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Expandable pedicle screw may have better fixation than normal pedicle screw: preclinical investigation on instrumented L4-L5 vertebrae based on various physiological movements

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Abstract

Lumbar spine fracture is typically treated by means of screw fixation, the primary aim of which is to reduce fracture by achieving bony union such that the spinal anatomy is restored. Pedicle screw fixation has certain advantages over conventional vertebral screws, e.g. 3-column fixation and improved surgical alignment. However, expandable pedicle screws have been reported to impart better anchorage as compared to conventional pedicle screws, both in case of healthy and osteoporotic bone. The clinical studies notwithstanding, there is a paucity of preclinical investigations on expandable pedicle screws used on lumbar vertebrae. By employing anatomically viable FE models, the present study intended to estimate stress–strain fields of a functional spinal unit (FSU) of intact L4-L5 vertebra and to further compare the same with FSUs instrumented with normal and expandable pedicle screws under different physiological loading condition. The various physiological loading regimes appeared to have significant influence on the overall load transfer in the L4-L5 vertebrae. The expandable pedicle screw predicted marginally improved anchorage as compared to the normal pedicle screws, with more contact area with the bone resulting in higher stresses (~ 1.6 MPa) and high strain at the contact sites. This is indicative of improved stability albeit having marginally greater risk of screw pullout. Greater area (15–80%) with peak stresses at the bone-screw interfaces also indicates lesser degree of stress shielding. Thus, stability aside, one may expect to have lower loosening issues too with the use of expandable pedicle screws.

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  • 08 July 2022

    Springer Nature’s version of this paper was updated to present the correct DOI of reference 36.

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Acknowledgements

The authors would like to acknowledge the computational facilities available at the Biomechanics Laboratory of the Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, which has helped carry out this study. The authors would like to thank Rahul Gautam Talukdar, PhD scholar, IIT Kharagpur for his valued help. The authors would also like to acknowledge Dr. Chandralekha Baruah, MD Radiodiagnosis, Senior Resident, Dr. Ram Manohar Lohia Hospital and ABVIMS, New Delhi, and Dr. Udit Chahal, MS Orthopedics, Fellow in Arthroplasty, Max Hospital, Mohali, for their valuable input. The study has been partially supported by SERB, India (Grant no. SRG/2019/000235).

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  1. Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India

    Devismita Sanjay, Jaideep Singh Bhardwaj, Neeraj Kumar & Souptick Chanda

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Sanjay, D., Bhardwaj, J.S., Kumar, N. et al. Expandable pedicle screw may have better fixation than normal pedicle screw: preclinical investigation on instrumented L4-L5 vertebrae based on various physiological movements. Med Biol Eng Comput 60, 2501–2519 (2022). https://doi.org/10.1007/s11517-022-02625-w

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