Abstract
ObjectiveTo compare the spinal stability with different fixation methods after thoracic TES using finite element analysisMethodsThe spinal finite element model was established from a healthy volunteer, and the validity was verified. The models of T8 thoracic total en bloc spondylectomy (TES) with and without artificial vertebral body were established combination with different fixation methods: the first was long segment fixation with fixed segments T5–7, T9–11; the second was short segment fixation with fixed segments T6–7, T9–10; the third was modified short segment with a pair of vertebral body screws on T7 and T9 added on the basis of short segment fixation. The motions of each model in standing state were simulated in software. The range of motion (ROM) and internal fixation stress changes were analyzed.ResultsWhen anterior support was effective, the three fixation methods could effectively maintain the stability of the spine. However, when anterior support failed, the ROM of the long segment fixation group and the short segment fixation group in the flexion-extension directions was significantly higher than that of when the anterior support existed, while the modified short segment fixation group had no significant changes. Meanwhile, the stress of internal fixation in the long segment fixation group and the short segment fixation group were greatly increased. However, there were no significant changes in modified short segment fixation group.ConclusionAfter TES, the presence of the thoracic cage gives partial anterior stabilization. When the anterior support failed, the modified short segment fixation method can provide better stability.
Highlights
With the deepening understanding of spinal tumors, especially the establishment of the Weinstein-BorianiBiagini (WBB) surgical staging and the Tomita classification system [1, 2], the continuous development of spinal fixation and reconstruction instruments, the techniques used for spinal tumor surgery have made great progress
The surgical treatment of spinal tumors has been no longer limited to simple laminectomy and piecemeal resection, and the total en bloc spondylectomy (TES) have been well performed, which significantly improved the treatment of spinal tumors
Because of the limitations of the surgical approach, the most common reconstruction method currently is the anterior support with titanium mesh or artificial vertebral body combined with posterior pedicle screw fixation [4]
Summary
With the deepening understanding of spinal tumors, especially the establishment of the Weinstein-BorianiBiagini (WBB) surgical staging and the Tomita classification system [1, 2], the continuous development of spinal fixation and reconstruction instruments, the techniques used for spinal tumor surgery have made great progress. Compared with partial vertebral resection, reconstruction of spinal stability is more difficult after TES due to removal of the affected vertebral body, posterior column structure, and the associated stabilizing soft-tissue structures [3]. Because of the limitations of the surgical approach, the most common reconstruction method currently is the anterior support with titanium mesh or artificial vertebral body combined with posterior pedicle screw fixation [4]. The number of fixed segments of the spine after resection has been the focus of debate. The commonly posterior fixation method is bilateral pedicle screw fixation at least two segments above and below the resection segment [5,6,7]. Current biomechanical experiments are all performed in vitro, in addition, the presence of the anterior thoracic cage can increase the stability of the thoracic spine [10]. We consider whether the number of fixed segments can be reduced after thoracic TES
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