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Transpedicular stabilization strategies for thoracolumbar burst fractures: evaluation and improvement in the context of flexion loads


MOJ Orthopedics & Rheumatology
Oleksii S Nekhlopochyn,1 Vadim V Verbov,2 Ievgen V Cheshuk,2 Michael Yu Karpinsky,3 Oleksandr V Yaresko3

Abstract

Introduction: Burst fractures, characterized by a wide variability in pathomorphological changes, represent one of the most tactically debated issues in modern spinal surgery. The question of treatment strategy is particularly relevant for the thoracolumbar junction area, which, due to its biomechanical features, is especially prone to traumatic injuries. The aim of the study is to investigate the stress-strain state of a lumbar spine model with a burst fracture of the T12 vertebra under different transpedicular fixation options and forward trunk inclination. Material and methods: We developed a mathematical finite element model of the human thoracolumbar spine, considering a burst fracture of the T12 vertebra. The model also includes a transpedicular stabilization system consisting of 8 screws implanted in the T10, T11, L1, and L2 vertebrae. We simulated four variants of transpedicular fixation using short (monocortical) and long (bicortical) screws, which penetrate the anterior wall of the vertebral body, both with and without two cross-links. Results: The analysis revealed that the different configurations demonstrated varying stress levels in the analyzed regions of the model. For example, the calculated stress values for the body of the fractured vertebra were 22.6, 25.1, 22.4, and 24.7 MPa, respectively, for models with monocortical screws without cross-links, bicortical screws without cross-links, monocortical screws with cross-links, and bicortical screws with cross-links. Conclusion: The study provides data on the stress distribution within the lumbar spine model with a burst fracture of the T12 vertebra under various fixation strategies and simulated flexion loading. These findings can aid in clinical decisions regarding the most effective transpedicular stabilization methods to optimize patient outcomes.

Keywords

thoracolumbar junction, spinal trauma, burst fractures, biomechanics, finite element analysis, spinal stabilization

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