Biomechanical analysis of stabilization for thoracolumbar anterior spinal failure caused by osteolytic lesions, a finite element comparison of direct lateral corpectomy and posterior long segment instrumentation.

Autor: Nevzati E; Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, Basel 4056, Switzerland; Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA., Kemp OA; Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland., Rhoads C; Department of Orthopedic Surgery, Cleveland Clinic South Pointe Hospital, 20000 Harvard Rd, Warrensville Heights, OH 44122, USA. Electronic address: Rhoadsc2@ccf.org., Witt JP; Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA., Finn M; Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA., Moser M; Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland; Department of Neurosurgery, Cantonal Hospital Graubuenden, Loëstrasse 170, Chur 7000, Switzerland., Spiessberger A; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave Clevland, OH 44195, USA.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2024 Nov; Vol. 24 (11), pp. 2181-2190. Date of Electronic Publication: 2024 Jul 27.
DOI: 10.1016/j.spinee.2024.06.570
Abstrakt: Background Context: Osteolytic lesions caused by infection or metastatic disease of the spine can induce instability. Different surgical strategies are available to restore stability in this scenario, however little is known how various reconstruction techniques affect spinal biomechanics.
Purpose: To analyze and quantify the biomechanical effects of three different surgical reconstruction techniques in the treatment of a T12 osteolytic model.
Study Design/setting: Finite element analysis of the thoracic spine with a T12 osteolytic lesion.
Methods: Using CT scans from a 20-year-old man without structural deformity, simulation of an osteolytic lesion with a 50% defect at the posterior aspect of T12 vertebral body was created by a 490 N vertical force to T9. Next, three common instrumentation techniques treating the osteolytic lesion were modeled and biomechanically tested. These included: Model A, corpectomy with short segment fixation (T11-L1) and two long-segment instrumentations; Model B long segment fixation with triple rod construct; Model C long segment fixation with dual rod construct. A load of 480N was then applied on the spine models in vertically downward direction on T9. Von Mises stresses were measured (MPa) in the discs, vertebrae, and implants.
Results: Model A demonstrated the lowest stress on construct material, adjacent vertebral bodies, and discs but increased stress on the instrumented vertebrae. Model B was more rigid and demonstrated lower construct stress compared to Model C. However, Model C had the lowest vertebral body stress in flexion, extension, and lateral bending in the most upper instrumented vertebral body, but the highest screw pull-out stress when compared to Model A and Model B.
Conclusions: This osteolytic T12 model provides unique biomechanical data that can help to tailor surgical strategies in select scenarios. While optimal outcomes are best achieved with a construct tailored to a specific patient's need for stabilization, our findings can be generalized for instances of cancerous lesions, low bone density, and infectious causes.
Clinical Relevance: The results of this study can help with the choice of appropriate surgical reconstruction technique based on patient-specific characteristics.
Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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