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Development of a sacral fracture model to demonstrate effects on sagittal alignment

  • Biomechanics
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Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

To develop a modeling framework to predict the secondary consequences on spinal alignment following correction and to demonstrate the impact of pedicle subtraction osteotomy (PSO) location on sagittal alignment.

Methods

Six patients were included, and pelvic incidence (PI) was measured. Full-length standing radiographs were uploaded into PowerPoint and manipulated to model S1–S2 joint line sacral fractures at 15°, 20°, 25°, and 30°. PSO corrections with hinge points at the anterior superior corner and vertical midpoint of the L3-5 vertebral bodies were modeled. Anterior translation (AT) and vertical shortening (VS) were calculated for the six PSO locations in the four fracture angle (FA) models.

Results

PI had a strong effect in the mixed AT and VS models (P < 0.001). Both AT and VS were significantly different from zero at all FA (p < 0.001), and pairwise comparisons revealed all FA were different from each other with respect to both AT and VS after adjusting for PSO location (p < 0.001), increasing as FA increased. Varying PSO location resulted in significant differences in AT when comparing all locations (p < 0.001). AT was greatest for all FA in all patients when the PSO correction was performed at the L3-AS (p < 0.001). There were significant differences in VS when comparing the L5-Mid PSO location to the L3-AS, L3-Mid, L4-AS, and L4-Mid PSO locations (p < 0.034).

Conclusion

PSO correction superior to a sacral fracture resulted in AT and VS of the spine. It is crucial that these changes in spinal measures be predicted and accounted for to optimize patient sagittal alignment and outcomes.

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Acknowledgements

We thank Paul Lender, BS for his assistance with statistical analysis.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA

    Cole J. Homer, Jason J. Haselhuhn, Arin M. Ellingson, Joan E. Bechtold & David W. Polly Jr.

  2. The Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA

    Arin M. Ellingson

  3. The Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA

    Joan E. Bechtold

  4. The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

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  1. Cole J. Homer
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  2. Jason J. Haselhuhn
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Contributions

Cole J. Homer: Made substantial contributions to the conception and design of the work, and the acquisition, analysis, and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Jason J. Haselhuhn: Made substantial contributions to the analysis and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Arin M. Ellingson: Made substantial contributions to the conception and design of the work, and the acquisition, analysis, and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Joan E. Bechtold: Made substantial contributions to the conception and design of the work, and the acquisition, analysis, and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. David W. Polly: Made substantial contributions to the conception and design of the work, and the acquisition, analysis, and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Jason J. Haselhuhn or David W. Polly Jr..

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Conflict of interest

CH and JH declare no financial conflicts. AE declares institutional research support from Medtronic and the NIH. JB declares research support from the Department of Defense, DePuy Synthes, FocusStart, Medtronic, NIH (NIAID, NIAMS, NICHD), SI-Bone, and Zimmer Biomet; is an American Society of Biomechanics board/committee member; and is on an editorial/governing board, receives publishing royalties, and financial/material support from JBJS—American. DP declares consulting fees from Globus Medical and Alexion; institutional grant/research support from Medtronic and MizuhoOSI; consulting fees, royalties, and honoraria from SI-Bone; and royalties/other financial/material support from Springer.

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This study was approved by the University of Minnesota Institutional Review Board.

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Homer, C.J., Haselhuhn, J.J., Ellingson, A.M. et al. Development of a sacral fracture model to demonstrate effects on sagittal alignment. Spine Deform 11, 1325–1333 (2023). https://doi.org/10.1007/s43390-023-00721-x

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  • DOI: https://doi.org/10.1007/s43390-023-00721-x

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