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Background Context: Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. Methods: A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. Results: Trans-iliac–trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. Conclusions: Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique. [ABSTRACT FROM AUTHOR]

Verifying the intervertebral stability of each intervertebral fusion procedure, including transforaminal, posterior, and lateral lumbar interbody fusion (TLIF, PLIF, and LLIF, respectively), and the ratio of stress on the rods and pedicle screws during initial fixation may help select a fixation procedure that reduces the risk of mechanical complications, including rod fracture and screw loosening. Thus, we aimed to assess whether these procedures could prevent mechanical complications. Using the finite element method (FEM), we designed 4 surgical models constructed from L2-5 as follows: posterior lumbar fusion (PLF), TLIF, PLIF, and LLIF models. Bilateral rods and each pedicle screw stress were tracked and calculated as Von Mises stress (VMS) for comparison among the PLF and other 3 interbody fusion models during flexion, extension, and side-bending movements. The lowest rod VMS was LLIF, followed by PLIF, TLIF, and PLF in flexion and side bending movements. Compared with PLF, intervertebral fixation significantly reduced stress on the rods. No remarkable differences were observed in extension movements in each surgical procedure. A tendency for higher pedicle screw VMS was noted at the proximal and distal ends of the fixation ranges, including L2 and L5 screws for each procedure in all motions. Intervertebral fixation significantly reduced stress on the L2 and L5 screws, particularly in LLIF. Stress on the rods and pedicle screws in the LLIF model was the lowest compared with that induced by other intervertebral fusion procedures. Therefore, LLIF may reduce mechanical complications occurrence, including rod fracture and screw loosening. [ABSTRACT FROM AUTHOR]

Thoracolumbar vertebral fractures are one of the most common fractures; however, there is a lack of mechanical analyses for what the posterior fixation is for different spine alignments. This study used a three-dimensional finite element model of a T1-sacrum. Three alignment models were created: intact, degenerative lumbar scoliosis (DLS), and adolescent idiopathic scoliosis (AIS). The burst fracture was assumed to be at the L1 vertebral level. Posterior fixation models with pedicle screws (PS) were constructed for each model: 1 vertebra above to 1 below PS (4PS) and 1 vertebra above to 1 below PS with additional short PS at the L1 (6PS); intact-burst-4PS, intact-burst-6PS, DLS-burst-4PS, DLS-burst-6PS, AIS-burst-4PS, and AIS-burst-6PS models. T1 was loaded with a moment of 4 Nm assuming flexion and extension. The vertebrae stress varied with spinal alignment. The stress of L1 in intact burst (IB), DLS burst, and AIS burst increased by more than 190% compared with each nonfractured model. L1 stress in IB, DLS, and AIS-4PS increased to more than 47% compared with each nonfractured model. L1 stress in IB, DLS, and AIS-6PS increased to more than 25% compared with each nonfractured model. In flexion and extension, stress on the screws and rods of intact-burst-6PS, DLS-6PS, and AIS-6PS was lower than in the intact-burst-4PS, DLS-4PS, and AIS-4PS models. It may be more beneficial to use 6PS compared with 4PS to reduce stresses on the fractured vertebrae and instrumentation, regardless of the spinal alignment. [ABSTRACT FROM AUTHOR]

Lumbar spinal canal stenosis (LSS) with diffuse idiopathic skeletal hyperostosis (DISH) can require revision surgery because of the intervertebral instability after decompression. However, there is a lack of mechanical analyses for decompression procedures for LSS with DISH. This study used a validated, three-dimensional finite element model of an L1-L5 lumbar spine, L1-L4 DISH, pelvis, and femurs to compare the biomechanical parameters (range of motion [ROM], intervertebral disc, hip joint, and instrumentation stresses) with an L5-sacrum (L5-S) and L4-S posterior lumbar interbody fusion (PLIF). A pure moment with a compressive follower load was applied to these models. ROM of L5-S and L4-S PLIF models decreased by more than 50% at L4-L5, respectively, and decreased by more than 15% at L1-S compared with the DISH model in all motions. The L4-L5 nucleus stress of the L5-S PLIF increased by more than 14% compared with the DISH model. In all motions, the hip stress of DISH, L5-S, and L4-S PLIF had very small differences. The sacroiliac joint stress of L5-S and L4-S PLIF models decreased by more than 15% compared with the DISH model. The stress values of the screws and rods in the L4-S PLIF model was higher than in the L5-S PLIF model. The concentration of stress because of DISH may influence adjacent segment disease on the nonunited segment of PLIF. A shorter-level lumbar interbody fixation is recommended to preserve ROM; however, it should be used with caution because it could provoke adjacent segment disease. [ABSTRACT FROM AUTHOR]

