Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis

Publikation: Beitrag in FachzeitschriftArtikelForschungPeer-Review

Autoren

  • Meike Gierig
  • Fangrui Liu
  • Lukas Weiser
  • Wolfgang Lehmann
  • Peter Wriggers
  • Michele Marino
  • Dominik Saul

Organisationseinheiten

Externe Organisationen

  • Georg-August-Universität Göttingen
  • Università degli studi di Roma Tor Vergata
  • Mayo Clinic Rochester MN
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Details

OriginalspracheEnglisch
Aufsatznummer669321
FachzeitschriftFrontiers in Bioengineering and Biotechnology
Jahrgang9
PublikationsstatusVeröffentlicht - 26 Mai 2021

Abstract

Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.

ASJC Scopus Sachgebiete

Zitieren

Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis. / Gierig, Meike; Liu, Fangrui; Weiser, Lukas et al.
in: Frontiers in Bioengineering and Biotechnology, Jahrgang 9, 669321, 26.05.2021.

Publikation: Beitrag in FachzeitschriftArtikelForschungPeer-Review

Gierig, M, Liu, F, Weiser, L, Lehmann, W, Wriggers, P, Marino, M & Saul, D 2021, 'Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis', Frontiers in Bioengineering and Biotechnology, Jg. 9, 669321. https://doi.org/10.3389/fbioe.2021.669321
Gierig, M., Liu, F., Weiser, L., Lehmann, W., Wriggers, P., Marino, M., & Saul, D. (2021). Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis. Frontiers in Bioengineering and Biotechnology, 9, Artikel 669321. https://doi.org/10.3389/fbioe.2021.669321
Gierig M, Liu F, Weiser L, Lehmann W, Wriggers P, Marino M et al. Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis. Frontiers in Bioengineering and Biotechnology. 2021 Mai 26;9:669321. doi: 10.3389/fbioe.2021.669321
Gierig, Meike ; Liu, Fangrui ; Weiser, Lukas et al. / Biomechanical Effects of a Cross Connector in Sacral Fractures : A Finite Element Analysis. in: Frontiers in Bioengineering and Biotechnology. 2021 ; Jahrgang 9.
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title = "Biomechanical Effects of a Cross Connector in Sacral Fractures: A Finite Element Analysis",
abstract = "Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.",
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note = "Funding Information: The authors thank Lennart Viezens for his technical support. Funding. DS was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) ? 413501650. MG, MM, and PW acknowledge the Masterplan SMART BIOTECS (Ministry of Science and Culture of Lower Saxony, Germany). MM was also funded by the Ministry of Education, University and Research (Italy) in the 2017 Rita Levi Montalcini Program for Young Researchers.",
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Download

TY - JOUR

T1 - Biomechanical Effects of a Cross Connector in Sacral Fractures

T2 - A Finite Element Analysis

AU - Gierig, Meike

AU - Liu, Fangrui

AU - Weiser, Lukas

AU - Lehmann, Wolfgang

AU - Wriggers, Peter

AU - Marino, Michele

AU - Saul, Dominik

N1 - Funding Information: The authors thank Lennart Viezens for his technical support. Funding. DS was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) ? 413501650. MG, MM, and PW acknowledge the Masterplan SMART BIOTECS (Ministry of Science and Culture of Lower Saxony, Germany). MM was also funded by the Ministry of Education, University and Research (Italy) in the 2017 Rita Levi Montalcini Program for Young Researchers.

PY - 2021/5/26

Y1 - 2021/5/26

N2 - Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.

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