J Korean Fract Soc.  2007 Jan;20(1):70-75. 10.12671/jkfs.2007.20.1.70.

Biomechanical Efficacy of Various Anterior Spinal Fixation in Treatment of Thoraco-lumbar Spine Fracture

• Park YS
• Kim HJ
• Choi CH
• Park WM
• Kim YH

• KMID: 2294382
• DOI: http://doi.org/10.12671/jkfs.2007.20.1.70

Abstract

PURPOSE
To evaluate the biomechanical results according to various anterior spinal fixation methodology in the treatment of thoracolumbar spine fracture.
MATERIALS AND METHODS
The comparative analysis of fixation method was evaluated by three dimensional finite element model using the 1 mm reconstruction image of CT. Authors evaluated the flexion, extension, lateral bending, torsional stresses with 12 fixation methods for the compression and burst fracture.
RESULTS
In biomechanical analysis, stiffness of body-fixation device was more stable in two-rod system in compression fracture and was stable in one-rod, two-rod system in burst fracture, but two-rod system was showed over-increase of stiffness.
CONCLUSION
Authors recommend the usage of two-rod system in anterior fixation only and anterior one-rod system in anterior-posterior fixation.

Keyword

Thoracolumbar spine fracture; Anterior fixation; One-rod system

MeSH Terms

Fractures, Compression
Methods
Spine*

Figure

• 

  Fig. 1 The finite element models of thoracolumbar spine segments with different anteroposterior fixation techniques were developed. (A) One-rod anterior fixation with posterior fixation (1R-M-P). (B) Two-rod anterior fixation with posterior fixation (2R-M-P). (C) Posterior fixation (0R-M-P).

Reference

1. An HS, Vaccaro A, Cotler JM, Lin S. Low lumbar burst fractures. Comparison among body cast, Harrington rod, Luque rod, and Steffee plate. Spine (Phila Pa 1976). 1991; 16:Suppl 8. S440–S444.

2. Been HD. Anterior decompression and stabilization of thoracolumbar burst fractures by the use of the Slot-Zielke device. Spine. 1991; 16:70–77.

3. Been HD, Bouma GJ. Comparison of two types of surgery for thoraco-lumbar burst fractures: combined anterior and posterior stabilisation vs. posterior instrumentation only. Acta Neurochir (Wien). 1999; 141:349–357.

4. Carl AL, Tranmer BI, Sachs BL. Anterolateral dynamized instrumentation and fusion for unstable thoracolumbar and lumbar burst fractures. Spine (Phila Pa 1976). 1997; 22:686–690.

5. Choi IS, Kim WI, Lim S, Lee SH. Treatment of unstable fracture of the thoracolumbar spine using Kaneda instrumentation. J Korean Fract Soc. 1994; 7:192–200.

6. Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurological deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res. 1984; 189:142–149.

7. Dewald RL. Burst fractures of the thoracic and lumbar spine. Clin Orthop Relat Res. 1984; 189:150–161.

8. Ebelke DK, Asher MA, Neff JR, Kraker DP. Survivorship analysis of VSP spine instrumentation in the treatment of thoracolumbar and lumbar burst fractures. Spine (Phila Pa 1976). 1991; 16:Suppl 8. S428–S432.

9. Edwards CC, Levine AM. Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am. 1986; 17:121–145.

10. Goel VK, Ramirez SA, Kong W, Gilbertson LG. Cancellous bone Young's modulus variation within the vertebral body of a ligamentous lumbar spine - application of bone adaptive remodeling concepts. J Biomech Eng. 1995; 117:266–271.

11. Gurr KR, McAfee PC, Shih CM. Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg Am. 1988; 70:1182–1191.

12. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine (Phila Pa 1976). 1993; 18:977–982.

13. Kaneda K, Abumi K, Fujiya M. Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine. Results of anterior decompression and stabilization with anterior instrumentation. Spine (Phila Pa 1976). 1984; 9:788–795.

14. Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am. 1997; 79:69–83.

15. Kim JO, Kang OY, Kang CN, Ahn SY. The comparison of conservative treatment with operative treatment in bursting fracture. J Korean Fract Soc. 1995; 8:807–814.

16. Kostuik JP. Anterior fixation for fractures of the thoracic and lumbar spine with or without neurologic involvement. Clin Orthop Relat Res. 1984; 189:103–115.

17. Lu YM, Hutton WC, Gharpuray VM. Do bending, twisting and diurnal fluid changes in the disc affect the propensity to prolapse? A viscoelastic finite element model. Spine (Phila Pa 1976). 1996; 21:2570–2579.

18. McDonough PW, Davis R, Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976). 2004; 29:1901–1908.

19. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993; 75:162–167.

20. Natarajan RN, Andersson GB. The influence of lumbar disc height and cross-sectional area on the mechanical response of the disc to physiologic loading. Spine (Phila Pa 1976). 1999; 24:1873–1881.

21. Olerud S, Karlstrom G, Sjostrom L. Transpedicular fixation of thoracolumbar vertebral fractures. Clin Orthop Relat Res. 1988; 227:44–51.

22. Payer M. Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation. Acta Neurochir (Wien). 2006; 148:299–306.

23. Pflugmacher R, Schleicher P, Schaefer J, et al. Biomechanical comparison of expandable cages for vertebral body replacement in thoracolumbar spine. Spine (Phila Pa 1976). 2004; 29:1413–1419.

24. Polikeit A, Ferguson SJ, Nolte LP, Orr TE. Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis. Eur Spine J. 2003; 12:413–420.

25. Schreiber U, Bence T, Grupp T, et al. Is a single anterolateral screw-plate fixation sufficient for the treatment of spinal fractures in the thoracolumbar junction? A biomechanical in vitro investigation. Eur Spine J. 2005; 14:197–204.

26. Whitesides TE Jr. Traumatic kyphosis of the thoracolumbar spine. Clin Orthop Relat Res. 1977; 128:78–92.

27. Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech. 2005; 18:S15–S23.

28. Zhong ZC, Wei SH, Wang JP, Feng CK, Chen CS, Yu CH. Finite element analysis of the lumbar spine with a new cage using a topology optimization method. Med Eng Phys. 2006; 28:90–98.