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dc.contributor.author
Fasser, Marie-Rosa
dc.contributor.author
Gerber, Gabriela
dc.contributor.author
Passaplan, Caroline
dc.contributor.author
Cornaz, Frédéric
dc.contributor.author
Snedeker, Jess Gerrit
dc.contributor.author
Farshad, Mazda
dc.contributor.author
Widmer, Jonas
dc.date.accessioned
2022-10-20T07:24:12Z
dc.date.available
2022-05-01T02:52:39Z
dc.date.available
2022-06-16T13:05:27Z
dc.date.available
2022-10-20T07:24:12Z
dc.date.issued
2022
dc.identifier.issn
0940-6719
dc.identifier.issn
1432-0932
dc.identifier.other
10.1007/s00586-022-07187-x
en_US
dc.identifier.uri
http://hdl.handle.net/20.500.11850/544524
dc.identifier.doi
10.3929/ethz-b-000544524
dc.description.abstract
Purpose Pedicle screw loosening is a frequent complication in lumbar spine fixation, most commonly among patients with poor bone quality. Determining patients at high risk for insufficient implant stability would allow clinicians to adapt the treatment accordingly. The aim of this study was to develop a computational model for quantitative and reliable assessment of the risk of screw loosening. Methods A cohort of patient vertebrae with diagnosed screw loosening was juxtaposed to a control group with stable fusion. Imaging data from the two cohorts were used to generate patient-specific biomechanical models of lumbar instrumented vertebral bodies. Single-level finite element models loading the screw in axial or caudo-cranial direction were generated. Further, multi-level models incorporating individualized joint loading were created. Results The simulation results indicate that there is no association between screw pull-out strength and the manifestation of implant loosening (p = 0.8). For patient models incorporating multiple instrumented vertebrae, CT-values and stress in the bone were significantly different between loose screws and non-loose screws (p = 0.017 and p = 0.029, for CT-values and stress, respectively). However, very high distinction (p = 0.001) and predictability (R-Pseudo(2) = 0.358, AUC = 0.85) were achieved when considering the relationship between local bone strength and the predicted stress (loading factor). Screws surrounded by bone with a loading factor higher than 25% were likely to be loose, while the chances of screw loosening were close to 0 with a loading factor below 15%. Conclusion The use of a biomechanics-based score for risk assessment of implant fixation failure might represent a paradigm shift in addressing screw loosening after spondylodesis surgery.
en_US
dc.format
application/pdf
en_US
dc.language.iso
en
en_US
dc.publisher
Springer
en_US
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject
Lumbar spine
en_US
dc.subject
Spondylodesis surgery
en_US
dc.subject
Pedicle screw fixation strength
en_US
dc.subject
Finite element simulations
en_US
dc.subject
Musculoskeletal modeling
en_US
dc.title
Computational model predicts risk of spinal screw loosening in patients
en_US
dc.type
Journal Article
dc.rights.license
Creative Commons Attribution 4.0 International
dc.date.published
2022-04-23
ethz.journal.title
European Spine Journal
ethz.journal.volume
31
en_US
ethz.journal.abbreviated
Eur Spine J
ethz.pages.start
2639
en_US
ethz.pages.end
2649
en_US
ethz.version.deposit
publishedVersion
en_US
ethz.identifier.wos
ethz.identifier.scopus
ethz.publication.place
New York, NY
ethz.publication.status
published
en_US
ethz.leitzahl
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02070 - Dep. Gesundheitswiss. und Technologie / Dep. of Health Sciences and Technology::02518 - Institut für Biomechanik / Institute for Biomechanics::03822 - Snedeker, Jess G. / Snedeker, Jess G.
ethz.leitzahl.certified
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02070 - Dep. Gesundheitswiss. und Technologie / Dep. of Health Sciences and Technology::02518 - Institut für Biomechanik / Institute for Biomechanics::03822 - Snedeker, Jess G. / Snedeker, Jess G.
ethz.date.deposited
2022-05-01T02:53:15Z
ethz.source
WOS
ethz.eth
yes
en_US
ethz.availability
Open access
en_US
ethz.rosetta.installDate
2022-10-20T07:24:13Z
ethz.rosetta.lastUpdated
2024-02-02T18:46:28Z
ethz.rosetta.versionExported
true
ethz.COinS
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