. 2021;12(4):30-38.

doi: 10.17691/stm2020.12.4.04. Epub 2020 Aug 27.

Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

S V Likhachev¹, V B Arsenievich², V V Ostrovskiy³, A E Shulga¹, A V Zaretskov⁴, D V Ivanov⁵, A V Dol⁵, A M Donnik⁶, V V Zaretskov⁷

Affiliations

¹ Senior Researcher, Department of Innovative Projects in Neurosurgery and Vertebrology, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
² Head of Traumatology and Orthopedics Department No.3, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
³ Director, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
⁴ Associate Professor, Department of Traumatology and Orthopedics; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
⁵ Associate Professor, Department of Mathematical Theory of Elasticity and Biomechanics; Saratov State University, 83 Astrakhanskaya St., Saratov, 410012, Russia.
⁶ Assistant, Department of Mathematical Theory of Elasticity and Biomechanics; Saratov State University, 83 Astrakhanskaya St., Saratov, 410012, Russia.
⁷ Leading Researcher, Department of Innovative Projects in Neurosurgery and Vertebrology, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia; Professor, Department of Traumatology and Orthopedics V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.

PMID: 34795990
PMCID: PMC8596269
DOI: 10.17691/stm2020.12.4.04

Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

S V Likhachev et al. Sovrem Tekhnologii Med. 2021.

. 2021;12(4):30-38.

doi: 10.17691/stm2020.12.4.04. Epub 2020 Aug 27.

Authors

S V Likhachev¹, V B Arsenievich², V V Ostrovskiy³, A E Shulga¹, A V Zaretskov⁴, D V Ivanov⁵, A V Dol⁵, A M Donnik⁶, V V Zaretskov⁷

Affiliations

¹ Senior Researcher, Department of Innovative Projects in Neurosurgery and Vertebrology, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
² Head of Traumatology and Orthopedics Department No.3, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
³ Director, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
⁴ Associate Professor, Department of Traumatology and Orthopedics; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.
⁵ Associate Professor, Department of Mathematical Theory of Elasticity and Biomechanics; Saratov State University, 83 Astrakhanskaya St., Saratov, 410012, Russia.
⁶ Assistant, Department of Mathematical Theory of Elasticity and Biomechanics; Saratov State University, 83 Astrakhanskaya St., Saratov, 410012, Russia.
⁷ Leading Researcher, Department of Innovative Projects in Neurosurgery and Vertebrology, Research Institute of Traumatology, Orthopedics, and Neurosurgery; V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia; Professor, Department of Traumatology and Orthopedics V.I. Razumovsky Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, 410012, Russia.

PMID: 34795990
PMCID: PMC8596269
DOI: 10.17691/stm2020.12.4.04

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.

Keywords: anterior column support.; finite element method; intermediate transpedicular fixation; spine trauma; thoracolumbar transitional vertebra.

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Conflict of interest statement

Conflict of interests. The authors have no conflict of interests to disclose.

Figures

**Figure 1. Three-dimensional solid models of spine–hardware system**
(A)–(D) Arrangement options for fixation systems

**Figure 2. Fields of displacements in the spine model and 4-screw transpedicular system (*left*) and the model supplemented with intermediate screws inserted into the damaged vertebrae (*right*)**

**Figure 3. Fields of equivalent stresses in 4-screw transpedicular system model (*left*) and the model supplemented with intermediate screws inserted into the damaged vertebrae (*right*)**

Figure 4. Fields of equivalent stresses in the spine tissues when using a 4-screw transpedicular system (*left*) and a system supplemented with intermediate screws inserted into the damaged vertebrae (*right*)

Figure 5. Fields of displacements in models of 4-screw transpedicular fixation (*left*) and transpedicular fixation supplemented with intermediate screws (*right*). Anterior column support with Mesh was performed in both cases

Figure 6. Fields of equivalent stresses in implants in models of 4-screw transpedicular fixation (*left*) and transpedicular fixation supplemented with intermediate screws (*right*). Anterior column support with Mesh was performed in both cases

Figure 7. Fields of equivalent stresses in hard and soft tissues in cases of 4-screw transpedicular fixation (*left*) and transpedicular fixation supplemented with intermediate screws (*right*). Anterior column support with Mesh was performed in both cases

**Figure 8. CT scan of Th₁₂ and L₁ vertebrae of patient I. before surgery**

**Figure 9. X-ray pictures of thoracolumbar transitional spine of patient I. after transpedicular fixation**

**Figure 10. CT scan of Th₁₂ and L₁ vertebrae of patient I. 6 months after surgery**

**Figure 11. X-ray pictures of thoracolumbar transitional spine of patient I. after the second stage of spondylosynthesis**

See this image and copyright information in PMC

References

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Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

Affiliations

Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical