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<p>A coupled thoracolumbar spine (T1—L1)-meninges-nerve roots-spinal cord model was established for patients with severe scoliosis undergoing orthopedic surgeries. This model was employed to investigate the effects of different osteotomy heights on biomechanical properties of spinal cord and nerve roots during the surgical process. A three-dimensional model of the thoracolumbar vertebrae, dura mater, pia mater, nerve roots, and spinal cord of patients with severe scoliosis was constructed using the CT images of the patients and the associated clinical data. Next, the validity of the model was validated. The displacement loads equal to 1/4, 1/3, 1/2, and 2/3 of the height of the extracted vertebrae were separately applied to the osteotomy site to simulate the osteotomy surgery processes. And the biomechanical responses and injury risks of the spinal cord and nerve roots under varying osteotomy heights were evaluated. The maximum stresses in the vertebral body at the time of osteotomy for vertebral body heights of 1/4, 1/3, 1/2, and 2/3 were 7.233, 10.095, 15.753, and 22.845 MPa, respectively, and the maximum stress induced by osteotomy was located at the fixed end of T1. The stress levels in the vertebral body of the T5–T8 segments with severe deformity were higher than the average stress score. The maximum stresses in the spinal cord at the time of osteotomy for vertebral body heights of 1/4, 1/3, 1/2, and 2/3 were 0.17, 0.22, 0.32, and 0.88 kPa, respectively. Notably, the results indicated that the maximum stress at the time of osteotomy at the heights of 1/4 and 1/3 was located in the T7 segments, and that at the heights of 1/2 and 2/3 was located in the T11 segment. Among the four osteotomy conditions, the spinal cord stress in the deformed segments T5–T8 exceeded the average stress values. The maximum nerve root stresses at osteotomies of vertebral heights of 1/4, 1/3, 1/2, and 2/3 were 35.35, 57.18, 115.24, and 223.92 kPa, respectively, and the maximum strains for each condition were 3.535%, 7.654%, 11.284%, and 15.912%, with the maximum stress and strain located in the T11 segment. This study shows that during spinal osteotomy operations, vertebrae within severe deformity segments may experience significant stress levels, which can induce vertebral tissue injury. Notably, the vertebral stress exhibits a nonlinear escalation as the osteotomy magnitude increases, underscoring the application of robust evaluation to determine appropriate resection heights. Moreover, during spinal corrective osteotomy procedures, mechanical stress on the spinal cord and nerve roots increases with osteotomy height. Resections within 1/2 vertebral height were deemed biomechanically safe, whereas heights exceeding 1/2 may cause immediate injury to both spinal cord and neural structures.</p>

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Excessive Vertebral Shortening in Spinal Osteotomy Increases the Risk of Spinal Cord and Nerve Root Injuries

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Yonghao Chen,
  • Rongchang Fu,
  • Feng Li,
  • Huaiyue Zhang,
  • Huai Wang

摘要

A coupled thoracolumbar spine (T1—L1)-meninges-nerve roots-spinal cord model was established for patients with severe scoliosis undergoing orthopedic surgeries. This model was employed to investigate the effects of different osteotomy heights on biomechanical properties of spinal cord and nerve roots during the surgical process. A three-dimensional model of the thoracolumbar vertebrae, dura mater, pia mater, nerve roots, and spinal cord of patients with severe scoliosis was constructed using the CT images of the patients and the associated clinical data. Next, the validity of the model was validated. The displacement loads equal to 1/4, 1/3, 1/2, and 2/3 of the height of the extracted vertebrae were separately applied to the osteotomy site to simulate the osteotomy surgery processes. And the biomechanical responses and injury risks of the spinal cord and nerve roots under varying osteotomy heights were evaluated. The maximum stresses in the vertebral body at the time of osteotomy for vertebral body heights of 1/4, 1/3, 1/2, and 2/3 were 7.233, 10.095, 15.753, and 22.845 MPa, respectively, and the maximum stress induced by osteotomy was located at the fixed end of T1. The stress levels in the vertebral body of the T5–T8 segments with severe deformity were higher than the average stress score. The maximum stresses in the spinal cord at the time of osteotomy for vertebral body heights of 1/4, 1/3, 1/2, and 2/3 were 0.17, 0.22, 0.32, and 0.88 kPa, respectively. Notably, the results indicated that the maximum stress at the time of osteotomy at the heights of 1/4 and 1/3 was located in the T7 segments, and that at the heights of 1/2 and 2/3 was located in the T11 segment. Among the four osteotomy conditions, the spinal cord stress in the deformed segments T5–T8 exceeded the average stress values. The maximum nerve root stresses at osteotomies of vertebral heights of 1/4, 1/3, 1/2, and 2/3 were 35.35, 57.18, 115.24, and 223.92 kPa, respectively, and the maximum strains for each condition were 3.535%, 7.654%, 11.284%, and 15.912%, with the maximum stress and strain located in the T11 segment. This study shows that during spinal osteotomy operations, vertebrae within severe deformity segments may experience significant stress levels, which can induce vertebral tissue injury. Notably, the vertebral stress exhibits a nonlinear escalation as the osteotomy magnitude increases, underscoring the application of robust evaluation to determine appropriate resection heights. Moreover, during spinal corrective osteotomy procedures, mechanical stress on the spinal cord and nerve roots increases with osteotomy height. Resections within 1/2 vertebral height were deemed biomechanically safe, whereas heights exceeding 1/2 may cause immediate injury to both spinal cord and neural structures.