Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Effect of a Pedicle Screw Fixation System on Lumbar Spinal Segments: A Finite Element Study
Pedikül Vidalı Sabitleme Sisteminin Lomber Spinal Segmentler Üzerindeki Etkisi: Sonlu Elemanlar Çalışması
Saliha Zeyneb AKINCIa , Derya KARABULUTb , Suzan Cansel DOĞRUb , Hasan Kemal SÜRMENc , Onur YAMANd , Yunus Ziya ARSLANe
aDepartment of Biomedical Engineering and Bioinformatics, İstanbul Medipol University Faculty of Engineering and Natural Sciences, İstanbul, Türkiye
bDepartment of Mechanical Engineering, İstanbul University-Cerrahpaşa Faculty of Engineering, İstanbul, Türkiye
cDepartment of Automotive Technology, İstanbul University-Cerrahpaşa Vocational School of Technical Sciences, İstanbul, Türkiye
dClinic of Brain and Nerve Surgery, Memorial Bahçelievler Hospital, İstanbul, Türkiye
eDepartment of Robotics and Intelligent Systems, Turkish-German University Institute of Graduate Studies in Science and Engineering, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(4):372-81
doi: 10.5336/medsci.2023-99005
Article Language: EN
Full Text
ABSTRACT
 Objective: Spinal implants have been used to stimulate fusion by surgical adjustment and correct abnormal alignment of the vertebral column. Spinal fusion can cause some spinal disorders and hence describing the changes in biomechanical forces would help to understand these complications. In this study, we used two lumbar models. One of them is used without the fixed pedicle screw system, and the other one was used with that system. Therefore, we aimed to investigate the biomechanical effect of a pedicle screw fixation system on the lumbar functional spinal unit under applied forces. Material and Methods: Computed tomography data of a scoliotic patient was used for the construction of the lumbar models. The second and third vertebrae (L2- L3) of the lumbar spine, two facet joints, an intervertebral disc, and ligaments were constructed. A screw fixation system was employed and Von-Mises stress analysis was carried out for both models. Results: The von Mises stress distribution results showed that the presence of fixed implantation transmitted the compressive forces to the screws and rods in all directions and decreased the stress levels considerably by allowing to stabilize the model. The upper side of the L2 vertebra was the most affected region in flexion and lateral bending. However, the pedicle region had the maximum affected area under applied loads in extension and axial rotation. Conclusion: It was concluded that a fixed implant system preserves the maintenance of the vertebral column and decreases the stress on the adjacent spinal segments, especially for the intervertebral discs.

Keywords: Spine; lumbar vertebrae; finite element analysis; pedicle screws
ÖZET
 Amaç: Omurga implantları, cerrahi müdahale ile füzyonu hızlandırmaları ve omurganın anormal eğriliğini düzeltmek için kullanılmaktadır. Spinal füzyon bazı spinal bozukluklara neden olabilir ve bu nedenle füzyon ile lomber omurların komşu bölümlerine uygulanan biyomekanik kuvvetlerdeki değişiklikleri açıklamak, bu komplikasyonları anlamaya yardımcı olacaktır. Bu çalışmada iki tane lomber model kullanıldı. Bir tanesi sabit pedikül vida sistemi olmadan kullanıldı, diğeri ise bu sistem ile birlikte kullanıldı. Bu sebeple, bu çalışmada lomber fonksiyonel omurga biriminde pedikül vida sisteminin uygulanan kuvvetler altındaki biyomekanik etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Skolyoz bir hastanın bilgisayarlı tomografi verileri lomber omurganın temel birimini oluşturmak için kullanılmıştır. Lomber omurganın ikinci ve üçüncü omurları (L2-L3), iki tane faset eklem, bir tane omurlar arası disk ve bağ dokuları oluşturulmuştur. Bir titanyum vida sabitleme sistemi tasarlanmış ve Von Mises gerilme analizleri intakt (implant olmayan sistemler) ve implant olan sistemler için uygulanmıştır. Bulgular: Von Mises gerilme dağılımı sonuçları, sabit implantasyonun olması durumunda baskı yapan kuvvetlerin vidalara ve çubuklara tüm yönlerde iletildiğini göstermiştir ve gerilme seviyelerini önemli ölçüde azaltarak modelin dengede durmasına olanak sağlamıştır. L2 omurunun en üst bölümünün fleksiyon ve yana eğilmede en fazla etkilenen bölge olmuştur. Ancak uygulanan yükler altındaki ekstansiyon ve aksiyal rotasyonda pedikül bölümü en çok etkilenen alan olmuştur. Sonuç: Sabit bir implant sisteminin omurganın bütünlüğünü koruduğu ve özellikle omurlar arası diskler için komşu bölümler üzerindeki gerilmeyi azalttığı sonucuna varılmıştır.

Anahtar Kelimeler: Omurga; lomber omur; sonlu eleman analizi; pedikül vidaları
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