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Chang SY, Kang DH, Cho SK. Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review. Asian Spine J 2024; 18:444-457. [PMID: 38146053 PMCID: PMC11222887 DOI: 10.31616/asj.2023.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023] Open
Abstract
This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul,
Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Ho Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Seoul,
Korea
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
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Shukla G, Matur AV, Tao X, Khalid S, Garner R, Gibson J, Cass D, Wu A, Street S, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Motley B, Cheng J, Adogwa O. Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions. Spine (Phila Pa 1976) 2024; 49:615-620. [PMID: 37661823 DOI: 10.1097/brs.0000000000004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. SUMMARY OF BACKGROUND DATA Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized. PATIENTS AND METHODS Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications. RESULTS 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort. CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Al-Adli NN, Tummala S, Oh MC. Early radiographic outcomes after anterior cervical discectomy and fusion with anatomic versus lordotic cages. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100292. [PMID: 38193109 PMCID: PMC10772290 DOI: 10.1016/j.xnsj.2023.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
Background Anterior cervical discectomy and fusion (ACDF) interbody implants are shaped anatomically, with a convex superior aspect, or lordotically, with an angle and flat surfaces. However, the effect of implant shape on cervical sagittal balance (CSB) is not well described. Methods Of the 192 cases reviewed from 2018 to 2019, 118 were included with matching pre- and postoperative imaging. Cases were categorized by interbody implant type (anatomic or lordotic) and number of levels fused (1-level, 2-level, etc.). SurgiMap was used to measure cervical lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope (T1S), and T1S minus CL (T1S-CL) on pre- and postoperative imaging. Pre- and postoperative parameters were compared within and between each cohort. Change in CL (ΔCL), cSVA (ΔcSVA), and T1S-CL (ΔT1S-CL) were calculated as the difference between pre- and postoperative values and were compared accordingly (1) anatomic versus lordotic and (2) 1-level versus 2-level versus 3-level fusion. Results Thirty-nine (33.1%), 57 (48.3%), and 22 (18.6%) cases comprised the anatomic, lordotic, and mixed (anatomic and lordotic) groups, respectively. ACDFs improved CL and T1S-CL by 5.71° (p<.001) and 3.32° (p<.01), respectively. CL was improved in the lordotic (5.27°; p<.01) and anatomic (4.57°; p<.01) groups, while only the lordotic group demonstrated improvement in T1S-CL (3.4°; p=.02). There were no differences in ΔCL (p=.70), ΔcSVA (p=.89), or ΔT1S-CL (p=.1) between the groups. Two- and 3-level fusions improved CL by 7.48° (p<.01) and 9.62° (p<.01), and T1S-CL by 4.43° (p<.01) and 5.96° (p<.01), respectively. Conclusions Overall, ACDFs significantly improved CL and T1S-CL however, there were no differences in CSB correction between the anatomic and lordotic groups. Two- and 3-level fusions more effectively improved CL (vs. single-level) and T1S-CL (vs. 3-level). These results suggest that implants should continue to be personalized to the patient's anatomy, however, future research is needed to validate these findings and incorporate the effects of preoperative deformities.
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Affiliation(s)
- Nadeem N. Al-Adli
- Texas Christian University School of Medicine, TCU Box 297085, Fort Worth, Texas 76129, USA
| | - Siri Tummala
- Texas Christian University School of Medicine, TCU Box 297085, Fort Worth, Texas 76129, USA
| | - Michael C. Oh
- Methodist Moody Brain and Spine Institute, 1411 North Beckley Ave, Pavilion III, Suite 152, Dallas, TX 75203, USA
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Kwon JW, Lee YH, Lee BH, Kim JH, Suk KS. Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone. Sci Rep 2024; 14:4035. [PMID: 38369553 PMCID: PMC10874951 DOI: 10.1038/s41598-024-54786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO2-P2O5-B2O3) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Yong Ho Lee
- Department of Orthopedic Surgery, Yonsei Baro-Chuk Hospital, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Jae Hong Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kyung Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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He H, Fan L, Lü G, Li X, Li Y, Zhang O, Chen Z, Yuan H, Pan C, Wang X, Kuang L. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord 2024; 25:96. [PMID: 38279132 PMCID: PMC10811816 DOI: 10.1186/s12891-024-07213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND To find out if three-dimensional printing (3DP) off-the-shelf (OTS) prosthesis is superior to titanium mesh cages in anterior cervical corpectomy and fusion (ACCF) when treating single-segment degenerative cervical spondylotic myelopathy (DCSM). METHODS DCSM patients underwent ACCF from January 2016 to January 2019 in a single center were included. Patients were divided into the 3DP group (28) and the TMC group (23). The hospital stays, operation time, intraoperative blood loss, and the cost of hospitalization were compared. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) were recorded pre-operatively, 1 day, 3, 6, 12, and 24 months post-operatively. Radiological data was measured to evaluate fusion, subsidence, and cervical lordosis. Patients were sent with SF-36 to assess their health-related quality of life (HRQoL). RESULTS The differences in operative time, intraoperative blood loss, and hospital stay were not statistically significant between groups (p > 0.05). Postoperative dysphagia occurred in 2 cases in the 3DP group and 3 cases in the TMC group, which all relieved one week later. The difference in improvement of JOA and NDI between the two groups was not statistically significant (p > 0.05). No hardware failure was found and bony fusion was achieved in all cases except one in the 3DP group. The difference in cervical lordosis (CL), fused segmental angle (FSA), mean vertebral height (MVH), and subsidence rates between groups at each follow-up time point was not statistically significant and the results of the SF-36 were similar (p > 0.05). The total cost was higher in the 3DP group with its higher graft cost (p < 0.05). CONCLUSION In treating single-segment DCSM with ACCF, both 3DP OTS prosthesis and TMC achieved satisfactory outcomes. However, the more costly 3DP OTS prosthesis was not able to reduce subsidence as it claimed.
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Affiliation(s)
- Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Fan
- Department of Spinal Surgery, Third Hospital of Changsha, Changsha, Hunan Province, China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xinyi Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ou Zhang
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Ham DW, Jung CW, Chang DG, Yang JJ, Song KS. Feasibility of Non-window Three-Dimensional-Printed Porous Titanium Cage in Posterior Lumbar Interbody Fusion: A Pilot Trial. Clin Orthop Surg 2023; 15:960-967. [PMID: 38045587 PMCID: PMC10689219 DOI: 10.4055/cios22404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background The commercially available design of a three-dimensional (3D)-printed titanium (3D-Ti) cage can be divided into two types according to the presence of a window: a cage with a window that allows filling of bone graft materials and a non-window cage for stand-alone use. This prospective observational case series study aimed to explore the clinical feasibility of using a non-window type 3D-Ti cage in cases of combined window and non-window cage implantation. Furthermore, we evaluated the bone in growth patterns of non-window cages and their correlation with published fusion grading systems. Methods A total of 31 consecutive patients who underwent single-level posterior lumbar interbody fusion surgery were included. Two 3D-Ti cages with different designs were inserted: a non-window cage on the left side and a window cage on the right side. Radiographic fusion was defined by the segmental angle between flexion and extension radiographs (F-E angle) and cage bridging bone (CBB) scores on computed tomography. The association between the F-E angle and osteointegration scoring system including the surface osteointegration ratio (SOR) score was analyzed. Results Radiographic fusion was achieved in 27 of 31 patients (87%) at 12 months postoperatively. Among the non-window cages, 23 of 31 (74.2%) had fair SOR scores, while 19 of 31 (61.3%) window cages had fair intra-cage CBB scores. The higher the SOR score was, the smaller the flexion-extension angle (SOR 0 vs. SOR 1: 6.30° ± 2.43° vs. 1.95° ± 0.99°, p < 0.001; SOR 0 vs. SOR 2: 6.03° ± 2.43° vs. 0.99°± 0.74°, p < 0.001). Conclusions The clinical feasibility of using a non-window 3D-Ti cage during lumbar interbody fusion might be acceptable. Furthermore, a newly suggested fusion criterion for the use of the non-window cage, the SOR score, showed a significant association with the published fusion grading systems, demonstrating its feasibility in determining interbody fusion in lumbar spinal surgery.
