scholarly journals Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ye Han ◽  
Xiaodong Wang ◽  
Jincheng Wu ◽  
Hanpeng Xu ◽  
Zepei Zhang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Vertebral Column ◽  
Vertebral Compression Fractures ◽  
Lateral Bending ◽  
Short Segment ◽  
Vertebral Column Resection ◽  
Compression Fractures ◽  
Short Segment Fixation ◽  
Vertebral Resection

Abstract Background Regarding the repair of vertebral compression fractures, there is a lack of adequate biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs affect spinal biomechanics; there also remains debate as to the appropriate length of fixation. Methods A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery. Results Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 mPa in a lateral bending motion and minimum stress of 40.22 mPa in a lateral bending motion in the SVCR. Conclusion There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was most significant at the screw-rod junction and greatest at the ribcage–vertebral body interface, partly explaining the high probability of internal fixation failure and prosthesis migration in these two positions.

scholarly journals Treatment of Old Vertebral Compression Fracture With Kyphosis by Different Reconstruction Methods: a Finite Element Analysis

2020 ◽  
Author(s):  
Han Ye ◽  
Wang Xiaodong ◽  
Wu Jincheng ◽  
Xu Hanpeng ◽  
Zhang Zepei ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Lateral Bending ◽  
Short Segment ◽  
Compression Fractures ◽  
Reconstruction Methods ◽  
Short Segment Fixation ◽  
Vertebral Resection

Abstract Background: In repair of vertebral compression fractures, there is a lack of effective biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs has any effect on spinal biomechanics; there also remains debate as to the appropriate length of fixation.Methods: A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery.Results: Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 MPa in a lateral bending motion, and a minimum stress of 40.22 MPa in a lateral bending motion in the SVCR.Conclusion: There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was greatest at the screw-rod junction and greatest at the ribcage–vertebral body interface, which partly explains the high probability of internal fixation failure and prosthesis migration in these two positions.

scholarly journals Finite Element Analysis of Stability of Internal Fixation Reconstruction Methods for Lumbar Total Vertebral Resection

2020 ◽  
Author(s):  
Shengcheng Wan ◽  
Zhaoyi Wu ◽  
Yuanwu Cao ◽  
Xiaoxing Jiang ◽  
Zixian Chen ◽  
...  
Keyword(s):  
Finite Element ◽  
Lumbar Spine ◽  
Internal Fixation ◽  
Vertebral Body ◽  
Spinal Stability ◽  
Lateral Bending ◽  
Short Segment ◽  
Short Segment Fixation ◽  
Anterior Support ◽  
Artificial Vertebral Body

Abstract Objective To compare the effect of different fixation methods on spinal stability after total en bloc spondylectomy(TES) of lumbar spine.Method The finite element models were established based on the CT scan of a healthy volunteer. After the validity of the models was confirmed, the models with different posterior fixation methods of the lumbar spine were established with and without the artificial vertebral body, respectively. The motions of flexion, extension, lateral bending and rotation under supine and standing conditions were simulated. The angular displacement of T11-L3 and stress of internal fixations were compared and analyzed.Results The finite element models of spinal reconstruction after TES were obtained. When the anterior support existed, the movement of the spine after TES was not affected by the gravity of the upper body. The movements in the opposite direction on the same plane were similar. All three methods provided enough stability to the spine. The improved short-segment fixation shared stress of the artificial vertebral body with no obvious negative effect. The long-segment fixation had stronger fixation effect with the huge loss of the range of motion of lumbar spine. When the anterior support failed, obvious rotation showed in lateral bending in all models. The short-segment fixation and the long-segment fixation failed to maintain the spinal stability with fixations breakage or functional loss. The improved short-segment fixations showed strong ability in maintaining the spinal stability. The vertebral body screws can prevent the failure of anterior fixation by sharing great stress of the whole internal fixation system. The improved short-segment had huge advantages over the others.Conclusion After TES, the improved short-segment fixation can provide more stability to the spine. The vertebral body screws can prevent the failure of the internal fixation by reducing the stress of the anterior support. This fixation method should be promoted in clinical practice while the effect requires more observation.

Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures

2015 ◽  
Vol 8 (7) ◽  
pp. 756-763 ◽  
Author(s):  
Avery J Evans ◽  
Kevin E Kip ◽  
Waleed Brinjikji ◽  
Kennith F Layton ◽  
Mary L Jensen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Vertebral Body ◽  
Controlled Trial ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Time Points ◽  
Randomized Controlled ◽  
Primary Endpoints ◽  
Average Pain ◽  
Registration Number

BackgroundWe present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures.MethodsPatients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0–10 scale) and disability assessed using the Roland–Morris Disability Questionnaire (RMDQ). Outcomes were assessed at 3 days, 1 month, 6 months, and 1 year following the procedure.Results115 subjects were enrolled in the trial with 59 (51.3%) randomly assigned to kyphoplasty and 56 (48.7%) assigned to vertebroplasty. Mean (SD) pain scores at baseline, 3 days, 30 days, and 1 year for kyphoplasty versus vertebroplasty were 7.4 (1.9) vs 7.9 (2.0), 4.1 (2.8) vs 3.7 (3.0), 3.4 (2.5) vs 3.6 (2.9), and 3.0 (2.8) vs 2.3 (2.6), respectively (p>0.05 at all time points). Mean (SD) RMDQ scores at baseline, 3 days, 30 days, 180 days, and 1 year were 17.3 (6.6) vs 16.3 (7.4), 11.8 (7.9) vs 10.9 (8.2), 8.6 (7.2) vs 8.8 (8.5), 7.9 (7.4) vs 7.3 (7.7), 7.5 (7.2) vs 6.7 (8.0), respectively (p>0.05 at all time points). For baseline to 12-month assessment in average pain and RMDQ scores, the standardized effect size between kyphoplasty and vertebroplasty was small at −0.36 (95% CI −1.02 to 0.31) and −0.04 (95% CI −1.68 to 1.60), respectively.ConclusionsOur study indicates that vertebroplasty and kyphoplasty appear to be equally effective in substantially reducing pain and disability in patients with vertebral body compression fractures.Trial registration numberNCT00279877.

