Background: Total en bloc spondylectomy (TES) has emerged as an effective surgical intervention for spinal tumor management. The selection of prosthesis for spinal reconstruction significantly influences patient's postoperative outcomes. This study aims to analyze and compare the biomechanical effects of two types of 3D-printed prostheses and titanium mesh cage (TMC) after TES.
Methods: An intact finite element model (FEM) of L1–L5 segment was developed and validated for simulation. Three L3 TES models were constructed. Model A utilized a 3D-printed prosthesis with an artificial pedicle, model B employed a stand-alone 3D-printed prosthesis, and model C used a TMC. Following parameters were recorded and analyzed to evaluate the biomechanical effects of the three models: (1) the range of motion (ROM), (2) stress of the internal fixation systems, and (3) stress of the L2 inferior endplate and L4 superior endplate.
Results: The ROMs of all three models were significantly restricted in all directions. Compared with TMC, the implantation of 3D printed prosthesis significantly enhanced spinal stability during extension. The ROMs of models A and B were significantly lower than that of model C during extension, decreasing by 15.2% and 36.4%, respectively. The use of 3D-printed prosthesis for anterior column reconstruction could reduce the stress of prosthesis itself and adjacent endplates. Compared with model C, the maximal decrease in the stress of the endplate of models A and B was 41.5% during flexion and 49.1% during right lateral bending, respectively. In all directions, the stress of the prosthesis was largest in model C, followed by model A and smallest in model B, with statistically significant differences observed.
Conclusion: After single-segmental TES, 3D-printed prosthesis with favorable endplate matching could obtain better biomechanical effects, thereby reducing the risk of internal fixation failure and increasing the postoperative spinal stability.
| [1] |
K. W. Hammerberg, “Surgical Treatment of Metastatic Spine Disease,” Spine (Phila Pa 1976) 17, no. 10 (1992): 1148–1153.
|
| [2] |
H. Zhou, S. Liu, Z. Li, et al., “3D-Printed Vertebral Body for Anterior Spinal Reconstruction in Patients With Thoracolumbar Spinal Tumors,” Journal of Neurosurgery. Spine 37, no. 2 (2022): 274–282.
|
| [3] |
M. Jones, J. Holton, S. Hughes, and M. Czyz, “Total En Bloc Spondylectomy,” Journal of Spine Surgery 4, no. 3 (2018): 663–665.
|
| [4] |
V. G. Aleinikov, T. T. Kerimbayev, Y. N. Kenzhegulov, et al., “Biomechanical and Clinical Evaluation of 3D-Printed Personalized Vertebral Implants After Total En-Bloc Spondylectomy: Two-Year Follow-Up Outcomes,” 3D Printing in Medicine 11, no. 1 (2025): 43.
|
| [5] |
E. Schneider, M. C. Lutschounig, J. Straub, et al., “En Bloc Total Vertebrectomy of the Thoracic and Lumbar Spine,” Journal of Clinical Medicine 13, no. 17 (2024): 5312.
|
| [6] |
M. Jones, Z. Alshameeri, O. Uhiara, et al., “En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications,” International Journal of Spine Surgery 15, no. 6 (2021): 1223–1233.
|
| [7] |
X. Wang, S. Sun, Y. Jiang, et al., “Early Clinical Efficacy of 3D-Printed Artificial Vertebral Body in Spinal Reconstruction After Total En Bloc Spondylectomy for Spinal Tumors,” BMC Musculoskeletal Disorders 25, no. 1 (2024): 926.
|
| [8] |
K. Salame, G. Regev, O. Keynan, and Z. Lidar, “Total En Bloc Spondylectomy for Vertebral Tumors,” Israel Medical Association Journal 17, no. 1 (2015): 37–41.
|
| [9] |
J. Kang, Y. Wu, and J. Qiao, “Numerical Evaluation of Spinal Reconstruction Using a 3D Printed Vertebral Body Replacement Implant: Effects of Material Anisotropy,” Frontiers in Bioengineering and Biotechnology 12 (2024): 1305837.
|
| [10] |
J. Hu, G. Song, H. Chen, et al., “Surgical Outcomes and Risk Factors for Surgical Complications After En Bloc Resection Following Reconstruction With 3D-Printed Artificial Vertebral Body for Thoracolumbar Tumors,” World Journal of Surgical Oncology 21, no. 1 (2023): 385.