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Affiliation(s)
- Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chan-Woo Jung
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Liu Y, Park CW, Pholprajug P, Suvithayasiri S, Kim JH, Lee C, Kim E, Kim JS. Efficacy of Allograft Versus Bioactive Glass-Ceramic Cage in Anterior Cervical Discectomy and Fusion: A Randomized Controlled Study. Global Spine J 2023:21925682231219225. [PMID: 38030132 DOI: 10.1177/21925682231219225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
STUDY DESIGN A randomized controlled trial. OBJECTIVE The aim of this study is to compare the efficacy of allografts and bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) in treating cervical degenerative disc disease. METHODS We conducted a single-center, randomized controlled trial between August 2017 and August 2022. Participants were randomized into two groups, and consecutive patients requiring ACDF were randomly assigned to receive either the allograft cage or the BG cage. The surgical outcomes measured included pain levels, neck disability, surgical details, and radiological assessments. RESULTS Of the 45 assessed, 40 participants were included, with 18 in the allograft cage group and 22 in the BG cage group. By the 12-month follow-up, both groups exhibited significant improvements in pain levels and disability scores, with no notable intergroup differences. Over 85% of patients in both groups were satisfied with their outcomes. Radiological assessments revealed stability in the cervical spine with both cage types post intervention. Although both materials showed a trend toward increased subsidence over time, the difference between them was not statistically significant. Fusion rates were comparable between the groups at 12 months, with BG cage showing a slightly higher early fusion rate at 6 months. No significant differences were observed between the two groups in terms of complications. CONCLUSIONS Both allograft and BG cages are effective in ACDF surgeries for cervical degenerative disc disease, with both contributing to substantial postoperative improvements. Differences in disc height, interspinous motion, and subsidence were not significant in the last follow-up, indicating both materials' suitability for clinical use. Future research with a larger cohort and longer follow-up is needed to confirm these preliminary findings.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Woong Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Phattareeya Pholprajug
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopedics, Rayong hospital, Rayong, Thailand
| | - Siravich Suvithayasiri
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chorong Lee
- The Team of Clinical Research, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Kim
- The Team of Clinical Research, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Cheng CH, Chiu PY, Chen HB, Niu CC, Nikkhoo M. The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study. Front Bioeng Biotechnol 2023; 11:1217274. [PMID: 37650042 PMCID: PMC10464836 DOI: 10.3389/fbioe.2023.1217274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evaluated the effect of larger-sized interbody cages on the cervical spine with ACDF under both static and cyclic loading. Method: Twenty pre-operative personalized poro-hyperelastic finite element (FE) models were developed. ACDF post-operative models were then constructed and four clinical scenarios (i.e., 1) No-distraction; 2) 1 mm distraction; 3) 2 mm distraction; and 4) 3 mm distraction) were predicted for each patient. The biomechanical responses at adjacent spinal levels were studied subject to static and cyclic loading. Non-parametric Friedman statistical comparative tests were performed and the p values less than 0.05 were reflected as significant. Results: The calculated intersegmental range of motion (ROM) and intradiscal pressure (IDP) from 20 pre-operative FE models were within the overall ranges compared to the available data from literature. Under static loading, greater ROM, IDP, facet joint force (FJF) values were detected post ACDF, as compared with pre-op. Over-distraction induced significantly higher IDP and FJF in both upper and lower adjacent levels in extension. Higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were observed in ACDF group which significantly increased for over-distraction groups. Discussion: it was concluded that using larger-sized interbody cages (the height of ≥2 mm of the index disc height) can result in remarkable variations in biomechanical responses of adjacent levels, which may indicate as risk factor for adjacent segment disease. The results of this comprehensive FE investigation using personalized modeling technique highlight the importance of selecting the appropriate height of interbody cage in ACDF surgery.
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Affiliation(s)
- Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ping-Yeh Chiu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Bin Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Patel NA, O’Bryant S, Rogers CD, Boyett CK, Chakravarti S, Gendreau J, Brown NJ, Pennington ZA, Hatcher NB, Kuo C, Diaz-Aguilar LD, Pham MH. Three-Dimensional-Printed Titanium Versus Polyetheretherketone Cages for Lumbar Interbody Fusion: A Systematic Review of Comparative In Vitro, Animal, and Human Studies. Neurospine 2023; 20:451-463. [PMID: 37401063 PMCID: PMC10323354 DOI: 10.14245/ns.2346244.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 07/05/2023] Open
Abstract
Interbody fusion is a workhorse technique in lumbar spine surgery that facilities indirect decompression, sagittal plane realignment, and successful bony fusion. The 2 most commonly employed cage materials are titanium (Ti) alloy and polyetheretherketone (PEEK). While Ti alloy implants have superior osteoinductive properties they more poorly match the biomechanical properties of cancellous bones. Newly developed 3-dimensional (3D)-printed porous titanium (3D-pTi) address this disadvantage and are proposed as a new standard for lumbar interbody fusion (LIF) devices. In the present study, the literature directly comparing 3D-pTi and PEEK interbody devices is systematically reviewed with a focus on fusion outcomes and subsidence rates reported in the in vitro, animal, and human literature. A systematic review directly comparing outcomes of PEEK and 3D-pTi interbody spinal cages was performed. PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Mean Newcastle-Ottawa Scale score for cohort studies was 6.4. A total of 7 eligible studies were included, comprising a combination of clinical series, ovine animal data, and in vitro biomechanical studies. There was a total population of 299 human and 59 ovine subjects, with 134 human (44.8%) and 38 (64.4%) ovine models implanted with 3D-pTi cages. Of the 7 studies, 6 reported overall outcomes in favor of 3D-pTi compared to PEEK, including subsidence and osseointegration, while 1 study reported neutral outcomes for device related revision and reoperation rate. Though limited data are available, the current literature supports 3D-pTi interbodies as offering superior fusion outcomes relative to PEEK interbodies for LIF without increasing subsidence or reoperation risk. Histologic evidence suggests 3D-Ti to have superior osteoinductive properties that may underlie these superior outcomes, but additional clinical investigation is merited.
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Affiliation(s)
- Neal A. Patel
- School of Medicine, Mercer University, Columbus, GA, USA
| | | | | | | | - Sachiv Chakravarti
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Nolan J. Brown
- Department of Neurosurgery, University of California Irvine, Orange, CA, USA
| | | | | | - Cathleen Kuo
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA
| | | | - Martin H. Pham
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
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10
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Wuertzer SD, Pohl EC, Stevens EA, Geer CP. Spinal Fusion: Role of Perioperative Radiography. Radiographics 2023; 43:e220061. [PMID: 36893053 DOI: 10.1148/rg.220061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Scott D Wuertzer
- From the Departments of Radiology (S.D.W., E.C.P., C.P.G.) and Neurosurgery (E.A.S., C.P.G.), Wake Forest School of Medicine, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC 27157
| | - Evan C Pohl
- From the Departments of Radiology (S.D.W., E.C.P., C.P.G.) and Neurosurgery (E.A.S., C.P.G.), Wake Forest School of Medicine, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC 27157
| | - E Andrew Stevens
- From the Departments of Radiology (S.D.W., E.C.P., C.P.G.) and Neurosurgery (E.A.S., C.P.G.), Wake Forest School of Medicine, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC 27157
| | - Carol P Geer
- From the Departments of Radiology (S.D.W., E.C.P., C.P.G.) and Neurosurgery (E.A.S., C.P.G.), Wake Forest School of Medicine, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC 27157
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11
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Milczynska WM, Ahmad A, Ahmed AI, Panchmatia JR, Fakouri B, Liantis P, Panteliadis P. Does titanium cage subsidence affect clinical outcomes in ACDF surgery? A tertiary centre experience. Ann R Coll Surg Engl 2023; 105:378-383. [PMID: 35950498 PMCID: PMC10066656 DOI: 10.1308/rcsann.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cage subsidence after anterior cervical discectomy and fusion (ACDF) surgery has been well documented with rates of up to 40%. Cages fill the void after cervical discectomy and promote fusion. These materials have different biomechanical profiles with differing rates of subsidence. This retrospective cohort study aimed to determine subsidence rates specifically associated with the novel Emerging Implant Technologies (EIT) titanium cage, identify risk factors associated with subsidence, and evaluate whether subsidence affects clinical outcomes. METHODS ACDF with insertion of stand-alone EIT cage was performed in 39 patients (64 levels) between December 2016 and February 2019 with a median follow-up of 11 months. Patients were classified into two groups; subsidence and non-subsidence, and were compared in terms of the resultant clinical outcomes as well as presence of risk factors. Health-related quality of life (HRQOL) outcomes were assessed using Visual Analogue Scale (VAS) for neck and arm pain, EuroQol 5-Dimension 5-Level (EQ-5D-5L), EuroQol Visual Analogue Scale (EQ VAS) and Neck Disability Index (NDI) scores. RESULTS Cage subsidence (>3mm) was present in nine patients (23%), which corresponded to ten levels treated (16%). Development of subsidence was not associated with gender (p = 0.12), age (p = 0.27), smoking (p = 0.13), number of treatment levels (p = 0.10) or cage size used (p = 0.34). It had no effect on any of the HRQOL outcomes, namely VAS Neck (p = 0.07), VAS Arms (p = 0.08), EQ-5D-5L (p = 0.36), EQ VAS (p = 0.85) and NDI (p = 0.80). CONCLUSIONS The EIT cage seems to be associated with lower rates of subsidence compared with other cage types. Cage subsidence was not associated with HRQOL outcomes or risk factors.
