Biomechanical modeling of metal screw loadings on the human vertebra

Abstract: During spinal fusion surgery, angled screw insertion can provide a more favorable stress distribution reducing failure events (screw breakage and loosening). Finite element (FE) analysis can be employed for identifying the optimal insertion path, preventing stress concentrations, and ensuring a lower failure incidence. In this work, a patient-specific FE model of L4 vertebra, virtually implanted with two pedicle screws, was obtained from diagnostic images and numerically investigated. Linearly elastic, inhomogeneous, and isotropic material properties were assigned to bone based on density distributions reconstructed from the medical images. The mechanical response of the screws-vertebra system was analyzed through a progressive damage procedure, considering a stress-based criterion. Different screws insertion angles were simulated, as well as physiological loading conditions. In each loading case, screw orientation influences the fracture mechanism (i.e., brittle or ductile one), as well as the fracture pattern and load. Besides, stresses in trabecular bone and pedicle screws are significantly affected by the screw configuration. The caudomedial trajectory indicates the most safe case, significantly reducing the stress concentrations in both trabecular bone and screws. Our findings aim to furnish a useful indication to surgeons regarding the screws insertion angle, further reducing the failure risk and improving the clinical outcome of the fixation procedure. GraphicAbstract: A patient-specific image-based FE modeling strategy of implanted human vertebra is developed and used to investigate the effect of pedicle screw insertion angles on the stress distribution in the human vertebra to find the safest screw insertion trajectory that minimizes stress concentrations reducing the onset of loosening phenomena and/or screw breakage. A caudomedial trajectory significantly reduces the stress concentrations in both trabecular bone and screws, resulting in the least critical case, thus safer from a clinical perspective.[Figure not available: see fulltext.]