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research-article

Finite Element Study to Evaluate the Biomechanical Performance of the Spine After Augmenting Percutaneous Pedicle Screw Fixation with Kyphoplasty for the Treatment of Burst Fractures

[+] Author and Article Information
Shady Elmasry

University of Miami, Department of Industrial Engineering, Biomechanics Research Lab, 1251 Memorial Drive, Mc Arthur Engineering, Building #156, Coral Gables, FL, USA
shady.elmasry.cu@gmail.comr

Shihab Asfour

University of Miami, Department of Industrial Engineering, Biomechanics Research Lab, 1251 Memorial Drive, Mc Arthur Engineering, Building #268, Coral Gables, FL, USA
sasfour@miami.edu

Francesco Travascio

ASME Member, University of Miami, Department of Industrial Engineering, Biomechanics Research Lab, 1251 Memorial Drive, Mc Arthur Engineering, Building #276, Coral Gables, FL, USA
f.travascio@miami.edu

1Corresponding author.

ASME doi:10.1115/1.4039174 History: Received July 22, 2017; Revised January 12, 2018

Abstract

Percutaneous pedicle screw fixation (PPSF) is a minimally invasive surgery (MIS) employed in the treatment of thoracolumbar burst fractures (TBF). However, hardware failure and loss of angular correction are common limitations caused by the poor support of the anterior column of the spine. Balloon Kyphoplasty (KP) is another MIS successfully used in the treatment of compression fractures by augmenting the injured vertebral body with cement. To overcome its limitations as a stand-alone procedure, it was suggested to augment PPSF with KP when treating TBF. Yet, little is known about the biomechanical alteration occurring to the spine after performing such a procedure. This study aimed at evaluating and comparing the post-operative biomechanical performance of stand-alone PPSF, stand-alone KP, and KP-augmented PPSF procedures. Novel 3D finite element models of the thoracolumbar junction mimicking the fractured spine and the three investigated procedures were developed and tested under physiological loading conditions. Spinal stiffness, stresses at the implanted hardware, and intradiscal pressure at adjacent segments were measured and compared. The results showed no major differences in all the measured parameters when stand-alone PPSF or KP-augmented PPSF procedures were simulated. In addition, it was shown that stand-alone KP may be a suitable approach in the attempt of restoring the stiffness of the intact spine. In conclusion, the results reported in this analysis suggest that, when treating TBF, the augmentation of PPSF with KP does not improve the biomechanical performance of the spine in the immediate post-operative term.

Copyright (c) 2018 by ASME
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