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Affiliation(s)
- WM Milczynska
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - A Ahmad
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - AI Ahmed
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - JR Panchmatia
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - B Fakouri
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - P Liantis
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
| | - P Panteliadis
- Guy’s and St Thomas’s NHS Foundation Trust (GSTT), UK
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12
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Pao JL. Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes. Neurospine 2023; 20:80-91. [PMID: 37016856 PMCID: PMC10080423 DOI: 10.14245/ns.2346036.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To describe the surgical techniques and the treatment outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BETLIF) using double cages.Methods: This study included 89 patients with 114 fusion segments between July 2019 and May 2021. One pure polyetheretherketone (PEEK) cage and 1 composite titanium-PEEK cage were used for interbody fusion. Clinical outcomes measures included visual analogue scale (VAS) scores for lower back pain and leg pain, Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Computed tomography (CT) of the lumbar spine 1 year postoperatively was used to evaluate the Bridwell interbody fusion grades.Results: There were significant improvement in VAS for lower back pain from 5.2 ± 3.1 to 1.7 ± 2.1, VAS for leg pain from 6.3 ± 2.5 to 1.7 ± 2.0, ODI from 46.7 ± 17.0 to 12.7 ± 16.1, and JOA score from 15.6 ± 6.3 to 26.4 ± 3.2. The p-values were all < 0.001. The average hospital stay was 5.7 ± 1.1 days. The CT studies available for 60 fusion segments showed successful fusion (Bridwell grade I or grade II) in 56 segments (93.3%). Significant cage subsidence of more than 2 mm was only noted in 3 segments (5.0%). Complications included 1 dural tear, 2 pedicle screws malposition, and 2 epidural hematomas, in which 2 patients required reoperations.Conclusion: BETLIF with double cages provided good neural decompression and a sound environment for interbody fusion with a big cage footprint, a large amount of bone graft, endplate preservation, and segmental stability.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
- Longhwa University of Science and Technology, Taoyuan, Taiwan
- Corresponding Author Jwo-Luen Pao Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, 21, Section 2, Nanya South Road, Banqiao District, New Taipei 22060, Taiwan
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13
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Yao YC, Chou PH, Lin HH, Wang ST, Chang MC. Outcome of Ti/PEEK Versus PEEK Cages in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Global Spine J 2023; 13:472-478. [PMID: 33733888 PMCID: PMC9972280 DOI: 10.1177/21925682211000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES This study aims to present the clinical and radiographical outcomes of the titanium-polyetheretherketone (Ti/PEEK) composite cage compared to those of the standard PEEK cage in patients receiving minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). METHODS Patients receiving 1 level MI-TLIF between October 2015 and October 2017 were included with a minimum of 2-year follow-up. The patients were segregated into 2 groups; Ti/PEEK group and PEEK group. Each patient was propensity-matched using preoperative age, sex, and body mass index. Early fusion rate was evaluated by computed tomography at postoperative 6 months. Clinical outcomes were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. RESULTS After matching, there were 27 patients included in each group. The demographics, diagnosis, and surgical details were not significantly different between the 2 groups. The 6-month rate was 88.9% in Ti/PEEK group. The fusion rate and cage subsidence rate had no difference between the 2 groups. The complication rate in the Ti/PEEK group was comparable to that in the PEEK group. There was no difference in VAS and ODI scores during a 2-year follow-up period. CONCLUSIONS The use of Ti/PEEK composite cage was as safe and effective as the use of PEEK cage in MI-TLIF. The 6-month fusion rate was 88.9%. Our finding revealed comparable clinical results for surgeons using Ti/PEEK composite cages in MI-TLIF compared to those using the PEEK cage.
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Affiliation(s)
- Yu-Cheng Yao
- Department of Orthopedics and
Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei,
Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and
Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei,
Taiwan,Department of Surgery, College of
Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsi-Hsien Lin
- Department of Orthopedics and
Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei,
Taiwan
| | - Shih-Tien Wang
- Department of Orthopedics and
Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei,
Taiwan,Department of Surgery, College of
Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopedics and
Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei,
Taiwan,Department of Surgery, College of
Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Ming-Chau Chang, Department of Orthopedics
and Traumatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai
Rd, Beitou District, Taipei 112, Taiwan.
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14
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Zeng Z, Zhu C, Deng Z, Liu L, Song Y. A novel nanohydroxyapatite/polyamide-66 cage for reducing the subsidence rate after single-level anterior cervical discectomy and fusion: a comparative study of 7-year follow-up. J Orthop Surg Res 2023; 18:54. [PMID: 36653859 PMCID: PMC9850518 DOI: 10.1186/s13018-023-03521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A novel nanohydroxyapatite/polyamide-66 cage (n-HA/PA66 cage) with a horseshoe shape was designed to lower the subsidence rate of the traditional hollow cylindrical n-HA/PA66 cage. However, no studies have compared the incidence of subsidence in the two cages. The purpose of this study was to compare the long-term clinical and radiological outcomes of the novel n-HA/PA66 cage with the hollow cylindrical n-HA/PA66 cage after anterior cervical discectomy and fusion (ACDF) to treat single-level cervical degenerative disk disease (CDDD). METHODS Fifty-two patients with novel n-HA/PA66 cages (Group A) and fifty-five patients with hollow cylindrical n-HA/PA66 cages (Group B) were included. The radiological parameters included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), subsidence rate, and fusion rate. The clinical outcomes were visual analog scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and patient satisfaction rates. RESULTS The pre- and postoperative SA, C2-7a, and fusion rates of the patients in Groups A and B were similar. The preoperative and 6-month postoperative IHs in both groups were comparable. However, the final follow-up IH in Group B was significantly smaller than that in Group A (35.9 mm vs. 36.7 mm). The difference in the subsidence rates at the final follow-up between Group A (5.8%, 3/52) and Group B (18.2%, 10/55) was significant. The VAS score, JOA score, and patient satisfaction rate were not significantly different. CONCLUSIONS The novel n-HA/PA66 cage had similar favorable SA, C2-7a, fusion rate, and clinical outcomes compared to the hollow cylindrical n-HA/PA66 cage for treating single-level ACDF. Moreover, the novel n-HA/PA66 cage achieved a lower subsidence rate and higher IH than the hollow cylindrical n-HA/PA66 cage at the final follow-up.
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Affiliation(s)
- Zhimou Zeng
- grid.13291.380000 0001 0807 1581Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China ,grid.414880.1Department of Orthopedic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500 China
| | - Ce Zhu
- grid.13291.380000 0001 0807 1581Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Zhipeng Deng
- grid.13291.380000 0001 0807 1581Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Limin Liu
- grid.13291.380000 0001 0807 1581Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Yueming Song
- grid.13291.380000 0001 0807 1581Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
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15
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Chen Z, Lü G, Wang X, He H, Yuan H, Pan C, Kuang L. Is 3D-printed prosthesis stable and economic enough for anterior spinal column reconstruction after spinal tumor resection? A retrospective comparative study between 3D-printed off-the-shelf prosthesis and titanium mesh cage. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:261-270. [PMID: 36477893 DOI: 10.1007/s00586-022-07480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECT To investigate the stability and cost-effectiveness of the three-dimensional-printed (3DP) off-the-shelf (OTS) prosthesis in the reconstruction of the anterior column of the thoracic/lumbar spine after tumor resection. METHODS Thirty-five patients (26 with primary malignant tumors and nine with metastatic malignant tumors) who underwent tumor resection and anterior column reconstruction between January 2014 and January 2019 were included in a single institute. Patients were divided into the 3DP OTS prosthesis (3DP) group (n = 14) and the titanium mesh cage (TMC) group (n = 21) by the type of implant. The operation time, intraoperative blood loss, hospital stay, history of radiotherapy, surgical level and total cost were collected and compared between the two groups. Mechanical complications and radiological parameters including mean vertebral height, subsidence, fixation failure(nonunion, migration, screw loosening, rod breakage) rate were recorded at preoperation, 1 week, 3 months, 6 months, 12 months after surgery then at 1 year interval or stop until the end of survival. The follow-up patients were also sent with short form-36 to assess their health-related quality of life (HRQoL) and questions about the current condition of their disease. RESULTS The mean overall follow-up was 24.6 months. Of the 35 patients involved, six patients died and six were lost to follow-up. The differences between the two groups in operative time, intraoperative blood loss, and hospital stay were not statistically significant (p > 0.05). The differences in fixation failure and the subsidence rate between the two groups were not statistical significant (p > 0.05). The difference of subsidence rate between the cases with and without osteoporosis, cases with and without radiotherapy was statistically significant within each group (p < 0.05). However, the difference of subsidence rate between the surgical level above or below T10 was not statistically significant (p > 0.05). The response rate of the questionnaire among the survived patients was 100% (23/23 patients). The results of the Short Form- (SF-)36 between the two groups were similar (p > 0.05). The total cost was higher in the 3DP group (p < 0.05) with its higher graft cost (p < 0.05), but the differences in internal fixation cost and other cost were not statistically significant between groups (p > 0.05). CONCLUSION Compared to TMC, the 3DP OTS prosthesis achieved similar clinical and radiological results in spinal anterior spinal column reconstruction of thoracic/lumbar spinal tumor resection. However, the 3DP OTS prosthesis was more expansive than TMC.
