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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-02-01
|
| Series: | Journal of Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4426/12/2/253 |
| _version_ | 1797478870330376192 |
|---|---|
| author | Guan-Heng Jhong Yu-Hsuan Chung Chun-Ting Li Yen-Nien Chen Chih-Wei Chang Chih-Han Chang |
| author_facet | Guan-Heng Jhong Yu-Hsuan Chung Chun-Ting Li Yen-Nien Chen Chih-Wei Chang Chih-Han Chang |
| author_sort | Guan-Heng Jhong |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-09T21:37:45Z |
| format | Article |
| id | doaj.art-df9bbeff7d2a42299e3d9cbc52cda503 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T21:37:45Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-df9bbeff7d2a42299e3d9cbc52cda5032023-11-23T20:40:36ZengMDPI AGJournal of Personalized Medicine2075-44262022-02-0112225310.3390/jpm12020253Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar SpineGuan-Heng Jhong0Yu-Hsuan Chung1Chun-Ting Li2Yen-Nien Chen3Chih-Wei Chang4Chih-Han Chang5Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, TaiwanDepartment of Orthopedics, Show Chwan Memorial Hospital, Changhua 500, TaiwanInstitute of Geriatric Welfare Technology & Science, Mackay Medical College, New Taipei 252, TaiwanDepartment of Physical Therapy, Asia University, Taichung 413, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, TaiwanDepartment of Biomedical Engineering, National Cheng Kung University, Tainan 701, TaiwanBackground 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.https://www.mdpi.com/2075-4426/12/2/253biomechanicsburst fracturekyphoplastystressSpineJackvertebral body height |
| spellingShingle | Guan-Heng Jhong Yu-Hsuan Chung Chun-Ting Li Yen-Nien Chen Chih-Wei Chang Chih-Han Chang Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine Journal of Personalized Medicine biomechanics burst fracture kyphoplasty stress SpineJack vertebral body height |
| 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 | biomechanics burst fracture kyphoplasty stress SpineJack vertebral body height |
| url | https://www.mdpi.com/2075-4426/12/2/253 |
| work_keys_str_mv | AT guanhengjhong numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine AT yuhsuanchung numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine AT chuntingli numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine AT yennienchen numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine AT chihweichang numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine AT chihhanchang numericalcomparisonofrestoredvertebralbodyheightafterincompleteburstfractureofthelumbarspine |