• Maxime Huneidi, Nicolas Bailly, Kaissar Farah, Adrien May, Pierre-Jean Arnoux, and Stéphane Fuentes.
• Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, CHU Bordeaux, France. maximehuneidi@gmail.com.
• Eur Spine J. 2024 Apr 1; 33 (4): 133213391332-1339.

PurposeThe occurrence of an iatrogenic vertebral fracture during non-spinal digestive surgery is an exceptional event that has not been previously documented. Our study aims to explain the occurrence of this fracture from a biomechanical perspective, given its rarity. Using a finite element model of the spine, we will evaluate the strength required to induce a vertebral fracture through a hyperextension mechanism, considering the structure of the patient's spine, whether it is ossified or healthy.MethodsA 70-year-old patient was diagnosed T12 fracture during a liver transplantation on ankylosed spine. We use a finite element model of the spine. Different mechanical properties were applied to the spine model: first to a healthy spine, the second to a osteoporotic ossified spine. The displacement and force imposed at the Sacrum, the time and location of fractures initiation were recorded and compared between the two spine conditions.ResultsA surgical treatment is done associating decompression with posterior fixation. After biomechanical study, we found that the fracture initiation occurred for the ossified spine after a sacrum displacement of 29 mm corresponding to an applied force of 65 N. For the healthy spine it occurred at a sacrum displacement of 52 mm corresponding to an applied force of 350 N.ConclusionThe force required to produce a type B fracture in an ankylosed spine is 5 times less than in a healthy spine. These data enable us to propose several points of management to avoid unexpected complications with ankylosed spines during surgical procedures.Level Of EvidenceIV.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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