Biomechanical effects of cement neck and interspinous process device on locking lumbar interbody cementation

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-05-07 DOI:10.1016/j.clinbiomech.2025.106554

Shang-Chih Lin , Yu-Kun Xu , Che-Wei Liu , Kung Chia Li

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引用次数: 0

Abstract

Background

Locking lumbar interbody cementation is a surgical option in patients with osteoporosis and low mobility. It can quickly stabilize the spine construct and prevent cage subsidence. However, establishing a stable bridging neck cement between the vertebrae and disc is a key procedure.

Methods

The validated lumbosacral model analyzed the stress cracking risks for five cement neck diameters under flexion, extension, bending, and twisting. The key indices included disc mobility and neck stress. The biomechanical impact of the interspinous process device was evaluated in high-stress fracture-prone necks.

Findings

The neck diameter has a significant impact on neck stress, especially extension. The maximum neck stress with a 4-mm diameter was very close to the ultimate tensile strength (25.4 MPa) of cement, inducing a high risk of neck fracture. Generally, neck fractures have little effect on disc mobility during flexion, bending, and twisting. However, after the fracture, neck failure led to a 17.1 % increase in disc mobility during extension. If the neck diameter was less than 5 mm on intraoperative radiography, the interspinous process device effectively reduced neck stress by 51.1 % during extension and 31.7 % during bending.

Interpretation

To improve neck strength, the neck diameter should be increased to at least 5 mm during the surgery. If the strength is inadequate, an interspinous process device can be considered to further minimize the risk of fractures, particularly during extension and bending movements.

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骨水泥颈棘突装置锁定腰椎椎间骨水泥的生物力学效应

背景锁定腰椎椎体间骨水泥是骨质疏松症和低活动能力患者的一种手术选择。它可以快速稳定脊柱结构，防止笼形沉降。然而，在椎体和椎间盘之间建立稳定的桥接颈骨水泥是一个关键步骤。方法采用经验证的腰骶模型，分析5种水泥颈径在屈伸弯曲扭转作用下的应力开裂风险。主要指标为椎间盘活动度和颈部应力。在高应力易骨折的颈部评估棘突间装置的生物力学影响。研究结果：颈径对颈部应力有显著影响，尤其是颈部伸度。4 mm直径的最大颈应力非常接近水泥的极限抗拉强度（25.4 MPa），导致颈骨折的风险很高。一般来说，颈部骨折在屈曲、弯曲和扭转过程中对椎间盘活动几乎没有影响。然而，骨折后，颈部失效导致伸展时椎间盘活动度增加17.1%。如果术中x线片显示颈直径小于5mm，棘间突装置可有效降低颈应力，在伸展时降低51.1%，在弯曲时降低31.7%。为提高颈部力量，术中应将颈部直径增加至至少5mm。如果强度不足，可以考虑采用棘突间固定装置，以进一步减少骨折的风险，特别是在伸展和弯曲运动时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.