Spinopelvic parameters are vital components that must be considered when treating patients with spinal disease. Several finite element (FE) studies have explored spinopelvic parameters such as sacral slope (SS) and the impact on the lumbar spine, although no study has examined the effect on the hip and sacroiliac joint (SIJ) on varying SS angles. Therefore, it is necessary to have a biomechanical understanding of the impact on the spinopelvic complex. An FE lumbar, pelvis, and femur model was created from computed tomography scans of a 55-year-old female patient with no abnormalities. Three models were created: a normal model (SS = 26°), a model with high SS (SS = 30°), and a model with low SS (SS = 20°). These models underwent loading for flexion, extension, lateral bending, and axial rotation. Range of motion (ROM), intradiscal pressures, hip joint, and SIJ contact stresses were analyzed. The high SS model (SS = 30°) indicated the highest ROM in the L5-S1 (slip angle) level and the highest intradiscal pressures. The highest average hip and SIJ contact stresses were present in this model, although the low SS model (SS = 20°) in extension had the largest stresses for the hip and SIJ. The results provide evidence that patients with higher SS may be more prone to increased ROM at the slip angle (L5-S1). In addition, patients with higher SS were shown to have higher contact stresses on the hip joint and SIJ, potentially leading to SIJ dysfunction. Clinically, correcting lumbar lordosis including SS is important; however, a high SS may have a negative impact on the intervertebral disc, SIJ, and hip joint. [ABSTRACT FROM AUTHOR]

This finite element analysis aimed to investigate the effects of surgical procedures for cervical spine injury. A three-dimensional finite element model of the cervical spine (C2-C7) was created from computed tomography. This model contained vertebrae, intervertebral discs, anterior longitudinal ligament, and posterior ligament complex. To create the cervical spine injury model, posterior ligament complex and anterior longitudinal ligament at C3-C4 were resected and the center of the intervertebral disc was resected. We created posterior-only fixation (PF), anterior-only fixation (AF), and combined anterior-posterior fixation (APF) models. A pure moment with a compressive follower load was applied, and range of motion, annular/nucleus stress, instrument stress, and facet forces were analyzed. In all motion except for flexion, range of motion of PF, AF, and APF models decreased by 80%–95%, 85%–93%, and 97%–99% compared with the intact model. C3-C4 annulus stress of PF, AF, and APF models decreased by 28%–72%, 96%–100%, and 99%–100% compared with the intact model. Facet contact forces of PF, AF, and APF models decreased by 77%–79%, 97%–99%, and 77%–86% at C3-C4 compared with the intact model. Screw stress in the PF model was higher than in the APF model, and plate stress in the AF model was lower than in the APF model, but bone graft stress in the AF model was higher than in the APF model. Cervical stabilization was preserved by the APF model. Regarding range of motion, the PF model had an advantage compared with the AF model except for flexion. An understanding of biomechanics provides useful information for the clinician. [ABSTRACT FROM AUTHOR]

There are several techniques for lumbar interbody fusion, and implant failure following lumbar interbody fusion can be troublesome. This study aimed to compare the stress in posterior implant and peri-screw vertebral bodies among lateral lumbar interbody fusion (LLIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) and to select the technique that is least likely to cause implant failure. We created an intact L3–L5 model and simulated the LLIF, PLIF, and TLIF techniques at L4–L5 using finite element methods. All models at the lower portion of L5 were fixed and imposed a preload of 400 N and a moment of 7.5 Nm on the upper portion of L3 to simulate flexion, extension, lateral bending, and axial rotation. We investigated the peak stresses and stress concentration in the posterior implant and peri-screw vertebral bodies for the LLIF, PLIF, and TLIF techniques. The extension, flexion, bending, and rotation peak stresses and stress concentration in the posterior implant, as well as the peri-screw vertebral bodies, were the lowest in LLIF, followed by PLIF and TLIF. It was found that implant failure was least likely to occur in LLIF, followed by PLIF and TLIF. Hence, surgeons should be aware of these factors when selecting an appropriate surgical technique and be careful for implant failure during postoperative follow-up. [ABSTRACT FROM AUTHOR]

