Finite-element analysis on closing-opening correction osteotomy for angular kyphosis of osteoporotic vertebral fractures

Background. Closing-opening correction (COC) osteotomy is a useful procedure for severe angular kyphosis. However, there is no previous research on the reconstructed vertebrae with kyphotic malalignment in the presence of osteoporosis. Finite-element (FE) analysis was performed to estimate the biomechanical stress with both osteoporotic grades and corrective kyphotic angles during COC osteotomy for osteoporotic angular kyphosis. Methods. FE models of COC osteotomy were created by changing three major parameters: (1) grade of osteoporosis; (2) kyphotic angle; and (3) compensated posture when standing still. Osteoporosis was graded at four levels: A, normal (nonosteoporotic); B, low-grade osteoporosis; C, middle-grade osteoporosis; D, high-grade osteoporosis. The kyphotic angle ranged from 0 degrees as normal to 15 degrees and 30 degrees as moderate and severe kyphosis, respectively. FE analyses were performed with and without assumed compensated posture in kyphotic models of 15 degrees and 30 degrees. Along each calculated axis of gravity, a 427.4-N load was applied to evaluate the maximum compressive principal stress (CPS) for each model. Results. The CPS values for the vertebral element were the highest at the anterior element of T10 in all FE models. The maximum CPS at T10 increased based on the increases in both the grade of osteoporosis and the kyphotic angle. Compensated posture made the maximum CPS value decrease in the 15 degrees and 30 degrees kyphotic models. The highest CPS value was 40.6MPa in the high-grade osteoporosis (group D) model with a kyphotic angle of 30 degrees. With the normal (nonosteoporotic) group A, the maximum CPS at T10 was relatively low. With middle- and high-grade osteoporosis (groups C and D, respectively), the maximum CPS at T10 was relatively high with or without compensated posture, except for the 0 degrees model. Conclusion. Lack of correction in osteoporotic kyphosis leads to an increase in CPS. This biomechanical study proved the advantage of correcting the kyphotic angle to as close as possible to physiological alignment in the thoracolumbar spine, especially in patients with high-grade osteoporosis.