Anterior support reduces the stresses on the posterior instrumentation after pedicle subtraction osteotomy: a finite-element study

Andrea Luca, Claudia Ottardi, Alessio Lovi, Marco Brayda-Bruno, Tomaso Villa, Fabio Galbusera

Research output: Contribution to journalArticlepeer-review

Abstract

Study design: The investigation was based on finite-element simulations. Objective: Pedicle subtraction osteotomy (PSO) is an effective but technical demanding surgical technique, associated with a high risk of rod failure. The present study aims at investigating the role of the anterior support in combination with PSO, with a numerical comparative analysis. Methods: An osteotomy was simulated at the L3 level of a lumbosacral spine. An implantation of various combinations of devices for the anterior (1 or 2 cages of different material) and posterior stabilization (1 or 2 rods) was then performed. ROM, loads, and stresses acting on the rods were calculated. Results: A 4–8% reduction of the ROM was obtained introducing one or two cages in the instrumented model. However, the anterior support had only a minor influence on the ROM. The load on the posterior instrumentation decreased up to 8% using one cage and about 15% with two anterior devices. A 20–30% reduction of the stresses on the rods was calculated inserting one cage and up to 50% using two cages. Following the introduction of the anterior support, the greatest stress reduction was observed in the model having two cages and spinal fixators with two rods. Conclusions: The use of cages is crucial to ensure anterior support and decrease loads and stresses on the posterior instrumentation.

Original languageEnglish
Pages (from-to)450-456
Number of pages7
JournalEuropean Spine Journal
Volume26
DOIs
Publication statusPublished - Oct 1 2017

Keywords

  • Cages
  • Finite elements
  • Lumbar spine
  • Osteotomy
  • Pedicle subtraction osteotomy
  • Rods
  • Spinal fixators

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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