Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy

Abstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neg...

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Autores principales:	Luigi La Barbera, Hans-Joachim Wilke, Maria Luisa Ruspi, Marco Palanca, Christian Liebsch, Andrea Luca, Marco Brayda-Bruno, Fabio Galbusera, Luca Cristofolini
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/431f7dffc161498dbf7468ca444e50f0
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spelling	oai:doaj.org-article:431f7dffc161498dbf7468ca444e50f02021-12-02T14:11:28ZLoad-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy10.1038/s41598-021-83251-82045-2322https://doaj.org/article/431f7dffc161498dbf7468ca444e50f02021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-83251-8https://doaj.org/toc/2045-2322Abstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion–extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature.Luigi La BarberaHans-Joachim WilkeMaria Luisa RuspiMarco PalancaChristian LiebschAndrea LucaMarco Brayda-BrunoFabio GalbuseraLuca CristofoliniNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
description	Abstract Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion–extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature.
format	article
author	Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini
author_facet	Luigi La Barbera Hans-Joachim Wilke Maria Luisa Ruspi Marco Palanca Christian Liebsch Andrea Luca Marco Brayda-Bruno Fabio Galbusera Luca Cristofolini
author_sort	Luigi La Barbera
title	Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
title_short	Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
title_full	Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
title_fullStr	Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
title_full_unstemmed	Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
title_sort	load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/431f7dffc161498dbf7468ca444e50f0
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Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy

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