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Affiliation(s)
- Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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16
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Duits A, Salvatori D, Schouten J, van Urk P, Gaalen SV, Ottink K, Öner C, Kruyt M. Preclinical model for lumbar interbody fusion in small ruminants: Rationale and guideline. J Orthop Translat 2023; 38:167-174. [DOI: 10.1016/j.jot.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
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17
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Tredan DAM, Mobbs RJ, Maharaj M, Parr WCH. Combining Virtual Surgical Planning and Patient-Specific 3D-Printing as a Solution to Complex Spinal Revision Surgery. J Pers Med 2022; 13:jpm13010019. [PMID: 36675680 PMCID: PMC9866145 DOI: 10.3390/jpm13010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
With the advent of three-dimensional printing, rapid growth in the field and application in spinal and orthopedic surgery has been seen. This technology is now being applied in creating patient-specific implants, as it offers benefits over the generic alternative, with growing literature supporting this. This report details a unique application of virtual surgical planning and manufacture of a personalized implant in a case of cervical disc replacement failure with severe osteolysis and resultant hypermobility. Where this degree of degenerative bone loss would often necessitate a vertebrectomy to be performed, this case highlights the considerable customizability of 3D-printed patient-specific implants to contour to the bony defects, allowing for a smaller and safer operation, with the achievement of stability as early as 3 months after the procedure, by the presence of osseointegration. With increasing developments in virtual planning technology and 3D printing ability, the future of complex spinal revision surgery may adopt these technologies as it affords the patient a faster, safer, and less invasive and destructive procedure.
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Affiliation(s)
- David A. M. Tredan
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Correspondence: ; Tel.: +61-(0)2-9382-2222
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia
- 3DMorphic Pty. Ltd., Matraville, NSW 2036, Australia
| | - Monish Maharaj
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - William C. H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia
- 3DMorphic Pty. Ltd., Matraville, NSW 2036, Australia
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18
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Deng Z, Hu B, Yang X, Wang L, Song Y. The improved bioactive n-HA/PA66 cage versus the PEEK cage in anterior cervical fusion: results from a 6-year follow-up and a case-matched study. BMC Musculoskelet Disord 2022; 23:1113. [PMID: 36544134 PMCID: PMC9768934 DOI: 10.1186/s12891-022-06081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage, a bioactive nonmetal cage, is fabricated in a hollow cylindrical shape and has been widely used for decades with good clinical outcomes for anterior cervical fusion. However, there remain some radiological complications, such as a slightly high subsidence rate. To improve the clinical outcomes, the improved n-HA/PA66 cage now has been developed into a trapezoidal and wedge shape, a better biomechanical shape matching the cervical spine that is similar to that of the PEEK cage. However, there have been no long-term comparisons of the improved n-HA/PA66 cage and PEEK cage in anterior cervical reconstruction. METHODS Fifty-eight patients who underwent single-level anterior cervical decompression and fusion (ACDF) with the improved n-HA/PA66 cage (n-HA/PA66 group) were matched with patients with the PEEK cage (PEEK group) by clinical presentation, segment, age and sex. All patients underwent a minimum of 6 years of follow-up. The radiographic parameters (cage subsidence, fusion status, cervical lordosis, and segmental sagittal alignment) and clinical parameters (10-point visual analogue scale, Neck Disability Index and Japanese Orthopedic Association scores) from patients were evaluated before surgery, immediately after surgery, and at the latest follow-up. RESULTS The n-HA/PA66 and PEEK groups were well matched in terms of clinical presentation, segment, age, and sex at surgery. The n-HA/PA66 and PEEK cages had similar fusion rates at 6 months postoperatively (n-HA/PA66: 58.6% vs. PEEK: 51.7%, P = 0.455) and at the last follow-up (n-HA/PA66: 96.6% vs. PEEK: 93.1%, P = 0.402). The respective cage subsidence rates in the n-HA/PA66 and PEEK groups were 6.9 and 12.1% (P = 0.342). The correction of SA was similar between the groups at the final follow-up (n-HA/PA66: 4.29 ± 1.99 vs. PEEK: 3.99 ± 2.59 P = 0.464). There were no significant differences between the two groups in mean cervical lordosis, visual analogue scale scores of the neck and arm, NDI scores, JOA scores or patients' overall satisfaction at the final follow-up. CONCLUSION After single-level ACDF, the improved n-HA/PA66 cage had similar excellent results in both radiological and clinical outcomes compared with the PEEK cage over 6 years of follow-up. According to these results, the improved n-HA/PA66 cage and the PEEK cage could be comparable for ACDF.
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Affiliation(s)
- Zhipeng Deng
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Bowen Hu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Xi Yang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Lei Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Yueming Song
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
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19
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Patel AH, Ofa SA, Collins LK, McCluskey LC, Sherman WF, Cyriac M. Trends of single-level anterior cervical discectomy and fusion documentation after the 2015 Centers for Medicare & Medicaid Services coding audit. J Neurosurg Spine 2022; 37:802-811. [PMID: 35932261 DOI: 10.3171/2022.5.spine22415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the use of anterior cervical discectomy and fusion (ACDF) expected to rise by 13.3% from 2020 to 2040, the increased usage of interbody cages with integral anterior fixation prompted a Centers for Medicare & Medicaid Services (CMS) review, which resulted in coding changes affecting anterior instrumentation documentation. CMS determined that Current Procedural Terminology (CPT) code 22845 should not be used to report integrated instrumentation (plate) with an interbody device, and if additional anterior instrumentation (e.g., plates and screws) is placed with an integrated interbody device, then a 59 modifier should be used. There is sparse literature examining the trends of ACDF without and with additional anterior instrumentation after the 2015 CMS audit. Therefore, this study aimed to evaluate the trends of single-level subaxial ACDF utilization from 2011 to 2019 to determine whether the 2015 CMS audit influenced the documented usage of additional anterior instrumentation. METHODS A retrospective cohort study was performed using the commercially available database PearlDiver. Patient records were queried from 2011 to 2019 for single-level subaxial ACDF without (CPT code 22551) and with (CPT codes 22551 + 22845) instrumentation. Cochran-Armitage trend analyses were performed to evaluate the hypothesis that ACDF with additional anterior instrumentation decreased over the given time period. RESULTS Between 2011 and 2019, the total number of single-level ACDFs decreased from 6202 to 4402. From 2011 to 2015, an average of 6240 patients per year underwent single-level subaxial ACDF; of those, 950 patients (15.2%) had ACDF without instrumentation and 5290 patients (84.8%) had ACDF with instrumentation. In 2016, the total number of single-level subaxial ACDFs decreased to 5525, with 1006 patients (18.2%) receiving no instrumentation and 4519 patients (81.8%) receiving instrumentation. From 2017 to 2019, an average of 4283 patients per year underwent a single-level subaxial ACDF; of these, 1280 (29.9%) had no instrumentation and 3003 (70.1%) had instrumentation (all p < 0.0001). CONCLUSIONS From 2015 to 2019, single-level ACDF without instrumentation significantly increased by 91.5% and ACDF with anterior instrumentation significantly decreased by 18.1%. The 2015 CMS audit of interbody cages and anterior instrumentation coding (CPT code 22845) may account for the decreased documentation of anterior instrumentation in the 9-year period. Understanding CMS auditing could help surgeons perceive changes in practice patterns that may lead to a more thorough evaluation of patient outcomes, cost, and overall value.
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Affiliation(s)
- Akshar H Patel
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Sione A Ofa
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Lacee K Collins
- 2Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Leland C McCluskey
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - William F Sherman
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Mathew Cyriac
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
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20
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Kang KC, Jang TS, Jung CH. Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques. Asian Spine J 2022; 16:995-1012. [PMID: 36599372 PMCID: PMC9827215 DOI: 10.31616/asj.2022.0445] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients' factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae Su Jang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea,Corresponding author: Tae Su Jang Department of Orthopaedic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8346, Fax: +82-2-964-3865, E-mail:
| | - Cheol Hyun Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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21
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Veronesi F, Sartori M, Griffoni C, Valacco M, Tedesco G, Davassi PF, Gasbarrini A, Fini M, Barbanti Brodano G. Complications in Spinal Fusion Surgery: A Systematic Review of Clinically Used Cages. J Clin Med 2022; 11:6279. [PMID: 36362508 PMCID: PMC9659217 DOI: 10.3390/jcm11216279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 09/30/2023] Open
Abstract
Spinal fusion (SF) comprises surgical procedures for several pathologies that affect different spinal levels, and different cages are employed in SF surgery. Few clinical studies highlight the role of cages in complications beyond the outcomes. The aim of this systematic review is to collect the last 10 years' worth of clinical studies that include cages in SF surgery, focusing on complications. Three databases are employed, and 21 clinical studies are included. The most-performed SF procedure was anterior cervical discectomy and fusion (ACDF), followed by lumbar SF. The polyetheretherketone (PEEK) cage was the most-used, and it was usually associated with autograft or calcium phosphate ceramics (hydroxyapatite (HA) and tricalcium phosphate (βTCP)). For lumbar SF procedures, the highest percentages of subsidence and pseudoarthrosis were observed with PEEK filled with bone morphogenetic protein 2 (BMP2) and βTCP. For ACDF procedures, PEEK filled with autograft showed the highest percentages of subsidence and pseudoarthrosis. Most studies highlighted the role of surgical techniques in patient complications. There are many interacting events that contextually affect the rate of clinical success or failure. Therefore, in future clinical studies, attention should focus on cages to improve knowledge of chemical, biological and topographical characteristics to improve bone growth and to counteract complications such as cage loosening or breaking and infections.