|
| [11] |
J. Chen, S. Zhai, H. Zhou, et al., “Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor,” Orthopaedic Surgery 15, no. 5 (2023): 1219–1227.
|
| [12] |
M. Dong, Y. Gao, H. Fan, et al., “Comparison of Clinical Efficacy of 3D-Printed Artificial Vertebral Body and Conventional Titanium Mesh Cage in Spinal Reconstruction After Total En Bloc Spondylectomy for Spinal Tumors: A Systematic Review and Meta-Analysis,” Frontiers in Oncology 14 (2024): 1327319.
|
| [13] |
T. Belytschko, R. F. Kulak, A. B. Schultz, and J. O. Galante, “Finite Element Stress Analysis of an Intervertebral Disc,” Journal of Biomechanics 7, no. 3 (1974): 277–285.
|
| [14] |
W. Wang, B. Pei, Y. Pei, et al., “Biomechanical Effects of Posterior Pedicle Fixation Techniques on the Adjacent Segment for the Treatment of Thoracolumbar Burst Fracture: A Biomechanical Analysis,” Computer Methods in Biomechanics and Biomedical Engineering 22, no. 13 (2019): 1083–1092.
|
| [15] |
E. Dong, L. Shi, J. Kang, et al., “Biomechanical Characterization of Vertebral Body Replacement In Situ: Effects of Different Fixation Strategies,” Computer Methods and Programs in Biomedicine 197 (2020): 105741.
|
| [16] |
R. Wang and Z. Wu, “Recent Advancement in Finite Element Analysis of Spinal Interbody Cages: A Review,” Frontiers in Bioengineering and Biotechnology 11 (2023): 1041973.
|
| [17] |
J. Lee, S. H. Chang, H. C. Cho, and K. S. Song, “Anterior Bridging Bone in a Newly Designed Cage for Lumbar Interbody Fusion: Radiographic and Finite Element Analysis,” World Neurosurgery 154 (2021): e389–e397.
|
| [18] |
J. Wu, J. Miao, G. Chen, et al., “Finite Element Biomechanical Analysis of 3D Printed Intervertebral Fusion Cage in Osteoporotic Population,” BMC Musculoskeletal Disorders 25, no. 1 (2024): 129.
|
| [19] |
J. Li, L. C. Zhang, J. Li, H. Zhang, J. X. Zhao, and W. Zhang, “A Hybrid Uniplanar Pedicle Screw System With a New Intermediate Screw for Minimally Invasive Spinal Fixation: A Finite Element Analysis,” BioMed Research International 2020 (2020): 5497030.
|
| [20] |
J. Wu, Q. Feng, D. Yang, et al., “Biomechanical Evaluation of Different Sizes of 3D Printed Cage in Lumbar Interbody Fusion–A Finite Element Analysis,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 85.
|
| [21] |
X. Liu, J. Ma, P. Park, X. Huang, N. Xie, and X. Ye, “Biomechanical Comparison of Multilevel Lateral Interbody Fusion With and Without Supplementary Instrumentation: A Three-Dimensional Finite Element Study,” BMC Musculoskeletal Disorders 18, no. 1 (2017): 63.
|
| [22] |
K. Pradeep, B. Pal, K. Mukherjee, and G. M. Shetty, “Finite Element Analysis of Implanted Lumbar Spine: Effects of Open Laminectomy Plus PLF and Open Laminectomy Plus TLIF Surgical Approaches on L3-L4 FSU,” Medical Engineering & Physics 128 (2024): 104178.
|
| [23] |
I. Yamamoto, M. M. Panjabi, T. Crisco, and T. Oxland, “Three-Dimensional Movements of the Whole Lumbar Spine and Lumbosacral Joint,” Spine (Phila Pa 1976) 14, no. 11 (1989): 1256–1260.
|
| [24] |
J. Su, W.-Z. Zhao, B.-Z. Chen, et al., “Establishing Finite Element Contact Model of Human L1~L5 Lumbar Segments. Journal of Medical,” Biomechanics 25, no. 3 (2010): 200–205.
|
| [25] |
Y. P. Huang, C. F. du, C. K. Cheng, et al., “Preserving Posterior Complex Can Prevent Adjacent Segment Disease Following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis,” PLoS One 11, no. 11 (2016): e0166452.
