Chenyu Jiang, Hanqiang Ouyang, Yali Li, Ning Lang, Yan Zhang, Liang Jiang, Huishu Yuan
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Hounsfield unit (HU) values and volumetric bone mineral density (vBMD) of the screw trajectory were also assessed for osteoporosis evaluation. The pullout force and osteoporotic assessment value were compared between PSL and controls.</p><p><strong>Results: </strong>Craniocaudal cyclic loading significantly reduced the pullout force (924.3 ± 195.1 N vs. 745.2 ± 188.7 N, p < 0.0001). The PSL group had a lower pullout force under cyclic load (629.6 ± 188.2 N vs. 836.9 ± 131.6 N, p < 0.0001) and lower HU value of screw trajectories (183.7 ± 42.6 vs. 206.7 ± 29.72, p = 0.026) than controls, while simple axial pullout force and vBMD showed no significant differences. Receiver operating characteristic (ROC) analysis indicated that pullout force under cyclic load (AUC = 0.806) was a better predictor of PSL than HU values (AUC = 0.629).</p><p><strong>Conclusion: </strong>This study demonstrates the critical role of craniocaudal cyclic loading in pedicle screw fixation strength and its predictive value for PSL. Craniocaudal cyclic load reduces screw fixation strength significantly. Pullout force under cyclic load assessed by CT-FEA enhances the predictive accuracy for PSL risk.</p>","PeriodicalId":12444,"journal":{"name":"Frontiers in Bioengineering and Biotechnology","volume":"13 ","pages":"1542352"},"PeriodicalIF":4.3000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973385/pdf/","citationCount":"0","resultStr":"{\"title\":\"Craniocaudal cyclic load improves risk assessment of lumbar pedicle screw loosening: finite element analysis based on computer tomography.\",\"authors\":\"Chenyu Jiang, Hanqiang Ouyang, Yali Li, Ning Lang, Yan Zhang, Liang Jiang, Huishu Yuan\",\"doi\":\"10.3389/fbioe.2025.1542352\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pedicle screw loosening (PSL) is a frequent complication in osteoporotic patients undergoing spinal fixation, yet effective risk assessment methods are limited. This study explores the impact of craniocaudal cyclic load on pedicle screw fixation strength using computed tomography-based finite element analysis (CT-FEA) and evaluates its predictive value for PSL.</p><p><strong>Methods: </strong>A total of 23 PSL cases (7 men and 16 women) and 29 matched controls were analyzed using CT-FEA. Both a simple axial pullout load and a pullout load with a preset craniocaudal cyclic load were applied to calculate the pullout force. Hounsfield unit (HU) values and volumetric bone mineral density (vBMD) of the screw trajectory were also assessed for osteoporosis evaluation. The pullout force and osteoporotic assessment value were compared between PSL and controls.</p><p><strong>Results: </strong>Craniocaudal cyclic loading significantly reduced the pullout force (924.3 ± 195.1 N vs. 745.2 ± 188.7 N, p < 0.0001). The PSL group had a lower pullout force under cyclic load (629.6 ± 188.2 N vs. 836.9 ± 131.6 N, p < 0.0001) and lower HU value of screw trajectories (183.7 ± 42.6 vs. 206.7 ± 29.72, p = 0.026) than controls, while simple axial pullout force and vBMD showed no significant differences. Receiver operating characteristic (ROC) analysis indicated that pullout force under cyclic load (AUC = 0.806) was a better predictor of PSL than HU values (AUC = 0.629).</p><p><strong>Conclusion: </strong>This study demonstrates the critical role of craniocaudal cyclic loading in pedicle screw fixation strength and its predictive value for PSL. Craniocaudal cyclic load reduces screw fixation strength significantly. 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引用次数: 0
摘要
