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Iatrogenic vertebral fracture in ankylosed spine during liver transplantation: a case report and biomechanical study using finite element method

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Abstract

Purpose

The occurrence of an iatrogenic vertebral fracture during non-spinal digestive surgery is an exceptional event that has not been previously documented. Our study aims to explain the occurrence of this fracture from a biomechanical perspective, given its rarity. Using a finite element model of the spine, we will evaluate the strength required to induce a vertebral fracture through a hyperextension mechanism, considering the structure of the patient's spine, whether it is ossified or healthy.

Methods

A 70-year-old patient was diagnosed T12 fracture during a liver transplantation on ankylosed spine. We use a finite element model of the spine. Different mechanical properties were applied to the spine model: first to a healthy spine, the second to a osteoporotic ossified spine. The displacement and force imposed at the Sacrum, the time and location of fractures initiation were recorded and compared between the two spine conditions.

Results

A surgical treatment is done associating decompression with posterior fixation. After biomechanical study, we found that the fracture initiation occurred for the ossified spine after a sacrum displacement of 29 mm corresponding to an applied force of 65 N. For the healthy spine it occurred at a sacrum displacement of 52 mm corresponding to an applied force of 350 N.

Conclusion

The force required to produce a type B fracture in an ankylosed spine is 5 times less than in a healthy spine. These data enable us to propose several points of management to avoid unexpected complications with ankylosed spines during surgical procedures.

Level of evidence

IV.

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Authors and Affiliations

  1. Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, CHU Bordeaux, France

    Maxime Huneidi

  2. Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France

    Nicolas Bailly & Pierre-Jean Arnoux

  3. Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France

    Kaissar Farah, Adrien May & Stéphane Fuentes

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  1. Maxime Huneidi
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Correspondence to Maxime Huneidi.

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SF: Medtronic, stryker consultant. Other: None.

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Huneidi, M., Bailly, N., Farah, K. et al. Iatrogenic vertebral fracture in ankylosed spine during liver transplantation: a case report and biomechanical study using finite element method. Eur Spine J 33, 1332–1339 (2024). https://doi.org/10.1007/s00586-023-08103-7

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