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      A Finite Element Based Comparative Study of Lumbosacral Pedicle Screw Fixation and Artificial Disc Replacement

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          Abstract

          The aim of this is to evaluate the biomechanical performance of double-level semirigid pedicle screw fixation and artificial intervertebral disc replacement in lumbar spine. Ti6Al4V and CFR-PEEK material are used for pedicle screw fixation and artificial disc replacement. In the present study, pedicle screw fixation and artificial intervertebral disc replacement are carried out between L3-L4-L5 regions under the application of moment 6,8,10 Nm and range of motion is compared during flexion, extension, and right-left lateral bending. Two-level pedicle screw fusion and total disc replacement are developed in the L3-L4-L5 of the lumber spine vertebrae. Carbon fiber reinforced (CFR-PEEK) and ultra-high molecular weight polyethylene (UHMWPE) are considered for the spinal fusion and the core part of the artificial disc respectively. Afterwards, applying the finite element analysis, it is detected that CFR-PEEK rod is able to increase range of motion at the implanted level in comparison to Ti6Al4V rod for both flexion–extension and lateral bending. In case of artificial intervertebral disc replacement hypermobility was observed. Hence, it is significant that rod material with CFR-PEEK is a better alternative for the treatment of degenerative diseases.

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          Most cited references40

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          PEEK biomaterials in trauma, orthopedic, and spinal implants.

          Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature.
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            Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members.

            A limited survey analysis of 617 surgical cases in which pedicle screw implants were used was undertaken to ascertain the incidence and variety of associated complications. The different implant systems used included variable spinal plating (n = 249), Edwards (n = 143), and AO fixateur interne (n = 101). The most common intraoperative problem was unrecognized screw misplacement (5.2%). Fracturing of the pedicle during screw insertion and iatrogenic cerebrospinal fluid leak occurred in 4.2% of cases. The postoperative deep infection rate was 4.2%. Transient neuropraxia occurred in 2.4% of cases, and permanent nerve root injury occurred in 2.3% of cases. Previously unreported injury to nerve roots occurred late in the postoperative course in three cases. Screw breakage occurred in 2.9% of cases. All other complications had an incidence of less than 2%. The authors conclude that pedicle screw placement may be associated with significant intraoperative and postoperative complications. This information is of value to surgeons using pedicle implant systems as well as to their patients. Repeat surgery is associated with greater numbers of complications.
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              Complications of pedicle screw fixation in scoliosis surgery: a systematic review.

              Systematic review. To review the published literature on the use of pedicle screws in pediatric spinal deformity to quantify the risks and complications associated with pedicle screw instrumentation, particularly in the thoracic spine. The use of pedicle screws in adolescent scoliosis surgery is common. Although many reports have been published regarding the use of pedicle screws in pediatric patients, there has been no systematic review on the risks of complications. PubMed, Ovid Medline, and Cochrane databases were searched for studies reporting the use of thoracic pedicle screws in pediatric deformity. We excluded articles dealing with neuromuscular scoliosis or bone dysplasia to focus mostly on adolescent thoracic idiopathic scoliosis and the likes. We then searched for cases reports dealing with thoracic pedicle screws complications. This systematic review retrieved 21 studies with a total of 4570 pedicle screws in 1666 patients. The mean age of the patients was 17.6 years; 812 patients were women and 252 were men, and 5 studies did not identify sex. Overall, 518 (4.2%) screws were reported as malpositioned. However, in studies in which postoperative computed tomography scans were done systematically, the rate of screw malpositioning was as high as 15.7%. The reported percentage of patients with screw malpositioned is around 11%. Eleven patients underwent revision surgery for instrumentation malposition. Other complications reported include loss of curve correction, intraoperative pedicle fracture or loosening, dural laceration, deep infection, pseudarthrosis, and transient neurologic injury. There were no major vascular complications reported in these 21 studies. We could identify 9 case report articles dealing with complications of pedicle screws. Such complications were mostly either vascular (10 cases) or neurologic (4 cases), without any irreversible complications. Malposition is the most commonly reported complication of thoracic pedicle screw placement, at a rate of 15.7% per screw inserted with postoperative computed tomography scans. The use of pedicle screws in the thoracic spine for the treatment of pediatric deformity has been reported to be safe despite the high rate of patients with malpositioned screws (11%). Major complications, such as neurologic or vascular injury, were almost never reported in this literature review of case series. Cases reports on the other hand have started to identify such complications.
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                Author and article information

                Journal
                Journal of Engineering and Science in Medical Diagnostics and Therapy
                ASME International
                2572-7958
                2572-7966
                August 01 2023
                August 01 2023
                March 13 2023
                : 6
                : 3
                Article
                10.1115/1.4056953
                b4b9d2c0-607a-487d-9996-534224afe0f3
                © 2023

                https://www.asme.org/publications-submissions/publishing-information/legal-policies

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