{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:59:06Z","timestamp":1786798746405,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Ankylosing spondylitis (AS) is a chronic disorder characterized by an imbalance between bone formation and resorption. Spinal fractures often occur after minor trauma in patients with AS. For thoracolumbar fractures, transpedicular screw (TPS) fixation through the posterior approach has been suggested. The cortical bone trajectory (CBT) technique has also been used to prevent screw pull-out in patients with poor bone quality. The aim of current study was to assess the biomechanical characteristics of the TPS and CBT technique in thoracolumbar AS fracture fixation by finite element analysis.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> The three-dimensional finite element models of the AS spine were created. The CBT and TPS methods of screw insertion were used in AS spinal fracture models. An intact AS spine model was considered the control. An axial force and torsion in rotation, flexion\/extension and lateral flexion were applied in all models in CBT, TPS, and control groups.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The AS spine showed similar construct stiffness after posterior fixation by CBT and TPS techniques under axial, rotational, and flexion\/extension loading conditions. The TPS technique showed better intact stability under all loading conditions. Similarly, the TPS technique provided superior fracture regional stability against axial and rotational loads than did the CBT technique. The maximum von Mises stresses were 1714.4 \u00b1 129.8 MPa and 1208.7 \u00b1 107.3 MPa (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), which occurred in the CBT and TPS groups under compressive loading.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The TPS technique provides better biomechanical strength under axial, rotational, flexion\/extension, and lateral flexion loading than does the CBT technique. Compared with CBT, TPS is more effective in maintaining the stability of AS thoracolumbar fractures from a finite element analysis perspective.<\/jats:p>","DOI":"10.3389\/fsurg.2021.706597","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T14:18:31Z","timestamp":1631110711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Biomechanical Evaluation of the Transcortical and Transpedicular Trajectories for Pedicle Screw Insertion in Thoracolumbar Fracture Fixation for Ankylosing Spondylitis"],"prefix":"10.3389","volume":"8","author":[{"given":"Zhizhong","family":"Tong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonggang","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"F1000","DOI":"10.12688\/f1000research.14956.1","article-title":"Recent advances in ankylosing spondylitis: understanding the disease and management","volume":"7","author":"Garcia-Montoya","year":"2018","journal-title":"F1000Researc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1148\/rg.2019180125","article-title":"Injuries to the rigid spine: what the spine surgeon wants to know","volume":"39","author":"Shah","year":"2019","journal-title":"Radiographics."},{"key":"B3","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s00296-015-3387-x","article-title":"Focal bone involvement in inflammatory arthritis: the role of IL17","volume":"36","author":"Rossini","year":"2016","journal-title":"Rheumatol Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s11882-014-0489-6","article-title":"Update on ankylosing spondylitis: current concepts in pathogenesis","volume":"15","author":"Smith","year":"2015","journal-title":"Curr Allergy Asthma Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1136\/annrheumdis-2016-210770","article-title":"2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis","volume":"76","author":"van der Heijde","year":"2017","journal-title":"Ann Rheum Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1097\/BOT.0000000000000953","article-title":"Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes","volume":"31","author":"Rustagi","year":"2017","journal-title":"J Orthop Trauma."},{"key":"B7","doi-asserted-by":"publisher","first-page":"241","DOI":"10.5435\/JAAOS-D-14-00149","article-title":"Spinal fractures in patients with ankylosing spondylitis: etiology, diagnosis, and management","volume":"24","author":"Werner","year":"2016","journal-title":"J Am Acad Orthop Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1007\/s00296-016-3524-1","article-title":"Spinal fractures in patients with ankylosing spondylitis","volume":"36","author":"Leone","year":"2016","journal-title":"Rheumatol Int."},{"key":"B9","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.otsr.2012.09.018","article-title":"Fracture in ankylosing spondylitis after minor trauma: radiological pitfalls and treatment by percutaneous instrumentation. 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