Abstract
BackgroundThis study compared the biomechanics of artificial pedicle fixation in spine reconstruction with a 3-dimensional (3D)-printed prosthesis after total en bloc spondylectomy (TES) by finite element analysis.MethodsA thoracolumbar (T10–L2) finite element model was developed and validated. Two models of T12 TES were established in combination with different fixation methods: Model A consisted of long-segment posterior fixation (T10/11, L1/2) + 3D-printed prosthesis; and Model B consisted of Model A + two artificial pedicle fixation screws. The models were evaluated with an applied of 7.5 N·m and axial force of 200 N. We recorded and analyzed the following: (1) stiffness of the two fixation systems, (2) hardware stress in the two fixation systems, and (3) stress on the endplate adjacent to the 3D-printed prosthesis.ResultsThe fixation strength of Model B was enhanced by the screws in the artificial pedicle, which was mainly manifested as an improvement in rotational stability. The stress transmission of the artificial pedicle fixation screws reduced the stress on the posterior rods and endplate adjacent to the 3D-printed prosthesis in all directions of motion, especially in rotation.ConclusionsAfter TES, the posterior long-segment fixation combined with the anterior 3D printed prosthesis could maintain postoperative spinal stability, but adding artificial pedicle fixation increased the stability of the fixation system and reduced the risk of prosthesis subsidence and instrumentation failure.
Highlights
Total en bloc spondylectomy (TES) is an effective treatment for primary and metastatic malignant spinal tumors as it greatly reduces local recurrence and improves patients’ quality of life [1,2,3] and prolongs their survival [4, 5]
Colman carried out a total en bloc spondylectomy (TES) model experiment and showed that application of a vertebral body replacement (VBR) with an artificial pedicle fixed to the posterior rod greatly enhanced the stability of the fixation system and prevented subsidence [10]
The range of motion (ROM) for T12–L2 junctions predicted by the model were in agreement with experimental data from previous studies [23,24,25], validating the current thoracolumbar model
Summary
Total en bloc spondylectomy (TES) is an effective treatment for primary and metastatic malignant spinal tumors as it greatly reduces local recurrence and improves patients’ quality of life [1,2,3] and prolongs their survival [4, 5]. Total resection of single or multiple vertebral bodies and surrounding ligaments leads to severe instability of the spinal segments. A solid vertebral body replacement (VBR) and long-segment posterior fixation. VBR subsidence is the main technical complication after TES, which can lead to rod breakage and fixation failure [7,8,9]. Colman carried out a TES model experiment and showed that application of a VBR with an artificial pedicle fixed to the posterior rod greatly enhanced the stability of the fixation system and prevented subsidence [10]. This study compared the biomechanics of artificial pedicle fixation in spine reconstruction with a 3dimensional (3D)-printed prosthesis after total en bloc spondylectomy (TES) by finite element analysis
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