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Affiliation(s)
- Francesca Veronesi
- Surgical Sciences and Technologies, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Sartori
- Surgical Sciences and Technologies, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS-Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Marcelo Valacco
- Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires 1437, Argentina
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS-Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Paolo Francesco Davassi
- Department of Spine Surgery, IRCCS-Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS-Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Barbanti Brodano
- Department of Spine Surgery, IRCCS-Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
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22
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Jalilvand E, Abollfathi N, Khajehzhadeh M, Hassani-Gangaraj M. Optimization of cervical cage and analysis of its base material: A finite element study. Proc Inst Mech Eng H 2022; 236:1613-1625. [DOI: 10.1177/09544119221128467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nowadays, cervical disorders are common due to human lifestyles. Accordingly, the cage design should be optimized as an essential issue. For an optimal design, an objective function is utilized to calculate the proper geometrical parameters. Additionally, the base material of the cage plays a key role in its functionality and final cost. Novel materials are currently introduced with more compatibility with the bone in terms of mechanical and chemical properties. In this study, a cervical cage was modeled based on PEEK material with three types of tooth designs on its surface. The cervical cage is assumed to be implanted between C6 and C7 vertebrae. The geometric parameters of the cage were optimized to minimize the mass by determining allowable stress and subsidence. The effect of complete cortical removal was investigated as a surgical mistake. Finally, a new composition of PEEK/titanium was introduced as the base material of the cage. Ansys 18.2 was used for FEA. The cage with a straight tooth was chosen due to its lower stress and subsidence compared with other designs. Furthermore, the optimized structures of all three tooth designs were determined. The mass and volume of the optimal cages were reduced by 41.47% and 41.52% respectively. Besides, complete cortical resection should not be carried out during fusion surgery, since it may lead to higher subsidence. The composition of PEEK/titanium was chosen as an appropriate base material due to its better performance compared with PEEK or titanium alone.
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Affiliation(s)
- Elahe Jalilvand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Nabiolah Abollfathi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohsen Khajehzhadeh
- Department of Mechanical Engineering, Amirkabir University of Technology, Tehran, Iran
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23
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Wang X, Lin Y, Wang Q, Gao L, Feng F. A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion. J Pain Res 2022; 15:3137-3156. [PMID: 36311292 PMCID: PMC9604433 DOI: 10.2147/jpr.s375720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Study design A bibliometric analysis. Objective To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion. Summary of Background Data Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends. Methods We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis. Results The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF". Conclusion ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.
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Affiliation(s)
- Xun Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Yanze Lin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Qiongtai Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Liqing Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Correspondence: Fabo Feng, Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China, Email
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24
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Virkar N, Bhilare P, Hadgaonkar S, Kothari A, Sancheti P, Aiyer S. Standalone cage versus anchored cage for anterior cervical discectomy and fusion: a comparative analysis of clinical and radiological outcomes. INTERNATIONAL ORTHOPAEDICS 2022; 46:2339-2345. [PMID: 35790547 DOI: 10.1007/s00264-022-05493-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The use of standalone cages (SAC) and anchored cages (AC) in anterior cervical discectomy and fusion surgery (ACDF) has shown advantage of reduced operative time and lower incidence of dysphagia. However, there is limited literature available comparing the clinical and radiological outcomes of SAC and AC. METHODS We conducted a prospective study for patients undergoing ACDF for cervical radiculopathy or myelopathy. Patient were classified based on the cage used into SAC group and the AC group. Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) for myelopathy and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for radiculopathy. Dysphagia was graded as per Bazaz score. Radiologically, global cervical lordosis, segmental lordosis, cage subsidence, and migration were assessed. RESULTS We analyzed 31 patients in each group with a minimum two year follow-up. The mean VAS improved from 7.9 to 4.56, mean NDI score improved from 27.6 to 19.8, and mean mJOA improved from 10.8 to 11.7 which were statistically significant (p < 0.05); however, no significant difference was noted between the SAC and AC groups. Mean global lordosis improved from 14.4 to 20.3° and mean segmental lordosis improved from 6 to 10.1° at six months and plateaued to 6.9° at final follow up without any significant difference between the groups. The subsidence was statistically more in 12.9% (4/31) in SAC than 6.4% (2/31) in AC. CONCLUSION AC showed of lower rates of subsidence while both SAC and AC had comparable clinical outcomes and radiological alignment outcomes.
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Affiliation(s)
- Niharika Virkar
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India
| | - Pramod Bhilare
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India
| | - Shailesh Hadgaonkar
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India
| | - Ajay Kothari
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India
| | - Parag Sancheti
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India
| | - Siddharth Aiyer
- Department of Orhtopaedic, Sancheti institute for Orthopaedics and Rehabiliation, Pune, India.
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25
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Ding Z, Ren Y, Cao H, Li J. Top 100 most cited articles on anterior cervical discectomy and fusion. Front Surg 2022; 9:1000360. [PMID: 36147696 PMCID: PMC9485582 DOI: 10.3389/fsurg.2022.1000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design Bibliometric analysis. Objective Anterior cervical discectomy and fusion (ACDF) is a typical surgical method in spine surgery and has progressed significantly in the last several decades. The purpose of this study is to determine how the 100 most-cited original articles on ACDF have been the most influential in this field by identifying and analyzing them. Methods The articles on ACDF were identified by searching the Thomson ISI Web of Science database on 30 May 2022. The 100 most-cited articles were selected according to specific criteria. The data extracted from the articles included title, publication date, total citations, journal name, first author, institutions, and keywords. Results The total number of citations was 13,181, with a mean number of 131.81 ± 100.18. The publication dates ranged from 1994 to 2018. Most of these articles originated in the United States (68%) and were published in the 2000s (32%) and 2010s (48%). Spine published most of the articles (30%), followed by the Journal of Neurosurgery-Spine (16%), Spine Journal (14%), and European Spine Journal (13%). The most prolific author was Dr. Todd J Albert (n = 7), with 1,312 citations. The Texas Back Institute was the most productive institution (n = 10). The keywords ACDF, cervical spine, cervical spine, and fusion showed the highest degree of centrality. Conclusion One hundred top-cited articles on ACDF were identified and analyzed in this study. We demonstrate that ACDF is a growing and popular area of research, with the focus of research varying through timeline trends. This will provide a comprehensive and detailed basis for spine surgeons to make clinical decisions and assimilate the research focus of cervical spine surgery.
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Affiliation(s)
- Zhiyu Ding
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jinsong Li
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Dimensional Changes of the Neuroforamen After Anterior Decompression of the Cervical Spine: An In Vitro Micro-Computed Tomography Investigation. World Neurosurg 2022; 165:e423-e431. [PMID: 35738534 DOI: 10.1016/j.wneu.2022.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this preliminary cadaveric study was to quantify the dimensional changes of the neuroforamen and area available for the cord (AAC) after implantation of various interbody devices with and without posterior longitudinal ligament (PLL) removal. METHODS Eight cervical spines (C3-T1) underwent micro-computed tomography (micro-CT) scanning of the intact spine, followed by discectomy and reconstruction at 3 contiguous levels (C4-C7). Under conditions of intact and resected PLL, the following interbody device configurations were evaluated: 1) parallel, 2) lordotic, and 3) optimal lordotic. Neuroforaminal measurements were calculated from an oblique angle and the AAC was calculated by quantifying the empty space compared with the total space available for the cord. Posterior disc height and operative range lordosis were measured and compared between groups. RESULTS Neuroforaminal height and area significantly increased for all reconstruction groups compared with intact. The increase in neuroforaminal height and area was greatest after PLL resection and placement of parallel (27.1% and 43.6%, respectively) and optimal lordotic (30.5% and 41.5%, respectively) implants. The AAC increased as a function of implant placement compared with intact and increased further after resection of the PLL (P < 0.05). There were no significant differences in operative range lordosis between parallel and lordotic implants. CONCLUSIONS Similar to the lumbar spine, segmental distraction via placement of an interbody device produces indirect decompression of the cervical neuroforamen. Results indicate that a 34% increase in neuroforaminal area and a 51% increase in AAC are achievable with appropriately sized interbody devices and adequate distraction at the posterior aspect of the vertebral body.