|
| [26] |
C. C. Lo, K. J. Tsai, Z. C. Zhong, S. H. Chen, and C. Hung, “Biomechanical Differences of Coflex-F and Pedicle Screw Fixation Combined With TLIF or ALIF–A Finite Element Study,” Computer Methods in Biomechanics and Biomedical Engineering 14, no. 11 (2011): 947–956.
|
| [27] |
Z. Li, F. Wei, Z. Liu, et al., “Risk Factors for Instrumentation Failure After Total En Bloc Spondylectomy of Thoracic and Lumbar Spine Tumors Using Titanium Mesh Cage for Anterior Reconstruction,” World Neurosurgery 135 (2020): e106–e115.
|
| [28] |
Z. Gu, L. Ma, Q. Liu, et al., “Biomechanical and Clinical Comparison of Different Prosthetic in Reconstruction Following Total En Bloc Spondylectomy in the Thoracolumbar Spine: Based on Finite Element Analysis and Clinical Data,” Frontiers in Bioengineering and Biotechnology 13 (2025): 1573086.
|
| [29] |
H. Xu, X. Wang, Y. Han, et al., “Biomechanical Comparison of Different Prosthetic Reconstructions in Total En Bloc Spondylectomy: A Finite Element Study,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 955.
|
| [30] |
Y. Han, X. Ren, Y. Liang, X. Ma, and X. Wang, “Biomechanical Effects of Transverse Connectors on Total En Bloc Spondylectomy of the Lumbar Spine: A Finite Element Analysis,” Journal of Orthopaedic Surgery and Research 18, no. 1 (2023): 484.
|
| [31] |
X. Wang, H. Xu, Y. Han, et al., “Biomechanics of Artificial Pedicle Fixation in a 3D-Printed Prosthesis After Total En Bloc Spondylectomy: A Finite Element Analysis,” Journal of Orthopaedic Surgery and Research 16, no. 1 (2021): 213.
|
| [32] |
H. Xu, W. Ke, D. Zhang, J. Miao, B. Wang, and C. Yang, “Biomechanical Effects of Different Prosthesis Types and Fixation Ranges in Multisegmental Total En Bloc Spondylectomy: A Finite Element Study,” Orthopaedic Surgery 16, no. 10 (2024): 2488–2498.
|
| [33] |
R. Pflugmacher, P. Schleicher, J. Schaefer, et al., “Biomechanical Comparison of Expandable Cages for Vertebral Body Replacement in the Thoracolumbar Spine,” Spine (Phila Pa 1976) 29, no. 13 (2004): 1413–1419.
|
| [34] |
J. Hu, G. Song, X. Zhu, and J. Wang, “Total En Bloc Spondylectomy With Resection and Replacement of the Aorta: A Case Report and Review of the Literature,” Asian Journal of Surgery 46, no. 11 (2023): 4826–4828.
|
| [35] |
M. W. Colman, A. Guss, K. N. Bachus, W. R. Spiker, B. D. Lawrence, and D. S. Brodke, “Fixed-Angle, Posteriorly Connected Anterior Cage Reconstruction Improves Stiffness and Decreases Cancellous Subsidence in a Spondylectomy Model,” Spine 41, no. 9 (2016): E519–E523.
|
| [36] |
S. H. Farber, A. J. Oldham, L. K. O'Neill, et al., “Optimization of 3D-Printed Titanium Interbody Cage Design. Part 1: In Vitro Biomechanical Study of Subsidence,” Spine Journal 25, no. 5 (2025): 1050–1059.
|
| [37] |
G. Fogel, N. Martin, K. Lynch, et al., “Subsidence and Fusion Performance of a 3D-Printed Porous Interbody Cage With Stress-Optimized Body Lattice and Microporous Endplates–A Comprehensive Mechanical and Biological Analysis,” Spine Journal 22, no. 6 (2022): 1028–1037.
|
| [38] |
Z. Liang, J. Cui, J. Zhang, et al., “Biomechanical Evaluation of Strategies for Adjacent Segment Disease After Lateral Lumbar Interbody Fusion: Is the Extension of Pedicle Screws Necessary?,” BMC Musculoskeletal Disorders 21, no. 1 (2020): 117.
|
| [39] |
S. J. Park, C. S. Lee, B. S. Chang, et al., “Rod Fracture and Related Factors After Total En Bloc Spondylectomy,” Spine Journal 19, no. 10 (2019): 1613–1619.
|
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