INFLUENCE OF THE SAGITTAL LUMBAR PARAMETERS ON THE STRESS-STRAIN STATE OF THE SPINAL MOTOR SEGMENTS AT TRANSPEDICULAR FIXATION
DOI:
https://doi.org/10.15674/0030-59872021337-48Keywords:
Stress-strain state, transpedicular fixation, lumbar spine, segmental lordosis, total lordosis, finite element method, equal tensions, geometric modellingAbstract
Objective. To study the stress-strain state of the elements of the human lumbar spine when we use the transpedicular system, taking into account different angular values of segmental and total lumbar lordosis. Methods. For computer modeling of the stress-strain state of the elements of the human lumbar spine after mono- and polysegmental fixation, the Workbench product was used, and for the construction of parametric three-dimensional geometric
models — the SolidWorks computer-aided design system was used. 4 groups of decisions were studied, which differed in angular values of segmental and total lumbar lordosis. In each group, 11 models were analyzed that describe the lumbar segments after mono- and polysegmental fixation in various configurations of the sagittal alignment of the lumbar spine. Results. It was found that the maximum stress on the cortical bone is concentrated on the base of the LV in case of the «pathological» intervertebral disc LV–S in the group of patients with hyperlordosis. At polysegmental fixation of the LI – S, there is a redistribution of stress on the cortical bone of all vertebrae, the maximum values of which is present in the bodies of the LV and S vertebrae. And only in the group with hypolordosis this stress is minimal. The maximum stress was always on the overlying intervertebral disc during transpedicular
fixation. Significant increasing of cartilage stress in the facet joints of the LIV–LV segment was recorded during fixation of the LV–S segment
in case of hyperlordosis. The maximum stress on the rods was identified in the group of patients with hyperlordosis and polysegmental
fixation of the LI –S, on screws — on LV, LIV, LIII vertebrae during fixation in all groups, except for hypolordosis. Conclusions. Increasing in angular values (hyperlordosis), which describe segmental and total lumbar lordosis, leads to the stress elevation in the fixing elements and structures of the spinal motor segments, and, conversely, a decreasing in angular values (hypolordosis) causes the stress falling.
References
- Zienkiewicz, O. C., Taylor, R. L., & Zhu, J. Z. (2006). The finite element method: its basis and fundamentals. Amsterdam; Heidelberg: Butterworth-Heinemann.
- Roussouly, P., & Nnadi, C. (2010). Sagittal plane deformity: An overview of interpretation and management. European Spine Journal, 19(11), 1824-1836. https://doi.org/10.1007/s00586-010-1476-9
- Lafage, V., Schwab, F., Patel, A., Hawkinson, N., & Farcy, J. (2009). Pelvic tilt and truncal inclination. Spine, 34(17), E599-E606. https://doi.org/10.1097/brs.0b013e3181aad219
- Smith, J. S., Shaffrey, C. I., Glassman, S. D., Berven, S. H., Schwab, F. J., Hamill, C. L., ... & Bridwell, K. H. (2011). Risk-benefit assessment of surgery for adult scoliosis. Spine, 36(10), 817-824. https://doi.org/10.1097/brs.0b013e3181e21783
- Rose, P. S., Bridwell, K. H., Lenke, L. G., Cronen, G. A., Mulconrey, D. S., Buchowski, J. M., & Kim, Y. J. (2009). Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine, 34(8), 785-791. https://doi.org/10.1097/brs.0b013e31819d0c86
- Kim, M. K., Lee, S., Kim, E., Eoh, W., Chung, S., & Lee, C. (2011). The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A pilot study. BMC Musculoskeletal Disorders, 12(1). https://doi.org/10.1186/1471-2474-12-69
- Jackson, R. P., & McManus, A. C. (1994). Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. Spine, 19(Supplement), 1611-1618. https://doi.org/10.1097/00007632-199407001-00010
- Lazennec, J., Ramaré, S., Arafati, N., Laudet, C. G., Gorin, M., Roger, B., ... & Trabelsi, R. (2000). Sagittal alignment in lumbosacral fusion: Relations between radiological parameters and pain. European Spine Journal, 9(1), 47-55. https://doi.org/10.1007/s005860050008
- Mehta, V. A., Amin, A., Omeis, I., Gokaslan, Z. L., & Gottfried, O. N. (2011). Implications of Spinopelvic alignment for the spine surgeon. Neurosurgery, 70(3), 707-721. https://doi.org/10.1227/neu.0b013e31823262ea
- Piontkovsky, V. K., Tkachuk, M. A., Veretelnyk, O. V., & Radchenko, V. O. (2018). Influence of lumbar-pelvic relations on the stress-strain state of the lumbar spine. Orthopedics, traumatology and prosthetics, 4(613), 24–30. https://doi.org/10.15674/0030-59872018424-30. [in Ukrainian]
- ANSYS Workbench [web source]. Available from: http://www.ansys.com.
- Mezentsev, A. A., Petrenko, D. E., Barkov, A. A., & Yaresko, A. V. (2011). Investigation of the stress-strain state of the system "implant - lumbar spine - pelvis" with different fixation options. Orthopedics, traumatology and prosthetics, (2), 37– 41. https://doi.org/10.15674/0030-59872011237-41. [in Russian]
- Piontkovsky, V. K. (2019). Pathogenesis, diagnosis and surgical treatment of lumbar intervertebral disc herniation in elderly and senile patients. Diss. of Doctor in Medical Sciences. Kharkiv. [in Ukrainian]
- Bernhardt, M., & Bridwell, K. H. (1989). Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar Junction. Spine, 14(7), 717-721. https://doi.org/10.1097/00007632-198907000-00012
- http://fcpir.ru/upload/iblock/879/stagesummary_corebofs 000080000kif04cm57m6em8o.pdf.
- Kukin, I. A., Kirpichev, I. V., Maslov, L. B., & Vikhrev, S. V. (2013). Features of the strength characteristics of cancellous bone in diseases of the hip joint. Funfamental research, 7, 328–333. [in Russian]
- http://metallicheckiy-portal.ru/marki_metallov/tit/VT20
Downloads
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).