L, Su Q . Percutaneous Vertebroplasty Versus Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures in Patients with Distant Lumbosacral Pain. Pain Physician. 2021; 24(3):E349-E356. View

Yan J, Liao Z, Yu Y . Finite element analysis of dynamic changes in spinal mechanics of osteoporotic lumbar fracture. Eur J Med Res. 2022; 27(1):142. PMC: 9356497. DOI: 10.1186/s40001-022-00769-x. View

Lee J, Song K . Transpedicular Intravertebral Cage Augmentation in a Patient with Neurologic Deficits After Severely Collapsed Kummel Disease: Minimum 2-Year Follow-Up. World Neurosurg. 2019; 135:146-155. DOI: 10.1016/j.wneu.2019.11.131. View

Song K, Zheng G, Zhang Y, Zhang X, Mao K, Wang Y . A new method for calculating the exact angle required for spinal osteotomy. Spine (Phila Pa 1976). 2013; 38(10):E616-20. DOI: 10.1097/BRS.0b013e31828b3299. View

Lu H, Zhang Q, Ding F, Wu Q, Liu R . Finite Element Analysis of Unilateral versus Bipedicular Bone-Filling Mesh Container for the Management of Osteoporotic Compression Fractures. Biomed Res Int. 2022; 2022:6850089. PMC: 8894004. DOI: 10.1155/2022/6850089. View

10.

Chang K, Tu M, Huang H, Chen H, Chen Y, Lin C . Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2006; 31(13):E408-13. DOI: 10.1097/01.brs.0000219870.31561.c2. View

11.

Buell T, Bess S, Xu M, Schwab F, Lafage V, Ames C . Optimal tether configurations and preload tensioning to prevent proximal junctional kyphosis: a finite element analysis. J Neurosurg Spine. 2019; 30(5):574-584. DOI: 10.3171/2018.10.SPINE18429. View

12.

Liu D, Zhang B, Xie Q, Kang X, Zhou J, Wang C . Biomechanical comparison of pedicle screw augmented with different volumes of polymethylmethacrylate in osteoporotic and severely osteoporotic cadaveric lumbar vertebrae: an experimental study. Spine J. 2016; 16(9):1124-32. DOI: 10.1016/j.spinee.2016.04.015. View

13.

Pan A, Ding H, Wang J, Zhang Z, Zhang H, Liu Y . The application of finite element analysis to determine the optimal UIV of growing-rod treatment in early-onset scoliosis. Front Bioeng Biotechnol. 2022; 10:978554. PMC: 9478657. DOI: 10.3389/fbioe.2022.978554. View

14.

Plais N, Mengis C, Gallego Bustos J, Tome-Bermejo F, Peiro-Garcia A, Buitrago A . Simplified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Fractures. Int J Spine Surg. 2021; 15(5):1004-1013. PMC: 8651195. DOI: 10.14444/8129. View

15.

Cianfoni A, Delfanti R, Isalberti M, Scarone P, Koetsier E, Bonaldi G . Minimally Invasive Stent Screw-Assisted Internal Fixation Technique Corrects Kyphosis in Osteoporotic Vertebral Fractures with Severe Collapse: A Pilot "Vertebra Plana" Series. AJNR Am J Neuroradiol. 2022; 43(5):776-783. PMC: 9089263. DOI: 10.3174/ajnr.A7493. View

16.

Peng Y, Du X, Huang L, Li J, Zhan R, Wang W . Optimizing bone cement stiffness for vertebroplasty through biomechanical effects analysis based on patient-specific three-dimensional finite element modeling. Med Biol Eng Comput. 2018; 56(11):2137-2150. DOI: 10.1007/s11517-018-1844-x. View

17.

Guy A, Coulombe M, Labelle H, Rigo M, Wong M, Beygi B . Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis: A Comprehensive Multicenter Study. Spine (Phila Pa 1976). 2022; 47(15):1103-1110. DOI: 10.1097/BRS.0000000000004353. View

18.

Zhu Q, Kingwell S, Li Z, Pan H, Lu W, Oxland T . Enhancing pedicle screw fixation in the aging spine with a novel bioactive bone cement: an in vitro biomechanical study. Spine (Phila Pa 1976). 2012; 37(17):E1030-7. DOI: 10.1097/BRS.0b013e31825a676e. View

19.

Zhang W, Zhao J, Li L, Yu C, Zhao Y, Si H . Modelling tri-cortical pedicle screw fixation in thoracic vertebrae under osteoporotic condition: A finite element analysis based on computed tomography. Comput Methods Programs Biomed. 2019; 187:105035. DOI: 10.1016/j.cmpb.2019.105035. View

20.

Clynes M, Harvey N, Curtis E, Fuggle N, Dennison E, Cooper C . The epidemiology of osteoporosis. Br Med Bull. 2020; 133(1):105-117. PMC: 7115830. DOI: 10.1093/bmb/ldaa005. View