Finite element analysis of percutaneous vertebroplasty combined with pedicle augmentation in treatment of severe osteoporotic vertebral fractures

doi:10.12307/2025.109

Abstract

Abstract: BACKGROUND: Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell’s disease and osteolytic metastases of the pedicle. However, the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.
OBJECTIVE: A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.
METHODS: A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture (L1) was selected. Preoperative and postoperative CT files were extracted. The study range was T12 to L2, including the injured vertebra, adjacent vertebrae, and intervertebral discs. Software like Mimics, SolidWorks, and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery. A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion, extension, lateral bending, and rotation, analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.

RESULTS AND CONCLUSION: (1) Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established. (2) We calculated and analyzed that under simulated load, the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery, with no significant difference compared with before surgery (P > 0.05). The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery (P > 0.05). Similarly, the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced (P < 0.05). (3) Therefore, percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress, ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: pedicle augmentation, osteoporotic vertebral fracture, vertebroplasty, stress, finite element model, bone cement

CLC Number:

Li Hongtao, Pan Hongyu, Lei Yang, Xiao Changming. Finite element analysis of percutaneous vertebroplasty combined with pedicle augmentation in treatment of severe osteoporotic vertebral fractures[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(15): 3089-3094.

Figures/Tables 3

2.2 有限元模型的有效性验证模型有效性根据已发表的有限元模型进行验证，此次研究制备的模型在不同载荷方向下的角位移与既往报道相同边界条件和加载条件下的三维有限元分析实验研究结果数据接近[12]，证实了此次实验模型的有效性。 2.3 不同载荷方向下邻近椎体终板与椎间盘的最大应力值比较与分布情况不同部位的应力分布见表3及图5，6。在前屈、后伸、侧弯及旋转状态下，术前T12下终板最大的von Mise应力值分别为1.933 0，1.743 7，1.760 9，1.677 6，1.637 3及1.554 0 MPa；术后T12下终板的应力分布更均匀，最大的von Mise应力值较术前均减小，分别为1.927 8，1.645 0，1.749 3，1.630 3，1.627 0及1.549 9 MPa，但与术前相比无显著差异(P > 0.05)。术前L2上终板最大的von Mise应力值分别为3.051 9，4.161 5，3.861 1，3.403 1，3.724 9及3.492 6 MPa；术后L2上终板的应力分布也更均匀，最大的von Mise应力值分别为3.068 0，4.138 9，3.851 6， 3.436 4，3.714 4及3.496 7 MPa。其中术后前屈、右侧弯以及右旋转状态下L2上终板最大的von Mise应力值稍有增加(分别为3.068 0，3.436 4和3.496 7 MPa)，但术后所有最大的von Mise应力值与术前相比并无显著差异(P > 0.05)。在前屈、后伸、侧弯及旋转状态下，术前T12/L1椎间盘最大von Mise应力值分别为1.519 2，1.905 2，1.852 6， 1.480 2，1.655 6及1.508 9 MPa；术后T12/L1椎间盘应力较术前相比分布更均匀，最大von Mise应力值均减小，分别为1.253 3，1.610 9，1.640 5，1.439 7，1.415 0及1.439 2 MPa，与术前相比存在显著差异(P < 0.05)。同样的，术前L1/L2椎间盘最大von Mise应力值分别为1.804 6，2.510 5，2.199 0，2.280 9，2.138 3及2.179 8 MPa；术后L1/L2椎间盘应力较术前相比分布也更均匀，最大von Mise应力值均减小，分别为1.761 7，2.453 6，2.130 0，2.228 8，2.089 7及2.128 6 MPa，与术前相比差异有显著性意义(P < 0.05)。"

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