title: The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis.
abstract: Posterior instrumentation is a common fixation method used to treat thoracolumbar burst fractures. However, the role of different cross-link configurations in improving fixation stability in these fractures has not been established. A 3D finite element model of T11-L3 was used to investigate the biomechanical behavior of short (2 level) and long (4 level) segmental spine pedicle screw fixation with various cross-links to treat a hypothetical L1 vertebra burst fracture. Three types of cross-link configurations with an applied moment of 7.5 Nm and 200 N axial force were evaluated. The long construct was stiffer than the short construct irrespective of whether the cross-links were used (p < 0.05). The short constructs showed no significant differences between the cross-link configurations. The XL cross-link provided the highest stiffness and was 14.9% stiffer than the one without a cross-link. The long construct resulted in reduced stress to the adjacent vertebral bodies and screw necks, with 66.7% reduction in bending stress on L2 when the XL cross-link was used. Thus, the stability for L1 burst fracture fixation was best achieved by using long segmental posterior instrumentation constructs and an XL cross-link configuration. Cross-links did not improved stability when a short structure was used.
authors: Medical Implant Technology Group (MEDITEG), Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
authors: Mina
authors: M
authors: Alizadeh
authors: Mohammed Rafiq Abdul
authors: MR
authors: Kadir
authors: Miskon Mohd
authors: MM
authors: Fadhli
authors: Ali
authors: A
authors: Fallahiarezoodar
authors: Baharudin
authors: B
authors: Azmi
authors: Malliga Raman
authors: MR
authors: Murali
authors: Tunku
authors: T
authors: Kamarul
mesh_terms: D000328:Adult; D001863:Bone Screws; D003198:Computer Simulation; D055119:Elastic Modulus; D019544:Equipment Failure Analysis; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008954:Models, Biological; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
keywords: biomechanics; burst fracture; finite element analysis; orthopedic; pedicle screw instrumentation