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Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine

Background and objectives: Vertebral compression fracture is a major health care problem worldwide due to its direct and indirect negative influence on health-related quality of life and increased health care costs. Although a percutaneous surgical intervention with balloon kyphoplasty or metal expa...

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Autores principales: Jhong, Guan-Heng, Chung, Yu-Hsuan, Li, Chun-Ting, Chen, Yen-Nien, Chang, Chih-Wei, Chang, Chih-Han
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8875835/
https://www.ncbi.nlm.nih.gov/pubmed/35207743
http://dx.doi.org/10.3390/jpm12020253
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author Jhong, Guan-Heng
Chung, Yu-Hsuan
Li, Chun-Ting
Chen, Yen-Nien
Chang, Chih-Wei
Chang, Chih-Han
author_facet Jhong, Guan-Heng
Chung, Yu-Hsuan
Li, Chun-Ting
Chen, Yen-Nien
Chang, Chih-Wei
Chang, Chih-Han
author_sort Jhong, Guan-Heng
collection PubMed
description Background and objectives: Vertebral compression fracture is a major health care problem worldwide due to its direct and indirect negative influence on health-related quality of life and increased health care costs. Although a percutaneous surgical intervention with balloon kyphoplasty or metal expansion, the SpineJack, along with bone cement augmentation has been shown to efficiently restore and fix the lost vertebral height, 21–30% vertebral body height loss has been reported in the literature. Furthermore, the effect of the augmentation approaches and the loss of body height on the biomechanical responses in physiological activities remains unclear. Hence, this study aimed to compare the mechanical behavior of the fractured lumbar spine with different restored body heights, augmentation approaches, and posterior fixation after kyphoplasty using the finite element method. Furthermore, different augmentation approaches with bone cement and bone cement along with the SpineJack were also considered in the simulation. Materials and Methods: A numerical lumbar model with an incomplete burst fracture at L3 was used in this study. Two different degrees of restored body height, namely complete and incomplete restorations, after kyphoplasty were investigated. Furthermore, two different augmentation approaches of the fractured vertebral body with bone cement and SpineJack along with bone cement were considered. A posterior instrument (PI) was also used in this study. Physiological loadings with 400 N + 10 Nm in four directions, namely flexion, extension, lateral bending, and axial rotation, were applied to the lumbar spine with different augmentation approaches for comparison. Results: The results indicated that both the bone cement and bone cement along with the SpineJack could support the fractured vertebral body to react similarly with an intact lumbar spine under identical loadings. When the fractured body height was incompletely restored, the peak stress in the L2–L3 disk above the fractured vertebral body increased by 154% (from 0.93 to 2.37 MPa) and 116% (from 0.18 to 0.39 MPa), respectively, in the annular ground substance and nucleus when compared with the intact one. The use of the PI could reduce the range of motion and facet joint force at the implanted levels but increase the facet joint force at the upper level of the PI. Conclusions: In the present study, complete restoration of the body height, as possible in kyphoplasty, is suggested for the management of lumbar vertebral fractures.
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spelling pubmed-88758352022-02-26 Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine Jhong, Guan-Heng Chung, Yu-Hsuan Li, Chun-Ting Chen, Yen-Nien Chang, Chih-Wei Chang, Chih-Han J Pers Med Article Background and objectives: Vertebral compression fracture is a major health care problem worldwide due to its direct and indirect negative influence on health-related quality of life and increased health care costs. Although a percutaneous surgical intervention with balloon kyphoplasty or metal expansion, the SpineJack, along with bone cement augmentation has been shown to efficiently restore and fix the lost vertebral height, 21–30% vertebral body height loss has been reported in the literature. Furthermore, the effect of the augmentation approaches and the loss of body height on the biomechanical responses in physiological activities remains unclear. Hence, this study aimed to compare the mechanical behavior of the fractured lumbar spine with different restored body heights, augmentation approaches, and posterior fixation after kyphoplasty using the finite element method. Furthermore, different augmentation approaches with bone cement and bone cement along with the SpineJack were also considered in the simulation. Materials and Methods: A numerical lumbar model with an incomplete burst fracture at L3 was used in this study. Two different degrees of restored body height, namely complete and incomplete restorations, after kyphoplasty were investigated. Furthermore, two different augmentation approaches of the fractured vertebral body with bone cement and SpineJack along with bone cement were considered. A posterior instrument (PI) was also used in this study. Physiological loadings with 400 N + 10 Nm in four directions, namely flexion, extension, lateral bending, and axial rotation, were applied to the lumbar spine with different augmentation approaches for comparison. Results: The results indicated that both the bone cement and bone cement along with the SpineJack could support the fractured vertebral body to react similarly with an intact lumbar spine under identical loadings. When the fractured body height was incompletely restored, the peak stress in the L2–L3 disk above the fractured vertebral body increased by 154% (from 0.93 to 2.37 MPa) and 116% (from 0.18 to 0.39 MPa), respectively, in the annular ground substance and nucleus when compared with the intact one. The use of the PI could reduce the range of motion and facet joint force at the implanted levels but increase the facet joint force at the upper level of the PI. Conclusions: In the present study, complete restoration of the body height, as possible in kyphoplasty, is suggested for the management of lumbar vertebral fractures. MDPI 2022-02-10 /pmc/articles/PMC8875835/ /pubmed/35207743 http://dx.doi.org/10.3390/jpm12020253 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jhong, Guan-Heng
Chung, Yu-Hsuan
Li, Chun-Ting
Chen, Yen-Nien
Chang, Chih-Wei
Chang, Chih-Han
Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title_full Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title_fullStr Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title_full_unstemmed Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title_short Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine
title_sort numerical comparison of restored vertebral body height after incomplete burst fracture of the lumbar spine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8875835/
https://www.ncbi.nlm.nih.gov/pubmed/35207743
http://dx.doi.org/10.3390/jpm12020253
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