背景：椎弓根螺钉松动（PSL）是骨质疏松患者脊柱固定术中常见的并发症，但有效的风险评估方法有限。本研究利用基于计算机断层扫描的有限元分析（CT-FEA）探讨颅-趾循环载荷对椎弓根螺钉固定强度的影响，并评估其对PSL的预测价值。方法：对23例PSL患者（男7例，女16例）和29例对照者进行CT-FEA分析。采用简单的轴向拉拔载荷和预设的颅侧循环拉拔载荷计算拉拔力。同时评估螺钉轨迹的Hounsfield单位（HU）值和体积骨矿物质密度（vBMD）以评估骨质疏松症。比较PSL组与对照组的拔牙力及骨质疏松评价值。结果：颅-趾循环载荷显著降低拔牙力（924.3±195.1 N vs. 745.2±188.7 N, p < 0.0001）。PSL组在循环载荷下的拔牙力（629.6±188.2 N比836.9±131.6 N, p < 0.0001）和螺钉轨迹HU值（183.7±42.6比206.7±29.72,p = 0.026）低于对照组，而单纯轴向拔牙力和vBMD差异无统计学意义。受试者工作特征（ROC）分析表明，循环载荷下的拔出力（AUC = 0.806）比HU值（AUC = 0.629）更能预测PSL。结论：本研究表明颅-趾循环载荷在椎弓根螺钉固定强度中的关键作用及其对PSL的预测价值。颅侧循环载荷显著降低螺钉固定强度。ct -有限元法评估循环荷载下的拉拔力，提高了对PSL风险的预测精度。
Craniocaudal cyclic load improves risk assessment of lumbar pedicle screw loosening: finite element analysis based on computer tomography.
Background: Pedicle screw loosening (PSL) is a frequent complication in osteoporotic patients undergoing spinal fixation, yet effective risk assessment methods are limited. This study explores the impact of craniocaudal cyclic load on pedicle screw fixation strength using computed tomography-based finite element analysis (CT-FEA) and evaluates its predictive value for PSL.
Methods: A total of 23 PSL cases (7 men and 16 women) and 29 matched controls were analyzed using CT-FEA. Both a simple axial pullout load and a pullout load with a preset craniocaudal cyclic load were applied to calculate the pullout force. Hounsfield unit (HU) values and volumetric bone mineral density (vBMD) of the screw trajectory were also assessed for osteoporosis evaluation. The pullout force and osteoporotic assessment value were compared between PSL and controls.
Results: Craniocaudal cyclic loading significantly reduced the pullout force (924.3 ± 195.1 N vs. 745.2 ± 188.7 N, p < 0.0001). The PSL group had a lower pullout force under cyclic load (629.6 ± 188.2 N vs. 836.9 ± 131.6 N, p < 0.0001) and lower HU value of screw trajectories (183.7 ± 42.6 vs. 206.7 ± 29.72, p = 0.026) than controls, while simple axial pullout force and vBMD showed no significant differences. Receiver operating characteristic (ROC) analysis indicated that pullout force under cyclic load (AUC = 0.806) was a better predictor of PSL than HU values (AUC = 0.629).
Conclusion: This study demonstrates the critical role of craniocaudal cyclic loading in pedicle screw fixation strength and its predictive value for PSL. Craniocaudal cyclic load reduces screw fixation strength significantly. Pullout force under cyclic load assessed by CT-FEA enhances the predictive accuracy for PSL risk.
期刊介绍：
The translation of new discoveries in medicine to clinical routine has never been easy. During the second half of the last century, thanks to the progress in chemistry, biochemistry and pharmacology, we have seen the development and the application of a large number of drugs and devices aimed at the treatment of symptoms, blocking unwanted pathways and, in the case of infectious diseases, fighting the micro-organisms responsible. However, we are facing, today, a dramatic change in the therapeutic approach to pathologies and diseases. Indeed, the challenge of the present and the next decade is to fully restore the physiological status of the diseased organism and to completely regenerate tissue and organs when they are so seriously affected that treatments cannot be limited to the repression of symptoms or to the repair of damage. This is being made possible thanks to the major developments made in basic cell and molecular biology, including stem cell science, growth factor delivery, gene isolation and transfection, the advances in bioengineering and nanotechnology, including development of new biomaterials, biofabrication technologies and use of bioreactors, and the big improvements in diagnostic tools and imaging of cells, tissues and organs.
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