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Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion
BACKGROUND: Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechani...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636999/ https://www.ncbi.nlm.nih.gov/pubmed/37950318 http://dx.doi.org/10.1186/s13018-023-04349-5 |
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author | Eastlack, Robert K. Nunley, Pierce D. Poelstra, Kornelis A. Vaccaro, Alexander R. Stone, Marcus Miller, Larry E. Legay, Pierre Clin, Julien Agarwal, Aakash |
author_facet | Eastlack, Robert K. Nunley, Pierce D. Poelstra, Kornelis A. Vaccaro, Alexander R. Stone, Marcus Miller, Larry E. Legay, Pierre Clin, Julien Agarwal, Aakash |
author_sort | Eastlack, Robert K. |
collection | PubMed |
description | BACKGROUND: Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS). METHODS: The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a 415 N follower load and PSS conditions under a 222 N preload. Depending on the instrumented levels, two different interbody devices were used: a lateral lumbar interbody device at L4–5 or an anterior lumbar interbody device at L5-S1. Primary outcomes included range of motion of the functional spinal units and anterior load transfer, defined as the total load through the disk and interbody device after functional motion and follower load application. RESULTS: Across all combinations of interbody devices and lumbar levels evaluated, CPPF consistently demonstrated significant reductions in flexion (ranging from 90 to 98%), extension (ranging from 88 to 94%), lateral bending (ranging from 75 to 80%), and torsion (ranging from 77 to 86%) compared to the intact spine. Stability provided by the CPPF device was comparable to PSS in all simulations (range of motion within 0.5 degrees for flexion–extension, 0.6 degrees for lateral bending, and 0.5 degrees for torsion). The total anterior load transfer was higher with CPPF versus PSS, with differences across all tested conditions ranging from 128 to 258 N during flexion, 89–323 N during extension, 135–377 N during lateral bending, 95–258 N during torsion, and 82–250 N during standing. CONCLUSION: Under the modeled conditions, cortico-pedicular fixation for supplementing anterior or lateral interbody devices between L4 and S1 resulted in comparable stability based on range of motion measures and less anterior column stress shielding based on total anterior load transfer measures compared to PSS. Clinical studies are needed to confirm these finite element analysis findings. |
format | Online Article Text |
id | pubmed-10636999 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106369992023-11-11 Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion Eastlack, Robert K. Nunley, Pierce D. Poelstra, Kornelis A. Vaccaro, Alexander R. Stone, Marcus Miller, Larry E. Legay, Pierre Clin, Julien Agarwal, Aakash J Orthop Surg Res Research Article BACKGROUND: Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS). METHODS: The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a 415 N follower load and PSS conditions under a 222 N preload. Depending on the instrumented levels, two different interbody devices were used: a lateral lumbar interbody device at L4–5 or an anterior lumbar interbody device at L5-S1. Primary outcomes included range of motion of the functional spinal units and anterior load transfer, defined as the total load through the disk and interbody device after functional motion and follower load application. RESULTS: Across all combinations of interbody devices and lumbar levels evaluated, CPPF consistently demonstrated significant reductions in flexion (ranging from 90 to 98%), extension (ranging from 88 to 94%), lateral bending (ranging from 75 to 80%), and torsion (ranging from 77 to 86%) compared to the intact spine. Stability provided by the CPPF device was comparable to PSS in all simulations (range of motion within 0.5 degrees for flexion–extension, 0.6 degrees for lateral bending, and 0.5 degrees for torsion). The total anterior load transfer was higher with CPPF versus PSS, with differences across all tested conditions ranging from 128 to 258 N during flexion, 89–323 N during extension, 135–377 N during lateral bending, 95–258 N during torsion, and 82–250 N during standing. CONCLUSION: Under the modeled conditions, cortico-pedicular fixation for supplementing anterior or lateral interbody devices between L4 and S1 resulted in comparable stability based on range of motion measures and less anterior column stress shielding based on total anterior load transfer measures compared to PSS. Clinical studies are needed to confirm these finite element analysis findings. BioMed Central 2023-11-10 /pmc/articles/PMC10636999/ /pubmed/37950318 http://dx.doi.org/10.1186/s13018-023-04349-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Eastlack, Robert K. Nunley, Pierce D. Poelstra, Kornelis A. Vaccaro, Alexander R. Stone, Marcus Miller, Larry E. Legay, Pierre Clin, Julien Agarwal, Aakash Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title | Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title_full | Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title_fullStr | Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title_full_unstemmed | Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title_short | Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion |
title_sort | finite element analysis comparing a peek posterior fixation device versus pedicle screws for lumbar fusion |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636999/ https://www.ncbi.nlm.nih.gov/pubmed/37950318 http://dx.doi.org/10.1186/s13018-023-04349-5 |
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