Author:
Wu Jincheng,Yang Dongmei,Han Ye,Xu Hanpeng,Wen Wangqiang,Xu Haoxiang,Li Kepeng,Liu Yong,Miao Jun
Abstract
Abstract
Background
Advancements in medicine and the popularity of lumbar fusion surgery have made lumbar adjacent segment disease (ASDz) increasingly common, but there is no mature plan for guiding its surgical treatment. Therefore, in this study, four different finite element (FE) ASDz models were designed and their biomechanical characteristics were analysed to provide a theoretical basis for clinical workers to choose the most appropriate revision scheme for ASDz.
Methods
According to whether internal fixation was retained, different FE models were created to simulate ASDz revision surgery, and flexion, extension, axial rotation and lateral bending were simulated by loading. The biomechanical characteristics of the adjacent segments of the intervertebral disc and the internal fixation system and the range of motion (ROM) of the lumbar vertebrae were analysed.
Results
The difference in the ROM of the fixed segment between FE models that did or did not retain the original internal fixation was less than 0.1°, and the difference was not significant. However, the stress of the screw–rod system when the original internal fixation was retained and prolonged fixation was performed with dual-trajectory screws was less than that when the original internal fixation was removed and prolonged fixation was performed with a long bar. Especially in axial rotation, the difference between models A and B is the largest, and the difference in peak stress reached 30 MPa. However, for the ASDz revision surgery segment, the endplate stress between the two models was the lowest, and the intradiscal pressure (IDP) of the adjacent segment was not significantly different between different models.
Conclusion
Although ASDz revision surgery by retaining the original internal fixation and prolonging fixation with dual-trajectory screws led to an increase in stress in the fusion segment endplate, it provides stability similar to ASDz revision surgery by removing the original internal fixation and prolonging fixation with a long bar and does not lead to a significant change in the IDP of the adjacent segment while avoiding a greater risk of rod fracture.
Funder
National Natural Science Foundation of China
Natural Science Foundation of Tianjin City
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference41 articles.
1. Deyo RA. Trends major medical complications and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. (2010);303(13):1259.
2. Matsukawa K, Yato Y, Kato T, Imabayashi H, Asazuma T, Nemoto K. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine (Phila Pa 1976). [Journal Article]. 2014;39(4):E240–5.
3. Hekimoğlu M, Başak A, Yılmaz A, Yıldırım H, Aydın AL, Karadag K, et al. Adjacent segment disease (ASD) in incidental segmental fused vertebra and comparison. Cureus. 2021;13(10): e18647.
4. Georgios AM, Rouzbeh M, Aristotelis SF, Paul AG, Efstathios P. Factors predictive of adjacent segment disease after lumbar spinal fusion. World Neurosurg. 2020;133(C).
5. Song K, Choi B, Jeon T, Lee K, Chang H. Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments. Eur Spine J: Off Publ Eur Spine Soc. 2011;20(11):1940–5.
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献