Abstract
Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system.The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary.Materials and Methods.DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method.Results.The values of stress and displacement fields for spine–hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153–161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine–hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws.Conclusion.The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.
Highlights
Fractures of the thoracolumbar transitional vertebra (Th11–L2) account for nearly 90% of vertebral column injuries [1,2,3]
The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary
The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization
Summary
Fractures of the thoracolumbar transitional vertebra (Th11–L2) account for nearly 90% of vertebral column injuries [1,2,3]. Nearly 20% are burst fractures [4]. The problem of choosing the surgical approach for such injuries remains unsolved. Short-segment transpedicular fixation characterized by a minimal number of blocked spinal-motor segments and low intraoperative blood loss is the gold standard for this type of injury [5,6,7,8]. The advantages of such fixation system arrangement are partially offset by the risk of instability of short-segment hardware (almost 54% of cases) and subsequent relapse of post-traumatic kyphotic deformity [9,10,11,12]. It is proposed to use multisegment structures [13]
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