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. 2020 Apr 7;15(1):132.
doi: 10.1186/s13018-020-01650-5.

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Quan-Kun Zhou  1 , Fan-Hui Zeng  2 , Jian-Long Tu  1 , Zhang-Qing Dong  1 , Zhi-Hui Ding  1
Affiliations

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Quan-Kun Zhou et al. J Orthop Surg Res. .

Abstract

Purpose: To compare the effect of conventional pedicle screw (CPS) and cement-augmented pedicle screw instrumentation (CAPSI) on adjacent segment degeneration (ASD).

Methods: A normal male volunteer without a history of spinal disease was selected, lumbar CT data was collected, an intact L3-S1 three-dimensional finite element model was created by software including Mimics, Geomagic, and SolidWorks, and the fixation methods were performed accordingly. A common pedicle screw model and a cement-augmented pedicle screw model of L4-L5 with fusion and internal fixation were constructed. With ANSYS Workbench 17.0, a 500 N load was applied to the upper surface of L3 to simulate the weight of a human body, and a 7.5 N m moment was applied at the neutral point to simulate flexion, extension, left/right bending, left/right rotation of the spine. The peak von Mises stress of intervertebral disc and the range of motion (ROM) on the adjacent segments (L3-4 and L5-S1) were compared.

Results: The validity of the intact model shows that the ROM of the model is similar to that of a cadaveric study. Compared with the intact model, CPS model and CAPSI model in all motion patterns increased the ROM of adjacent segments. The intervertebral disc stress and the ROM of adjacent segments were found to be higher in the CAPSI model than in the CPS model, especially in L3-4.

Conclusion: In general, the biomechanical analysis of an osteoporotic lumbar spine showed that both CPS and CAPSI can increase the ROM and disc stresses of osteoporotic lumbar models, and compared with CPS, CAPSI is more likely to increase the potential risk of adjacent segment degeneration.

Keywords: Adjacent segment;; Cement-augmented pedicle screw;; Finite element study; Osteoporotic lumbosacral spine;.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Different types of models. a The intact lumbar model. b The model of cage in the transforaminal lumbar interbody fusion, the model of conventional pedicle screws, and the model of cement-augmented pedicle screw instrument. c The conventional pedicle screw instrumentation model. d The cement-augmented pedicle screw instrumentation model
Fig. 2
Fig. 2
Comparison of the range of motion (ROM) between the intact model and the in vitro study at the L3–4 (left) and L4–5 (right) levels
Fig. 3
Fig. 3
The stresses on the intervertebral disc at L3–4 and L5–S1 in the two fixed models
Fig. 4
Fig. 4
The ROM at L3–4 and L5–S1 in the two fixed models
Fig. 5
Fig. 5
The distribution of the peak von Mises stresses at L3–4
Fig. 6
Fig. 6
The distribution of the peak von Mises stresses at L5–S1
See this image and copyright information in PMC

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