Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress
Introduction: This study aimed to compare the biomechanical stress at the proximal junctional aspect between the conventional pedicle screw (PS) fixation (PSF) and the low PS density fixation (LPF) method. Methods: This study involved 10 patients, half of whom have non-osteoporosis and the other hal...
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The Japanese Society for Spine Surgery and Related Research
2025-03-01
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| Series: | Spine Surgery and Related Research |
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| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0169/_pdf/-char/en |
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| author | Takuhei Kozaki Takachika Shimizu Akimasa Murata Ryuichiro Nakanishi Takahiro Kozaki Ei Yamamoto Shunji Tsutsui Mamoru Kawakami Hiroshi Yamada |
| author_facet | Takuhei Kozaki Takachika Shimizu Akimasa Murata Ryuichiro Nakanishi Takahiro Kozaki Ei Yamamoto Shunji Tsutsui Mamoru Kawakami Hiroshi Yamada |
| author_sort | Takuhei Kozaki |
| collection | DOAJ |
| description | Introduction: This study aimed to compare the biomechanical stress at the proximal junctional aspect between the conventional pedicle screw (PS) fixation (PSF) and the low PS density fixation (LPF) method.
Methods: This study involved 10 patients, half of whom have non-osteoporosis and the other half have osteoporosis. We made two types of intact models (one is from the upper thoracic-to-pelvis model, and the other is from the lower thoracic-to-pelvis model). From the intact models, we constructed two kinds of fusion models: (1) PSF and (2) LPF. The LPF method was as follows: The claw hooks (the combination of the down-going transverse process hooks and facet hooks) were set at the upper instrumented vertebra (UIV) and sublaminar wires at the thoracic spine and PSs at the lumbo-pelvis.
Results: Upper thoracic to pelvis fixation model
In non-osteoporosis, no significant difference between the PSF and LPF is found. In osteoporosis, the von Mises stresses of the vertebra body at UIV, UIV+1, and disc were significantly lower in LPF than in PSF.
Lower thoracic-to-pelvis fixation model
In non-osteoporosis, the average von Mises stress of the vertebral body at UIV+1 and the maximum stress at UIV were lower in LPF than in PSF; however, no significant difference was found in the others. In osteoporosis, the von Mises stress was significantly lower in LPF than in PSF.
Conclusions: The claw hooks stabilized the vertebra body at UIV firmly, and sublaminar wires reduced load translation from the fixed spine. |
| format | Article |
| id | doaj-art-3efa11a494e449ea890a5a5d163a4a7a |
| institution | DOAJ |
| issn | 2432-261X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj-art-3efa11a494e449ea890a5a5d163a4a7a2025-08-20T03:08:37ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2025-03-019220221010.22603/ssrr.2024-01692024-0169Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction StressTakuhei Kozaki0Takachika Shimizu1Akimasa Murata2Ryuichiro Nakanishi3Takahiro Kozaki4Ei Yamamoto5Shunji Tsutsui6Mamoru Kawakami7Hiroshi Yamada8Department of Orthopaedic Surgery, Wakayama Medical UniversityDepartment of Orthopaedic Surgery, Gunma Spine Center (Harunaso Hospital)Department of Orthopaedic Surgery, Wakayama Medical UniversityDepartment of Orthopaedic Surgery, Wakayama Medical UniversityDepartment of Orthopaedic Surgery, Wakayama Medical UniversityDepartment of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai UniversityDepartment of Orthopaedic Surgery, Wakayama Medical UniversityDepartment of Orthopaedic Surgery, Saiseikai Wakayama HospitalDepartment of Orthopaedic Surgery, Wakayama Medical UniversityIntroduction: This study aimed to compare the biomechanical stress at the proximal junctional aspect between the conventional pedicle screw (PS) fixation (PSF) and the low PS density fixation (LPF) method. Methods: This study involved 10 patients, half of whom have non-osteoporosis and the other half have osteoporosis. We made two types of intact models (one is from the upper thoracic-to-pelvis model, and the other is from the lower thoracic-to-pelvis model). From the intact models, we constructed two kinds of fusion models: (1) PSF and (2) LPF. The LPF method was as follows: The claw hooks (the combination of the down-going transverse process hooks and facet hooks) were set at the upper instrumented vertebra (UIV) and sublaminar wires at the thoracic spine and PSs at the lumbo-pelvis. Results: Upper thoracic to pelvis fixation model In non-osteoporosis, no significant difference between the PSF and LPF is found. In osteoporosis, the von Mises stresses of the vertebra body at UIV, UIV+1, and disc were significantly lower in LPF than in PSF. Lower thoracic-to-pelvis fixation model In non-osteoporosis, the average von Mises stress of the vertebral body at UIV+1 and the maximum stress at UIV were lower in LPF than in PSF; however, no significant difference was found in the others. In osteoporosis, the von Mises stress was significantly lower in LPF than in PSF. Conclusions: The claw hooks stabilized the vertebra body at UIV firmly, and sublaminar wires reduced load translation from the fixed spine.https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0169/_pdf/-char/enlow pedicle screw density fixationthoracic claw hookssublaminar wiresosteoporosisproximal junctional kyphosisfinite element analysis |
| spellingShingle | Takuhei Kozaki Takachika Shimizu Akimasa Murata Ryuichiro Nakanishi Takahiro Kozaki Ei Yamamoto Shunji Tsutsui Mamoru Kawakami Hiroshi Yamada Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress Spine Surgery and Related Research low pedicle screw density fixation thoracic claw hooks sublaminar wires osteoporosis proximal junctional kyphosis finite element analysis |
| title | Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress |
| title_full | Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress |
| title_fullStr | Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress |
| title_full_unstemmed | Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress |
| title_short | Advantages of Combined Use of Claw Hooks and Sublaminar Wires as the Upper Foundation of Long Fixation from the Thoracic Spine to the Pelvis in Osteoporotic Cases: A Finite Element Analysis of Proximal Junction Stress |
| title_sort | advantages of combined use of claw hooks and sublaminar wires as the upper foundation of long fixation from the thoracic spine to the pelvis in osteoporotic cases a finite element analysis of proximal junction stress |
| topic | low pedicle screw density fixation thoracic claw hooks sublaminar wires osteoporosis proximal junctional kyphosis finite element analysis |
| url | https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0169/_pdf/-char/en |
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