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27
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Yuan K, Zhang K, Yang Y, Lin Y, Zhou F, Mei J, Li H, Wei J, Yu Z, Zhao J, Tang T. Evaluation of interbody fusion efficacy and biocompatibility of a polyetheretherketone/calcium silicate/porous tantalum cage in a goat model. J Orthop Translat 2022; 36:109-119. [PMID: 36090821 PMCID: PMC9437743 DOI: 10.1016/j.jot.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
Objective To evaluate the interbody fusion efficacy and biocompatibility of a graft-free cage made of polyetheretherketone/calcium silicate composite/porous tantalum (PEEK/CS/pTa cage) compared with a PEEK/CS cage with an autogenous bone graft in a goat model. Methods PEEK/CS/pTa and PEEK/CS cages were prepared through an injection-moulding method. The PEEK/CS composites and porous tantalum were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive spectroscopy (EDS) mapping. Then, adult goats were chosen for C2/C3 and C3/C4 discectomy via the anterior cervical approach and randomly implanted with PEEK/CS/pTa and PEEK/CS/cages with autogenous bone grafts. The fusion performance and osseointegration of the cages were evaluated by X-ray imaging, magnetic resonance imaging (MRI) scanning, and bone histomorphometry analysis. Moreover, the concentrations of Ca and Si in urine, serum, tissue around the fusion segments and major organs of the goats were determined by inductively coupled plasma–optical emission spectrometry (ICP–OES). Histological observation of major organs of the goats was used to evaluate the biosafety of PEEK/CS/pTa and PEEK/CS cages. Results X-ray and MRI imaging suggested that both PEEK/CS/pTa cages and PEEK/CS cages maintained similar average intervertebral space heights. The tissue volumes in the fusion area were comparable between the two groups of cages at 26 weeks after surgery. Histological morphometric data showed that PEEK/CS/pTa cages and PEEK/CS cages with autogenous bone grafts had similar bone contact and osseointegration at 12 and 26 weeks. Element determination of serum, urine, spinal cord, dura matter, bone and organs showed that the CS/PEEK cages did not cause abnormal systemic metabolism or accumulation of calcium and silicon in local tissues and major organs of goats after implantation. No obvious pathological changes were found in the heart, liver, spleen, liver or kidney tissues. Conclusion Overall, these results suggested that the graft-free PEEK/CS/pTa cage showed similar bony fusion performance to the PEEK/CS cages with autogenous bone grafts. The cages releasing calcium and silicon had good biological safety in vivo. The translational potential of this article: This study provided a new graft-free interbody fusion solution to patients with degenerative disc diseases, which could avert potential donor-site complications. This study also provided a detailed assessment of element excretion and accumulation of Ca and Si in vivo, which validated the biosafety of this new type of bioactive interbody fusion cage.
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Affiliation(s)
- Kai Yuan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yiqi Yang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yixuan Lin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Feng Zhou
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jingtian Mei
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Hanjun Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jie Wei
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Corresponding author.
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Corresponding author. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, 200011, China.
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Corresponding author. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, 200011, China.
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Goldberg JL, Meaden RM, Hussain I, Gadjradj PS, Quraishi D, Sommer F, Carnevale JA, Medary B, Wright D, Riew KD, Hartl R. Titanium versus polyetheretherketone versus structural allograft in anterior cervical discectomy and fusion: A systematic review. BRAIN AND SPINE 2022; 2:100923. [PMID: 36248133 PMCID: PMC9560672 DOI: 10.1016/j.bas.2022.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/12/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Introduction Anterior cervical discectomy and fusion (ACDF) is a common procedure to address cervical spine pathology. The most common grafts used are titanium, polyetheretherketone (PEEK), or structural allograft. Comparison of fusion rate is difficult due to non-standardized methods of assessment. We stratified studies by method of fusion assessment and performed a systematic review of fusion rates for titanium, PEEK, and allograft. Research question Which of the common implants used in ACDF has the highest reported rate of fusion? Materials and methods An experienced librarian performed a five-database systematic search for published articles between 01/01/1990 and 08/07/2021. Studies performed in adults with at least 1 year of radiographic follow up were included. The primary outcome was the rate of fusion. Fusion criteria were stratified into 6 classes based upon best practices. Results 34 studies met inclusion criteria. 10 studies involving 924 patients with 1094 cervical levels, used tier 1 fusion criteria and 6 studies (309 patients and 367 levels) used tier 2 fusion criteria. Forty seven percent of the studies used class 3–6 fusion criteria and were not included in the analysis. Fusion rates did differ between titanium (avg. 87.3%, range 84%–100%), PEEK (avg. 92.8%, range 62%–100%), and structural allograft (avg. 94.67%, range 82%–100%). Discussion and conclusion After stratifying studies by fusion criteria, significant heterogeneity in study design and fusion assessment prohibited the performance of a meta-analysis. Fusion rate did not differ by graft type. Important surgical goals aside from fusion rate, such as degree of deformity correction, could not be assessed. Future studies with standardized high-quality methods of assessing fusion, are required. Anterior cervical discectomy and fusion (ACDF) is a common procedure to address cervical spine pathology. The optimal graft type of promote fusion is unknown. The methods for assessing fusion are not standardized. This is a systematic review comparing fusion rates for ACDF grafts after first stratified by method of fusion assessment. Significant heterogeneity in study design and fusion assessment prohibited the performance of a meta-analysis; Fusion rate did not differ by graft type. Future studies with standardized high-quality methods of assessing fusion, are required.
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Affiliation(s)
- Jacob L. Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
- Corresponding author. New York Presbyterian, Department of Neurosurgery, 525 E. 68th Street, Box 99 New York, NY, 10065, USA.
| | - Ross M. Meaden
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Pravesh S. Gadjradj
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Danyal Quraishi
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Drew Wright
- Department of Library Information Technologies and Services, Weill Cornell Medicine, New York, NY, USA
| | - K. Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
| | - Roger Hartl
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA
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29
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Morphologic Change of CorticoCancellous Allograft Used for Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2022; 47:944-953. [PMID: 35275848 DOI: 10.1097/brs.0000000000004354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to evaluate the incidence and clinical implications of graft morphologic changes in corticocancellous allografts used for anterior cervical discectomy and fusion (ACDF), such as graft resorption or fracture. SUMMARY OF BACKGROUND DATA Although cortico-cancellous allograft is one of the most commonly used interbody spacer for ACDF, clinical implications of allograft resorption or fracture is unclear. METHODS One-hundred and thirty-eight consecutive patients who underwent ACDF for degenerative cervical myelopathy or radiculopathy were retrospectively reviewed. Patients with allograft morphologic changes, including graft resorption and fracture (morphologic change group), were compared with patients without morphologic changes (unchanged group). Furthermore, operated segments with morphologic changes were compared with unchanged segments. Patient characteristics, cervical lordosis, segmental lordosis, fusion, subsidence, neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDi) scores were evaluated. RESULTS Ninety patients (149 segments) were included in the study. Allograft resorption or fracture was detected in 46 (51.1%) patients and 81 (54.3%) segments, respectively. The fusion rate of morphologic change segments was significantly lower than that of the unchanged segments (P < 0.001). Furthermore, segments with morphologic changes had significantly higher rates of subsidence compared to unchanged segments ( P < 0.001). Segmental lordosis at the final follow-up was significantly smaller in the morphologic change segments ( P < 0.001). Neck pain VAS, arm pain VAS, and NDI scores did not demonstrate significant intergroup differences. CONCLUSION Corticocancellous allograft demonstrated a high rate of graft morphologic change (54.3%). Graft resorption or fracture was associated with increased pseudarthrosis, subsidence, and decreased postoperative segmental lordosis; however, the clinical results were not significantly affected. Caution is needed when choosing to use corticocancellous allografts for ACDF due to the high rate of graft resorption or fracture and the negative implications of these risks.