Soft tissue cervical spine injury (CSI) has the possibility of causing cervical segmental instability, which can lead to spinal cord injury. There is a lack of certainty in assessing whether soft tissue CSI is unstable or not. This biomechanical study aimed to investigate the risk factors of soft tissue CSI. A 3-dimensional finite element model of the ligamentous cervical spine (C2-C7) was created from medical images. Three soft tissue injury models were simulated at C4-C5: 1) posterior ligament complex (PLC) injury, 2) intervertebral disk (ID) with anterior longitudinal ligament injury (IDI), and 3) anterior longitudinal ligament, PLC, and ID injury (API) model. Pure moment with compressive follower load was applied, and the range of motion, annular stress, nucleus stress, and facet forces were analyzed. For the IDI and API models, the range of motion increased at the injury level in extension (by 101%) and left/right axial rotations (>30%) compared with the intact model. The IDI and API models showed an increase of >50% in annular and nucleus stresses at the injury level in extension and left/right rotations compared with the intact model. The PLC injury showed similar stresses as the intact model except for flexion. The facet contact forces of IDI and API models increased more than 100% compared with other models in all motions. In CSI, all soft tissues have a key role in stabilizing cervical spine, but ID is the most important component of all. [ABSTRACT FROM AUTHOR]

Spinal compression fractures commonly occur at the thoracolumbar junction. We have previously constructed a 3-dimensional whole-spine model from medical images by using the finite element method (FEM) and then used this model to develop a compression fracture model. However, these models lacked the rib cage. No previous study has used whole-spine models including the rib cage constructed from medical images to analyze compression fractures. Therefore, in this study, we added the rib cage to whole-spine models. We constructed the models, including a normal spine model without the rib cage, a whole-spine model with the rib cage, and whole-spine models with compression fractures, using FEM analysis. Then, we simulated a person falling on the buttocks to perform stress analysis on the models and to examine to what extent the rib cage affects the analysis of compression fractures. The results showed that the intensity of strain and the vertebral body with minimum principle strain differed between the spine model including the rib cage and that excluding the rib cage. The strain on the spine model excluding the rib cage had approximately twice the intensity of the strain on the spine model including the rib cage. Therefore, the rib cage contributed to the stability of the thoracic spine, thus preventing deformation of the upper thoracic spine. However, the presence of the rib cage increased the strain around the site of compression fracture, thus increasing the possibilities of a refracture and fractures of adjacent vertebral bodies. Our study suggests that the analysis using spine models including the rib cage should be considered in future investigations of disorders of the spine and internal fracture fixation. The development of improved models may contribute to the improvement of prognosis and treatment of individual patients with disorders of the spine. [ABSTRACT FROM AUTHOR]

Abstract: We proposed a novel surface modification for an artificial hip joint stem from the viewpoint of maintenance and establishment of appropriate bone function and microstructure, represented by the preferred alignment of biological apatite (BAp) and collagen (Col). Oriented grooves were introduced into the proximal medial region of the femoral stem to control the principal stress applied to the bone inside the grooves, which is a dominant factor contributing to the promotion of Col/BAp alignment. The groove angle and the stem material were optimized based on the stress inside the grooves through a finite element analysis (FEA). Only the groove oriented proximally by 60° from the normal direction of the stem surface generated the healthy maximum principal stress distribution. The magnitude of the maximum principal stress inside the groove decreased with increasing the stem Young''s modulus, while the direction of the stress did not largely changed. An in vivo implantation experiment showed that this groove was effective in inducing the new bone with preferential Col/BAp alignment along the groove depth direction which corresponded to the direction of maximum principal stress inside the groove. The anisotropic principal stress distribution and the oriented microstructure inside the groove are similar to those found in the femoral trabeculae; therefore, the creation of the oriented groove is a potent surface modification for optimizing implant design for a long-term fixation. [Copyright &y& Elsevier]