PRINCIPLES & BIOMECHANICS

OF
SPINE FRACTURE HEALING

Lukas Widhiyanto

Department of Orthopedics and Traumatology

Universitas Airlangga Medical Faculty – Dr. Soetomo Hospital
Surabaya
PRINCIPLES OF SPINAL FIXATION
in TRAUMA

1. Apply biomechanical principles of

internal fixation
2. Protect the neural elements and
enhance bone healing
3. Restore normal alignment
4. Preserve motion segments
 PRINCIPLES OF SPINAL FIXATION
in TRAUMA
1. Apply biomechanical principles of internal fixation

§ Load sharing between implants and spinal elements.

§ More axial load is supported by the vertebral bodies
than the posterior elements.
§ Anterior column support is necessary to protect
posterior implants during bone healing.
§ Posterior constructs are strengthened by cross-links.
§ Anterior plate systems act as a tension band in
extension and a buttress in flexion.
 PRINCIPLES BIOMECHANICS
OF POSTERIOR STABILIZATION

With anterior column support, in the posterior implant bears only a fraction
of the load
 PRINCIPLES OF SURGICAL
STABILIZATION
Buttressing Principle

Anterior cervical plate as an example of a buttressing implant

 PRINCIPLES OF SURGICAL
STABILIZATION
Neutralization principle

The thoracolumbar locking plate is an example of a neutralization or

protection implant
 PRINCIPLES OF SURGICAL
STABILIZATION
Tension Band Principle

Example of tension band implant allowing dynamic compression

through the load bearing column
 PRINCIPLES OF SURGICAL
STABILIZATION
Bridge Fixation Principle

A bridge construct may be used to support the spine during anterior

column healing
 PRINCIPLES OF SPINAL FIXATION
in TRAUMA
2. Protect the neural elements and enhance bone
healing

§ Protection of the spinal cord and spinal nerves

following trauma is paramount.
§ Maintenance of adequate oxygenation and
perfusion of the cord is essential during initial
resuscitation.
§ In the presence of neurological deficit, early
reduction of displacements and decompression
of neural structures may improve neurological
recovery.
 PRINCIPLES OF SPINAL FIXATION
in TRAUMA

§ Bone healing is vital for maintenance of spinal

alignment, stability, and function.
§ Augmentation with bone grafts, bone growth
factors, or vertebroplasty may be required
 Desirable
Biomechanical
Forces
J. Mater. Sci. Technol.,2020,36(0),190-208.DOI:10.1016/j.jmst.2019.07.024
 PRINCIPLES OF SPINAL FIXATION
in TRAUMA
3. Restore normal alignment

§ Normal spinal alignment balances the head and

thorax over the lower limbs.
§ In the sagittal plane the gravity line of the center
of body mass passes through the junctional
regions of the spine, then through the femoral
heads. In the coronal plane the head is centered
over the sacrum.
§ Correction of malalignment following trauma is
essential for optimal spinal function
 PRINCIPLES OF SPINAL FIXATION
in TRAUMA
4. Preserve motion segments

§ Early mobilization after spinal trauma minimizes

the risks of recumbency.
§ Spinal trauma implants must be able to resist the
stresses of spinal loading during bone healing or
be protected by external supports.
§ Long-segment constructs resist deformity but
sacrifice motion at normal levels.
§ Short-segment fixation is preferred in the lumbar
region to maintain motion segments.
 DEVICE RELATED OSTEOPENIA
§ Research has shown in canine models that the
volumetric density of bone was lower for fused versus
unfused spines and that the rigidity of the
instrumentation led to device-related osteoporosis
§ However, it was noted that the use of instrumentation
significantly improved the probability of achieving
fusion
§ This far outweighed the risks of device-related
osteoporosis.
§ The term "device-related osteoporosis" is a misnomer
and is more accurately replaced by "device-related
osteopenia."
 BRIDGING OF KNOWLEDGE

What can We elaborate together ?

1. Pain Control Modulation (postoperative)

2. Enhances Spinal healing / fusion process :
§ Increase vascularization to the pathologic Site
§ PEMF ( Pulsed Electromagnetic Field)
3. Help to decrease "device - related osteopenia“
4. Maintain muscle volume
THANK YOU