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Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

BACKGROUND: Advancements in medicine and the popularity of lumbar fusion surgery have made lumbar adjacent segment disease (ASDz) increasingly common, but there is no mature plan for guiding its surgical treatment. Therefore, in this study, four different finite element (FE) ASDz models were designe...

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Autores principales: Wu, Jincheng, Yang, Dongmei, Han, Ye, Xu, Hanpeng, Wen, Wangqiang, Xu, Haoxiang, Li, Kepeng, Liu, Yong, Miao, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509616/
https://www.ncbi.nlm.nih.gov/pubmed/36153558
http://dx.doi.org/10.1186/s13018-022-03317-9
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author Wu, Jincheng
Yang, Dongmei
Han, Ye
Xu, Hanpeng
Wen, Wangqiang
Xu, Haoxiang
Li, Kepeng
Liu, Yong
Miao, Jun
author_facet Wu, Jincheng
Yang, Dongmei
Han, Ye
Xu, Hanpeng
Wen, Wangqiang
Xu, Haoxiang
Li, Kepeng
Liu, Yong
Miao, Jun
author_sort Wu, Jincheng
collection PubMed
description BACKGROUND: Advancements in medicine and the popularity of lumbar fusion surgery have made lumbar adjacent segment disease (ASDz) increasingly common, but there is no mature plan for guiding its surgical treatment. Therefore, in this study, four different finite element (FE) ASDz models were designed and their biomechanical characteristics were analysed to provide a theoretical basis for clinical workers to choose the most appropriate revision scheme for ASDz. METHODS: According to whether internal fixation was retained, different FE models were created to simulate ASDz revision surgery, and flexion, extension, axial rotation and lateral bending were simulated by loading. The biomechanical characteristics of the adjacent segments of the intervertebral disc and the internal fixation system and the range of motion (ROM) of the lumbar vertebrae were analysed. RESULTS: The difference in the ROM of the fixed segment between FE models that did or did not retain the original internal fixation was less than 0.1°, and the difference was not significant. However, the stress of the screw–rod system when the original internal fixation was retained and prolonged fixation was performed with dual-trajectory screws was less than that when the original internal fixation was removed and prolonged fixation was performed with a long bar. Especially in axial rotation, the difference between models A and B is the largest, and the difference in peak stress reached 30 MPa. However, for the ASDz revision surgery segment, the endplate stress between the two models was the lowest, and the intradiscal pressure (IDP) of the adjacent segment was not significantly different between different models. CONCLUSION: Although ASDz revision surgery by retaining the original internal fixation and prolonging fixation with dual-trajectory screws led to an increase in stress in the fusion segment endplate, it provides stability similar to ASDz revision surgery by removing the original internal fixation and prolonging fixation with a long bar and does not lead to a significant change in the IDP of the adjacent segment while avoiding a greater risk of rod fracture.
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spelling pubmed-95096162022-09-26 Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study Wu, Jincheng Yang, Dongmei Han, Ye Xu, Hanpeng Wen, Wangqiang Xu, Haoxiang Li, Kepeng Liu, Yong Miao, Jun J Orthop Surg Res Research Article BACKGROUND: Advancements in medicine and the popularity of lumbar fusion surgery have made lumbar adjacent segment disease (ASDz) increasingly common, but there is no mature plan for guiding its surgical treatment. Therefore, in this study, four different finite element (FE) ASDz models were designed and their biomechanical characteristics were analysed to provide a theoretical basis for clinical workers to choose the most appropriate revision scheme for ASDz. METHODS: According to whether internal fixation was retained, different FE models were created to simulate ASDz revision surgery, and flexion, extension, axial rotation and lateral bending were simulated by loading. The biomechanical characteristics of the adjacent segments of the intervertebral disc and the internal fixation system and the range of motion (ROM) of the lumbar vertebrae were analysed. RESULTS: The difference in the ROM of the fixed segment between FE models that did or did not retain the original internal fixation was less than 0.1°, and the difference was not significant. However, the stress of the screw–rod system when the original internal fixation was retained and prolonged fixation was performed with dual-trajectory screws was less than that when the original internal fixation was removed and prolonged fixation was performed with a long bar. Especially in axial rotation, the difference between models A and B is the largest, and the difference in peak stress reached 30 MPa. However, for the ASDz revision surgery segment, the endplate stress between the two models was the lowest, and the intradiscal pressure (IDP) of the adjacent segment was not significantly different between different models. CONCLUSION: Although ASDz revision surgery by retaining the original internal fixation and prolonging fixation with dual-trajectory screws led to an increase in stress in the fusion segment endplate, it provides stability similar to ASDz revision surgery by removing the original internal fixation and prolonging fixation with a long bar and does not lead to a significant change in the IDP of the adjacent segment while avoiding a greater risk of rod fracture. BioMed Central 2022-09-24 /pmc/articles/PMC9509616/ /pubmed/36153558 http://dx.doi.org/10.1186/s13018-022-03317-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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
Wu, Jincheng
Yang, Dongmei
Han, Ye
Xu, Hanpeng
Wen, Wangqiang
Xu, Haoxiang
Li, Kepeng
Liu, Yong
Miao, Jun
Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title_full Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title_fullStr Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title_full_unstemmed Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title_short Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
title_sort application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509616/
https://www.ncbi.nlm.nih.gov/pubmed/36153558
http://dx.doi.org/10.1186/s13018-022-03317-9
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