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Anterior Cervical Discectomy and Fusion Using Interbody Cage Packed with Autologous Clavicle Bone Graft: Novel Technique. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shen YW, Yang Y, Liu H, Qiu Y, Li M, Ma LT, Gan FJ. Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study. Front Bioeng Biotechnol 2022; 10:842382. [PMID: 35372323 PMCID: PMC8969047 DOI: 10.3389/fbioe.2022.842382] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. A solid interbody fusion is of critical significance in achieving satisfactory outcomes after ACDF. However, the current radiographic techniques to determine the degree of fusion are inaccurate and radiative. Several animal experiments suggested that the mechanical load on the spinal instrumentation could reflect the fusion process and evaluated the stability of implant. This study aims to investigate the biomechanical changes during the fusion process and explore the feasibility of reflecting the fusion status after ACDF through the load changes borne by the interbody fusion cage. Methods: The computed tomography (CT) scans preoperatively, immediately after surgery, at 3 months, and 6 months follow-up of patients who underwent ACDF at C5/6 were used to construct the C2–C7 finite element (FE) models representing different courses of fusion stages. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the C7 vertebra fixed. The Von Mises stress at the surfaces of instrumentation and the adjacent intervertebral disc and force at the facet joints were analyzed. Results: The facet contact force at C5/6 suggested a significantly stepwise reduction as the fusion proceeded while the intradiscal pressure and facet contact force of adjacent levels changed slightly. The stress on the surfaces of titanium plate and screws significantly decreased at 3 and 6 months follow-up. A markedly changed stress distribution in extension among three models was noted in different fusion stages. After solid fusion is achieved, the stress was more uniformly distributed interbody fusion in all loading conditions. Conclusions: Through a follow-up study of 6 months, the stress on the surfaces of cervical instrumentation remarkably decreased in all loading conditions. After solid intervertebral fusion formed, the stress distributions on the surfaces of interbody cage and screws were more uniform. The stress distribution in extension altered significantly in different fusion status. Future studies are needed to develop the interbody fusion device with wireless sensors to achieve longitudinal real-time monitoring of the stress distribution during the course of fusion.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hao Liu,
| | - Yue Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Li
- Department of Measurement and Control Technology and Instrument, Sichuan University, Chengdu, China
| | - Li-Tai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Ji Gan
- Department of Measurement and Control Technology and Instrument, Sichuan University, Chengdu, China
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Salari N, Konz G, Ferry C, Gandhi A, Freeman A, Davis R, Yeung C. Anterior Cervical Discectomy and Fusion With a No-Profile Integrated Fixation Allograft Device: An In Vitro Biomechanical Analysis and Clinical Case Series. Int J Spine Surg 2022; 16:247-255. [PMID: 35444033 PMCID: PMC9930650 DOI: 10.14444/8224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND No-profile anterior cervical discectomy and fusion (ACDF) devices are commonplace in spinal surgery. Contained within the intervertebral margins, these devices diminish risks associated with anterior cervical plating, while also marginalizing cage migration and subsidence. However, these devices have been limited in their scope of implant material. Accordingly, a no-profile ACDF (npACDF) device supporting a machined allograft implant body with a connected load-sharing fixation interface was developed. However, it is not established in the literature whether the device supports early mechanical stability and subsequent boney fusion. The objective of this study was to assess this device in both the clinical and preclinical settings. METHODS Biomechanical Analysis: Twenty-four functional spinal units (FSUs) were divided into 4 groups (n = 6). Each group would receive a single construct: (1) npACDF device with connected polyetheretherketone (PEEK) body, (2) npACDF with connected allograft body, (3) npACDF (allograft body) with nonconnected fixation plate, and (4) standard ACDF plate and PEEK interbody cage. FSUs were subjected to pure moment loading (flexion/extension, lateral bending, and axial rotation) via a kinematic test machine in their intact state and then following instrumentation. Vertebral motion was recorded and range-of-motion (ROM) reduction, relative to intact, was calculated.Clinical Case Series: Ten patients receiving single-level ACDF with the npACDF allograft (connected) device for the treatment of persistent cervical radiculopathy or myelopathy were retrospectively reviewed at 12 months. Radiographic and patient reported outcomes were reported. RESULTS No differences in ROM existed between the npACDF constructs (P ≥ 0.99). Standard ACDF achieved more ROM reduction than the npACDF constructs in all directions (P ≥ 0.04). All subjects achieved fusion at 12 months. CONCLUSIONS The npACDF allograft device supported less motion reduction in comparison to traditional plating; however, case series data suggest the device provides clinically effective stability resulting in quality radiographic fusion and pain improvement. CLINICAL RELEVANCE This report provides both clinical and preclinical insight into a device which offers alternative design features to traditional continuous/rigid ACDF device designs. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Nima Salari
- Orthopaedic Spine Surgeon, Desert Institute for Spine Care, Phoenix, AZ, USA
| | - Gina Konz
- Lake Region Medical, Brooklyn Park, MN, USA
| | - Chris Ferry
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Anup Gandhi
- Pre-Clinical Research & Testing, Zimmer Biomet Spine, Westminster, CO, USA
| | | | - Richard Davis
- Orthopaedic Spine Surgeon, Healthpartners Specialty Center, Saint Paul, MN, USA
| | - Chris Yeung
- Orthopaedic Spine Surgeon, Desert Institute for Spine Care, Phoenix, AZ, USA
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Balakumar B, Raju S, Marconi SD, Hassan MF. A pragmatic single centre retrospective comparative review of complication profile between PEEK cages and Zero-P cage screw constructs. Br J Neurosurg 2021:1-7. [PMID: 34850648 DOI: 10.1080/02688697.2021.2005772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anterior Decompression and Fusion (ACDF) is a common surgery recommended for symptomatic cervical degenerative disc disease after failed conservative care. There is no consensus on the choice of implants, and it varies between surgeons. This study aims to analyse the early complications following ACDF performed using a standalone cage versus a Zero-P (Cage Screw - (CS)) construct for patients with cervical degenerative disc disease. METHODS A total of 162 patients underwent an ACDF between August 2016 and July 2018. There were 83 patients (111 cervical disc levels) with standalone cage (SA) and 79 patients (111 cervical disc levels) with cage-screw (CS) fixation. There was no difference between the groups in terms of age, gender, and levels of surgery. The follow-up ranged from 2 months to 24 months. Complications, both clinical and radiological, were assessed between the groups. RESULTS Both the SA and Zero-P (CS) groups were subdivided into single and multilevel surgery. Complications encountered in the SA group were temporary swallowing problems 10, hoarseness of voice 3, cage migration 1, delayed union 1, Horner's syndrome 1, cage subsidence 2. In the CS group swallowing problems 4, hoarseness of voice 4, CSF leak 1, recurrent symptoms 1. The observed difference in the incidence of complications between the groups did not reach statistical significance. Univariate analysis between the groups did not show any difference in the improvement of cervical sagittal balance, fusion rate, subsidence, and complications encountered. Multivariate logistic regression analysis for complications showed no difference between the groups when assessed for smoking, gender, age, Charlson comorbidity index, levels of surgery, fusion status, Odom score, or the type of implant. CONCLUSION In this short-term study, the standalone (SA) cages showed no difference in their complication profile in comparison to a cage-screw construct for both single and multilevel ACDF. Standalone cages might be a cost-effective option without increased complication risks. Nevertheless, we propose a longer-term follow-up with a prospective randomized trial for further evaluation of this finding.
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Affiliation(s)
- Balasubramanian Balakumar
- Specialty Registrar (ST6) Birmingham Orthopaedic Training Programme (BOTP) Rotation, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Sivashanmugam Raju
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Sam David Marconi
- Community Health Department, Christian Medical College, Vellore, India
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Mobbs RJ, Amin T, Ho D, McEvoy A, Lovric V, Walsh WR. Integral fixation titanium/polyetheretherketone cages for cervical arthrodesis: Two-year clinical outcomes and fusion rates using β-tricalcium phosphate or supercritical carbon dioxide treated allograft. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:368-375. [PMID: 35068818 PMCID: PMC8740808 DOI: 10.4103/jcvjs.jcvjs_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 11/13/2022] Open
Abstract
Context: Despite increasing promising reports regarding composite titanium (Ti)/PolyEtherEtherKetone (PEEK) cages, further longer-term, quality research is required. Synthetic bone graft substitutes are another rapidly developing area of spinal surgical research. Aims: The purpose of this study is to evaluate the outcomes of an integral fixation composite Ti/PEEK cage for anterior cervical discectomy and fusion (ACDF) and compare a synthetic bone graft substitute (β-tricalcium phosphate; [βTCP]) with allograft processed using supercritical fluid technology. Methods and Design: Data from 195 consecutive patients were prospectively collected from a single centre. Indications were largely degenerative. Allograft and βTCP were used in a 3:1 randomization protocol. Patients were followed up for a minimum of 6 months and up to 48 months. Clinical outcomes included visual analogue scale and neck oswestry disability index. Radiographic outcomes included fusion rates, subsidence rates and implant complications. Results: Graft sub-cohorts were largely comparable and included 133 and 52 patients in the allograft and βTCP sub-cohorts, respectively. Clinical outcomes overall significantly improved (P < 0.001), with no significant inter-cohort differences. There were no implant-related complications. Overall fusion rate was 94.1% (175/186). The allograft cohort produced a significantly greater fusion rate of 97.7% (126/129) compared to 77.6% (38/49) for the βTCP cohort (P = 0.001). Conclusions: This study demonstrates the viability of an integral fixation composite Ti/PEEK ACDF device in effectively and safely improving patient outcomes and achieving fusion. Allograft is more effective in achieving fusion compared to βTCP, though both were similarly efficacious in improving clinical outcomes.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
| | - Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Daniel Ho
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Aidan McEvoy
- Matrix Medical Innovations, Randwick, Sydney, Australia
| | - Vedran Lovric
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
| | - William R Walsh
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
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Manickam PS, Roy S. The biomechanical effects of S-type dynamic cage using Ti and PEEK for ACDF surgery on cervical spine varying loads. Int J Artif Organs 2021; 44:748-755. [PMID: 34387526 DOI: 10.1177/03913988211039525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anterior cervical discectomy with fusion (ACDF) is the common method to treat the cervical disc degeneration. The most serious problems in the fusion cages are adjacent disc degeneration, loss of lordosis, pain, subsidence, and migration of the cage. The objective of our work is to develop the three-dimensional finite element (FE) model from C3-C6 and virtually implant a designed S-type dynamic cage at C4-C5 segment of the model. The dynamic cage design will provide mobility in the early stage after ACDF surgery. Titanium (Ti) and PEEK (polyether ether ketone) were used as the material property for the cages. We applied the physiological motions at different loads from 0.5, 1, 1.5, 2.0 Nm to evaluate the dynamic cage design and the biomechanical performances of the designed S-type dynamic cage. It was observed that in all the loading condition the range of motion in the adjacent level was maintained and the maximum stress at the adjacent disc was reduced. The clinical significance of the S-type dynamic cage is better stress profile at the fusion level and adjacent segments which translates into higher rate of fusion, lower risk of cage subsidence, lower risk of adjacent segment degeneration, and good mechanical stability.
