Finite element analysis of a novel modular support system for lumbar reconstruction following vertebral column resection

doi:10.5312/wjo.124459

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Nov 18, 2026; 17(11): 124459
Published online Nov 18, 2026. doi: 10.5312/wjo.124459

Finite element analysis of a novel modular support system for lumbar reconstruction following vertebral column resection

Andhika Yudistira, Respati Suryanto Dradjat, Edi Mustamsir, Mochamad Agus Choiron, Yuyun Yueniwati, Hidayat Sujuti, I Ketut Suyasa

Andhika Yudistira, Respati Suryanto Dradjat, Edi Mustamsir, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Brawijaya-Dr. Saiful Anwar General Hospital, Malang 65112, Jawa Timur, Indonesia

Mochamad Agus Choiron, Department of Mechanical Engineering, Universitas Brawijaya, Malang 65112, Jawa Timur, Indonesia

Yuyun Yueniwati, Department of Radiology, Faculty of Medicine, Universitas Brawijaya-Dr. Saiful Anwar General Hospital, Malang 65112, Jawa Timur, Indonesia

Hidayat Sujuti, Department of Biochemistry and Biomolecular, Faculty of Medicine, Universitas Brawijaya, Malang 65112, Jawa Timur, Indonesia

I Ketut Suyasa, Department of Orthopaedics and Traumatology, Faculty of Medicine, Udayana University-Prof. Dr. IGNG Ngoerah General Hospital, Denpasar 80113, Bali, Indonesia

Author contributions: Yudistira A, Dradjat RS, Choiron MA, and Suyasa IK were responsible for the conceptualization and overall study design; Yudistira A and Choiron MA conducted the finite element modeling and simulations; Yudistira A, Dradjat RS, and Mustamsir E conducted the mechanical testing and data acquisition; Yueniwati Y performed the radiological data acquisition and morphometric analysis; Yudistira A provided expertise in material properties, biochemical considerations, broader methodological consultation, and drafted the manuscript; Yudistira A, Dradjat RS, Choiron MA, and Suyasa IK performed the data analysis and interpretation; Dradjat RS, Mustamsir E, Choiron MA, Yueniwati Y, Sujuti H, and Suyasa IK critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.

AI contribution statement: AI tools were utilized solely as writing and language assistance for manuscript drafting and formatting, in accordance with institutional guidelines (Universitas Brawijaya Regulation). The authors declare that AI was not used for study design, data generation, data analysis, or drawing scientific conclusions, and the authors assume full responsibility for all content presented in this manuscript.

Institutional review board statement: The study was reviewed and approved by the Health Research Ethics Committee of Dr. Saiful Anwar General Hospital, Malang, Indonesia, No. 400/083/K.3/102.7/2025.

Informed consent statement: The requirement for informed consent was waived because the study utilized retrospective, fully anonymized computed tomography imaging data for 3-dimensional computational modeling without involving direct human interaction or identifying personal health information.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Technical finite element models and anonymized simulation datasets generated during this study are available from the corresponding author upon reasonable request.

Corresponding author: Andhika Yudistira, MD, PhD, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Brawijaya-Dr. Saiful Anwar General Hospital, Jl. Jaksa Agung Suprapto No. 2, Klojen, Malang 65112, Jawa Timur, Indonesia. andhika.yudhistira@ub.ac.id

Received: June 16, 2026
Revised: August 2, 2026
Accepted: November 2, 2026
Published online: November 18, 2026
Processing time: 147 Days and 16.3 Hours

Abstract

BACKGROUND

Posterior vertebral column resection (VCR) is an effective procedure for treating severe rigid spinal deformities. However, this technique carries a high risk of nerve injury associated with the surgical approach. Conventional titanium mesh cages are widely used for anterior column support but have several reported disadvantages, including implant dislocation and subsidence, which may contribute to implant failure.

AIM

To evaluate a VCR modular support system (VCR-MSS) as an anterior-posterior construct for the Indonesian lumbar population.

METHODS

A 2-stage finite element analysis (FEA) framework was used. First, an ASTM F1717-21 polyethylene block model was used to validate the FEA methodology against mechanical testing of a posterior fixation prototype. Subsequently, the validated FEA framework was used to evaluate a conventional mesh cage construct and the proposed VCR-MSS under standardized loading in ASTM-based models and physiological loading in vertebra-based lumbar models.

RESULTS

In the preliminary stage, the ASTM-based model supported validation of the FEA methodology against mechanical testing of the posterior fixation prototype. In the main analysis, the VCR-MSS construct demonstrated greater structural stability than the conventional mesh cage construct. Total deformation was reduced from 6.0443 mm to 0.8435 mm under ASTM-based compressive loading and from 0.1100 mm to 0.0687 mm under vertebra-based flexion loading. In addition, posterior rod stress under ASTM-based compression was reduced from 429.09 MPa to 90.55 MPa, indicating improved load sharing with the VCR-MSS construct.

CONCLUSION

The VCR-MSS construct demonstrated greater stability and reduced posterior rod mechanical burden through integrated load sharing, suggesting its potential as a reconstruction option following lumbar VCR.

Keywords: Posterior vertebral column resection; Finite element analysis; Lumbar reconstruction; Titanium mesh cage; Vertebral column resection modular support system; Morphometric-guided implant design; Mechanics

Core Tip: The vertebral column resection modular support system (VCR-MSS) is a morphometry-guided modular implant specifically designed to match Indonesian lumbar anatomy. Using a 2-stage finite element analysis framework comprising an ASTM F1717-21-based model and a vertebra-based model, we demonstrated that the VCR-MSS exhibited lower total deformation than a conventional mesh cage under all loading conditions. In addition, the VCR-MSS reduced the mechanical demand on the posterior rods, indicating more favorable load sharing within the construct. Collectively, these findings suggest that the VCR-MSS functions as an integrated reconstruction system rather than simply as an anterior spacer.