Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (33): 5249-5253.doi: 10.12307/2021.309

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Cervical spondylosis with osteoporosis treated by the new pedicle fixation system through the anterior cervical approach with three-dimensional printing technology: three-dimensional finite element analysis

Yang Jiujie1, 2, Wang Tao1, Li Zhi1, Yang Lifeng1, Tian Ye3, Bi Zheng4, Zeng Yaling2   

  1. 1Department of Orthopedics, Affiliated Central Hospital of Shenyang Medical College, Shenyang 110034, Liaoning Province, China; 2Macao University of science and technology, Macao Special Administration Region, China; 3Department of Orthopedics, Peking Union Medical College Hospital, Beijing 100000, China; 4Beijing Medical Implant Engineering Technology Research Center, Beijing 100082, China
  • Received:2021-03-16 Revised:2021-04-06 Accepted:2021-04-14 Online:2021-11-28 Published:2021-08-02
  • Contact: Li Zhi, MD, Chief physician, Department of Orthopedics, Affiliated Central Hospital of Shenyang Medical College, Shenyang 110034, Liaoning Province, China
  • About author:Yang Jiujie, Doctoral candidate, Department of Orthopedics, Affiliated Central Hospital of Shenyang Medical College, Shenyang 110034, Liaoning Province, China; Macao University of science and technology, Macao Special Administration Region, China
  • Supported by:
    Key Research and Development Project Fund of Liaoning Provincial Department of Science and Technology, No. 2017225066 (to LZ)

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Abstract: BACKGROUND: In osteoporosis patients, the stability of cervical spine after internal fixation is poor; the fracture healing process is slow; and the risk of re-fracture at the same site and other sites is significantly increased. Therefore, it is necessary to design a new method of anterior internal fixation to reduce complications and surgical revision rate.  
OBJECTIVE: To design a new fixation system for the treatment of cervical spondylosis with osteoporosis through the anterior pedicle approach using three-dimensional (3D) finite element analysis and 3D printing technology, which is beneficial to improve the stability of the patient’s cervical spine after surgery.
METHODS:  3D CT data of 15 healthy cervical spine patients and 15 osteoporosis patients who were examined in the Department of Orthopedics, Affiliated Central Hospital of Shenyang Medical College from December 2017 to December 2019 were collected. The cervical spine models of 30 patients were constructed by 3D printing technology. A new nail plate internal fixation system was designed based on the pedicle positioning guide. 3D models were subjected to the vertebral pedicle fixation through the anterior approach guided by the localizer under external conditions. The prepared postoperative models were connected to the computer for finite element analysis and biomechanical analysis, and the best nail plate internal fixation system was designed based on the analysis results.  
RESULTS AND CONCLUSION: (1) 3D printing technology was used to successfully construct the cervical spine models of osteoporosis patients, as well as the anterior vertebral pedicle fixation and positioning guide and the anterior vertebral pedicle fixation nail plate system. (2) Finite element biomechanics analysis results showed that the bone mass of patients with severe osteoporosis was significantly higher than that of normal bone by torsional displacement and rotation angle. The addition of screws did not significantly improve the torsional deformation of the anterioposterior bending and the left and right bending. The addition of screws had a significant improvement in the deformation of the axial torsional load. (3) The results indicated that the trial designed a vertebral pedicle internal fixation nail plate system for the anterior cervical approach using 3D printing technology, confirming that 3D printing technology can successfully assist the cervical spine through anterior pedicle fixation for cervical spondylosis combined with osteoporosis.

Key words: bone, cervical spine, 3D printing technology, osteoporosis, pedicle, fixation, finite element analysis

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