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Influence of spinal lordosis correction location on proximal junctional failure: a biomechanical study

  • Biomechanics
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Assessment of sagittal lordosis distribution on mechanical proximal junctional failure-related risks through computer-based biomechanical models.

Objective

To biomechanically assess how lordosis distribution influences radiographical and biomechanical indices related to Proximal Junctional Failure (PJF).

Summary of background data

The “optimal” patient-specific targets to restore the sagittal balance in posterior spinal fusion are still not known. Among these, the effect of the lumbar lordosis correction strategy on complications such as PJF remain uncertain.

Methods

In this computational biomechanical study, five adult spinal deformity patients who underwent posterior spinal fixation were retrospectively reviewed. Their surgery, first erect posture and flexion movement were simulated with a patient-specific multibody model. Three pedicle subtraction osteotomy (PSO) levels (L3, L4, and L5) were simulated, with consistent global lordosis for a given patient and pelvic tilt adjusted accordingly to the actual surgery. Computed loads on the anterior spine and instrumentation were analyzed and compared using Kruskal–Wallis statistical tests and Spearman correlations.

Results

In these models, no significant correlations were found between the lordosis distribution index (LDI), PSO level and biomechanical PJF-related indices. However, increasing the sagittal vertical axis (SVA) and thoracolumbar junction angle (TLJ) and decreasing the sacral slope (SS) increased the bending moment sustained by the rods at the proximal instrumented level (r = 0.52, 0.57, − 0.56, respectively, p < 0.05). There was a negative correlation between SS and the bending moment held by the adjacent proximal segment (r = − 0.71, p < 0.05).

Conclusion

Based on these biomechanical simulations, there was no correlation between the lordosis distribution and PJF-associated biomechanical factors. However, increasing SS and flattening the TLJ, as postural adjustment strategies required by a more distal PSO, did decrease such PJF-related factors. Sagittal restoration and PJF risks remain multifactorial, and the use of patient-specific biomechanical models may help to better understand the complex interrelated mechanisms.

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Acknowledgements

Project funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research chair with Medtronic of Canada) Grant number: 31-001-39. We thank David Benoit for his previous work on PSO modeling that served as a basis for this project, as well as the valuable technical assistance of Nathalie Bourassa and Christian Bellefleur.

Funding

Project funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair with Medtronic of Canada).

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada

    Maeva Lopez Poncelas, Luigi La Barbera, Jeremy J. Rawlinson & Carl-Eric Aubin

  2. Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Maeva Lopez Poncelas, Luigi La Barbera & Carl-Eric Aubin

  3. Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133, Milan, MI, Italy

    Luigi La Barbera

  4. Spine Applied Research, Cranial and Spinal Technologies Medtronic, 18400 Pyramid Place, Memphis, TN, 38132, USA

    Jeremy J. Rawlinson

  5. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA

    David W. Polly

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  1. Maeva Lopez Poncelas
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  2. Luigi La Barbera
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Contributions

MLP: design, acquisition, analysis, interpretation of data for the work, drafting, final approbation, agree to be accountable, LLB: analysis, interpretation of the data for the work, revising, final approbation, agree to be accountable, JR: interpretation of the data for the work, revising, final approbation, agree to be accountable, DP: interpretation of the data for the work, revising, final approbation, agree to be accountable, C-ÉA: interpretation of the data for the work, revising, final approbation, agree to be accountable.

Corresponding author

Correspondence to Carl-Eric Aubin.

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Conflict of interest

Maeva Lopez Poncelas: supported by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair with Medtronic Canada). Luigi La Barbera: nothing to disclose. Jeremy Rawlinson: scientist employed by Medtronic, Inc. David Polly: Consultant SI Bone and Globus, Royalties SI Bone and Springer, Research support Medtronic and MizuhoOSI, Executive committee American Spine Registry and SI Medical Expert Group Carl-Éric Aubin: supported by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair with Medtronic Canada).

Ethical approval

Approval was obtained from the ethics committee of Polytechnique Montréal. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Lopez Poncelas, M., La Barbera, L., Rawlinson, J.J. et al. Influence of spinal lordosis correction location on proximal junctional failure: a biomechanical study. Spine Deform 11, 49–58 (2023). https://doi.org/10.1007/s43390-022-00571-z

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