Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 1;49(15):E229-E238.
doi: 10.1097/BRS.0000000000005034. Epub 2024 May 9.

Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis

Guodong Zhang  1   2 , Jianyi Li  1 , Li Zhang  3 , Jie Song  4 , Jiale Shao  1 , Changlin Lv  1 , Tianyu Bai  1 , Yukun Du  1 , Yongming Xi  1
Affiliations

Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis

Guodong Zhang et al. Spine (Phila Pa 1976). .

Abstract

Study design: Finite element analysis.

Objective: To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis.

Summary of background data: In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis.

Materials and methods: Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed.

Results: Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease.

Conclusion: LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The finite element model of the intact T10-L5 thoracolumbar spine. A, Coronal view. B, Saggital view. C, Section view.
Figure 2
Figure 2
The finite element model of L1 burst fracture.
Figure 3
Figure 3
The finite element models of four fixation techniques. A, CAPS. B, LSPS. C, CBT. D, CBT-PS.
Figure 4
Figure 4
ROM distribution of fixed segment in T10-L5 region under different movement conditions including flexion, extension, bending, and rotation.
Figure 5
Figure 5
ROM at adjacent level to fixed region of four finite element models.
Figure 6
Figure 6
Value of von Mises stress on adjacent intervertebral disks.
Figure 7
Figure 7
Nephogram of von Mises stress distribution on adjacent intervertebral disks. A, CAPS. B, LSPS. C, CBT. D, CBT-PS.
Figure 8
Figure 8
Value of von Mises stress on adjacent facet joints.
Figure 9
Figure 9
Nephogram of von Mises stress distribution on adjacent facet joints. A, CAPS. B, LSPS. C, CBT. D, CBT-PS.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Chou TY, Tsuang FY, Hsu YL, Chai CL. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit: a systematic review and meta-analysis. Global Spine J. 2024;14:740–49. - PMC - PubMed
    1. Xu J, Yin Z, Li Y, Xie Y, Hou J. Clinic choice of long or short segment pedicle screw-rod fixation in the treatment of thoracolumbar burst fracture: from scan data to numerical study. Int J Numer Method Biomed Eng. 2023;39:e3756. - PubMed
    1. Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14:145–64. - PubMed
    1. Xu G, Fu X, Du C, et al. . Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: a finite element analysis. Proc Inst Mech Eng H. 2014;228:1005–13. - PubMed
    1. Alimohammadi E, Bagheri SR, Joseph B, Sharifi H, Shokri B, Khodadadi L. Analysis of factors associated with the failure of treatment in thoracolumbar burst fractures treated with short-segment posterior spinal fixation. J Orthop Surg Res. 2023;18:690. - PMC - PubMed