scholarly journals Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: A retrospective study

2020 ◽  
Author(s):  
Chongqing Xu ◽  
Mengchen Yin ◽  
Wen Mo
Keyword(s):  
Cobb Angle ◽  
Bone Cement ◽  
Vertebral Body ◽  
Body Height ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Compression Fractures ◽  
Time Points ◽  
Postoperative Time

Abstract Background The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods/Design: All 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty were involved and retrospectively analyzed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The time of operation was 20–65 (34.5 ± 10.5) minutes. The volume of bone cement was 3–8 (5.3 ± 1.3) ml. VAS and ODI at different time points after operation were decreased compared with before operation (all P < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (P > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all P < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all P > 0.05). Conclusion Vesselplasty can reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It has a definite effect in relieving pain, restoring the vertebral body height and correcting the kyphosis caused by injured vertebrae, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

scholarly journals Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle polyaxial Screw at the Fractured Vertebra on the Treatment of Denis type B Thoracolumbar Fracture

2020 ◽  
Author(s):  
chengjie xiong ◽  
Biwang Huang ◽  
Tanjun Wei ◽  
Hui Kang ◽  
Feng Xu
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Body Height ◽  
Type B ◽  
Short Segment ◽  
Average Value ◽  
Significant Difference ◽  
Surgical Options ◽  
Inclined Angle ◽  
Duration Of Operation

Abstract Background: Short-segment internal fixation with intermediate straight-forward monoaxial screws (SSIF-SFM) and long-segment internal fixation (LSIF) are the tow major surgical options for thoracolumbar (TL) fracture. However, SS IF-SFM might not provide adequate support to the spine and LSIF is un necessarily extensive. SSIF with intermediate inclined-angle polyxial screw (SSIF-IAP) might offer an alternative solution for the treatment of TL fracture. Methods: A retrospective study was conducted. 69 patients (47 males and 22 females; average 34.5 years) with Denis type B TL fracture who met the criteria for inclusion were enrolled. Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed. Visual analogue scale (VAS) and oswestry disability index (ODI) were also evaluated. Results: The average value of incision length, blood loss, duration of operation and hospital stay in the SSIF–IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group. The AVBH and VBI in the SSIF-IAP group and LSIF group were significantly improved than those in the SSIF–SFM group at 6-month and the latest follow-ups (p < 0.05). The correction losses of AVBH and VBI (calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly decreased compared with those in the SSIF–SFM group at 6-month and the latest follow-ups (P < 0.05). There was no significant difference of SCE among the three groups postoperatively. The VAS and ODI in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group at 6-month and the latest follow-ups (P < 0.05). Conclusion: Both SSIF- IAP and LSIF can improve the biomechanical stability as compared with SSIF -SFM . Moreover, SSIF-IAP was an effective and reliable operative technique for patients with Denis type B TL fracture.

scholarly journals Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle polyaxial Screw at the Fractured Vertebrae on the Treatment of Denis type B Thoracolumbar Fracture

2020 ◽  
Author(s):  
Chengjie Xiong ◽  
Biwang Huang ◽  
Tanjun Wei ◽  
Hui Kang ◽  
Feng Xu
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Body Height ◽  
Type B ◽  
Short Segment ◽  
Significant Difference ◽  
Surgical Options ◽  
Cobb’S Angle ◽  
Inclined Angle ◽  
Duration Of Operation

Abstract Backgroud Short-segment internal fixation with straight-forward monoaxial screw (SSIF-SFM) and long-segment internal fixation (LSIF) are two major surgical options for thoracolumbar (TL) fracture, however, limitations of both surgical options l are obvious. SSIF with inclined-angle polyxial screw (SSIF-IAP) have been developed to take advantage of their benefits and minimize their adverse effects . Methods 69 consecutive patients (47 males and 22 females; average 34.5 years ) who met the criteria for inclusion were enrolled in this study . Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed . Functional recovery Visual Analogue Scale (VAS) and Oswestry disability index (ODI) were also evaluated. Results The value of incision length, mean blood loss, duration of operation and hospital stay in the SSIF–IAP group and SSIF-SFM group were significantly lower than those in the LSIF group. The AVBH and VBI in the SSIF–IA P group and LSIF group were significantly more improved than those in the SSIF–SFM group at 6 months and the latest follow-ups (p < 0.05). The correction losses of AVBH and VBI ( calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly lower than those in the SSIF–SFM group at 6 months and the latest follow-ups (P<0.05). There was no significant difference of SCE among three groups. The VAS and ODI in the SSIF–IAP group and SSIF-SFM group were significantly lower than those in the LSIF group at 6 months and the latest follow-ups (P<0.05). Conclusion SSIF-IAP can achieve comparable treatment outcomes compared with LSIF, but it was less invasive compared with LSIF . The SSIF–IA was an effective and reliable operative technique for patients with Denis type B TL fracture.

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