Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
Abstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neg...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2021-02-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-83251-8 |
| _version_ | 1818431862186442752 |
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| author | Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini |
| author_facet | Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini |
| author_sort | Luigi La Barbera |
| collection | DOAJ |
| description | Abstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion–extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature. |
| first_indexed | 2024-12-14T15:56:03Z |
| format | Article |
| id | doaj.art-431f7dffc161498dbf7468ca444e50f0 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-14T15:56:03Z |
| publishDate | 2021-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-431f7dffc161498dbf7468ca444e50f02022-12-21T22:55:16ZengNature PortfolioScientific Reports2045-23222021-02-0111111310.1038/s41598-021-83251-8Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomyLuigi La Barbera0Hans-Joachim Wilke1Maria Luisa Ruspi2Marco Palanca3Christian Liebsch4Andrea Luca5Marco Brayda-Bruno6Fabio Galbusera7Luca Cristofolini8Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, Politecnico Di MilanoInstitute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm UniversityDepartment of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, Università Di BolognaDepartment of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, Università Di BolognaInstitute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm UniversityDepartment of Spine Surgery III, IRCCS Istituto Ortopedico GaleazziDepartment of Spine Surgery III, IRCCS Istituto Ortopedico GaleazziIRCCS Istituto Ortopedico GaleazziDepartment of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, Università Di BolognaAbstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion–extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature.https://doi.org/10.1038/s41598-021-83251-8 |
| spellingShingle | Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy Scientific Reports |
| title | Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| title_full | Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| title_fullStr | Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| title_full_unstemmed | Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| title_short | Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| title_sort | load sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy |
| url | https://doi.org/10.1038/s41598-021-83251-8 |
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