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Affiliation(s)
- Pechimuthu Susai Manickam
- Department of Mechanical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Sandipan Roy
- Department of Mechanical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
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Bunmaprasert T, Luangkittikong S, Tosinthiti M, Nivescharoenpisan S, Raphitphan R, Sugandhavesa N, Liawrungrueang W, Riew KD. The aiming device for cervical distractor pin insertion: a proof-of-concept, feasibility study. BMC Musculoskelet Disord 2021; 22:648. [PMID: 34330246 PMCID: PMC8325237 DOI: 10.1186/s12891-021-04533-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Restoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to perform a proof-of-concept, feasibility study to evaluate the effectiveness of a pin insertion aiming device for vertebral distraction pin insertion. Methods A Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging. Results The average Superior Endplate-to-Caspar Pin angle (SE-CP) and the average Inferior Endplate-to-Caspar Pin angle (IE-CP) were 6.2 ± 2.0° and 6.3 ± 2.2° respectively. For the proximal pins, the SE-CP and the IE-CP were 4.0 ± 1.1°and 5.2 ± 2.4° respectively. For the distal pins, the SE-CP and the IE-CP were 7.7 ± 1.4° and 6.2 ± 2.0° respectively. No cervical endplate violations occurred. Conclusion The novel Caspar pin insertion aiming device can control the pin entry points and pin direction with the average SE-CP and average IE-CP of 6.2 ± 2.0° and 6.3 ± 2.2°, respectively. The study shows that the average different angles between the Caspar pin and cervical endplate are less than 7°.
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Affiliation(s)
- Torphong Bunmaprasert
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sittichai Luangkittikong
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Menghong Tosinthiti
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | | | - Raphi Raphitphan
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nantawit Sugandhavesa
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wongthawat Liawrungrueang
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - K Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA.,Department of Orthopedic Surgery At Columbia University, New York, NY, USA.,The Och Spine Hospital At New York Presbyterian Hospital, New York, NY, USA
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Wang TY, Mehta VA, Sankey EW, Shaffrey CI, Abd-El-Barr MM, Than KD. The Impact of Instrumentation and Implant Surface Technology on Cervical and Thoracolumbar Fusion. Oper Neurosurg (Hagerstown) 2021; 21:S12-S22. [PMID: 34128071 DOI: 10.1093/ons/opaa321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
Spinal fusion has undergone significant evolution and improvement over the past 50 yr. Historically, spine fusion was noninstrumented and arthrodesis was based entirely on autograft. Improved understanding of spinal anatomy and materials science ushered in a new era of spinal fusion equipped with screw-based technologies and various interbody devices. Osteobiologics is another important realm of spine fusion, and the evolution of various osteobiologics has perhaps undergone the most change within the past 20 yr. A new element to spinal instrumentation has recently gained traction-namely, surface technology. New data suggest that surface treatments play an increasingly well-recognized role in inducing osteogenesis and successful fusion. Until now, however, there has yet to be a unified resource summarizing the existing data and a lack of consensus exists on superior technology. Here, authors provide an in-depth review on surface technology and its impact on spinal arthrodesis.
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Affiliation(s)
- Timothy Y Wang
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Vikram A Mehta
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Eric W Sankey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Khoi D Than
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
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Manickam PS, Roy S, Shetty GM. Biomechanical Evaluation of a Novel S-Type, Dynamic Zero-Profile Cage Design for Anterior Cervical Discectomy and Fusion with Variations in Bone Graft Shape: A Finite Element Analysis. World Neurosurg 2021; 154:e199-e214. [PMID: 34246827 DOI: 10.1016/j.wneu.2021.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Variations in cage design, material, and graft shape can affect osteointegration and adjacent segment range of motion (ROM) and stress after anterior cervical discectomy and fusion (ACDF) surgery. This study aimed to evaluate the biomechanical properties of a novel dynamic cervical cage design in both titanium (Ti) and polyether ether ketone (PEEK) with variations in bone graft shape using a single level ACDF (FE) model. METHODS A 3-dimensional C3-C6 FE model was developed using computed tomography scan data from a healthy male subject. The novel S-shaped dynamic interbody fusion cage with a zero-profile fixation was inserted at the C4-C5 level with 4 different bone graft shapes (square, circular, rectangular, and elliptical). Changes in segmental ROM and maximum von Mises stresses at the fusion and adjacent segments were analyzed. RESULTS Both Ti and PEEK cages showed decreased ROM at the fusion and adjacent levels for all shapes of bone graft when compared with the intact spine model. The elliptical graft, for both Ti and PEEK cages, showed a lower percentage of reduction in segmental ROM at the fusion and adjacent levels (0%-5.6%) when compared with other graft shapes (0%-12%). Maximum stresses at the fusion level were lowest in Ti cage with elliptical graft (229.8-347.6 MPa) when compared with other shapes (241.2-476.2 MPa) in flexion, extension, and lateral bending. For the bone graft, maximum stresses were highest on the elliptical-shaped bone graft in flexion and extension in the Ti cage, and in flexion and lateral bending in the PEEK cage. CONCLUSIONS Both Ti and PEEK cages showed decreased ROM at the fusion and adjacent levels for all shapes of bone graft when compared with the intact spine model. In the Ti and PEEK dynamic cages, the elliptical shape bone graft showed decreased stress on the cage and increased stress on the bone graft. Further experimental and clinical studies are needed to confirm these encouraging biomechanical results of this novel dynamic, zero-profile fusion device with elliptical bone graft in ACDF surgery.
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Affiliation(s)
- Pechimuthu Susai Manickam
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamilnadu, India
| | - Sandipan Roy
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamilnadu, India.
| | - Gautam M Shetty
- Department of Orthopaedic Surgery, Knee & Orthopaedic Clinic, Mumbai, India; Department of Clinical Research, AIMD Research, Mumbai, India
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Tsai PI, Wu MH, Li YY, Lin TH, Tsai JSC, Huang HI, Lai HJ, Lee MH, Chen CY. Additive-manufactured Ti-6Al-4 V/Polyetheretherketone composite porous cage for Interbody fusion: bone growth and biocompatibility evaluation in a porcine model. BMC Musculoskelet Disord 2021; 22:171. [PMID: 33573634 PMCID: PMC7879644 DOI: 10.1186/s12891-021-04022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background We developed a porous Ti alloy/PEEK composite interbody cage by utilizing the advantages of polyetheretherketone (PEEK) and titanium alloy (Ti alloy) in combination with additive manufacturing technology. Methods Porous Ti alloy/PEEK composite cages were manufactured using various controlled porosities. Anterior intervertebral lumbar fusion and posterior augmentation were performed at three vertebral levels on 20 female pigs. Each level was randomly implanted with one of the five cages that were tested: a commercialized pure PEEK cage, a Ti alloy/PEEK composite cage with nonporous Ti alloy endplates, and three composite cages with porosities of 40, 60, and 80%, respectively. Micro-computed tomography (CT), backscattered-electron SEM (BSE-SEM), and histological analyses were performed. Results Micro-CT and histological analyses revealed improved bone growth in high-porosity groups. Micro-CT and BSE-SEM demonstrated that structures with high porosities, especially 60 and 80%, facilitated more bone formation inside the implant but not outside the implant. Histological analysis also showed that bone formation was higher in Ti alloy groups than in the PEEK group. Conclusion The composite cage presents the biological advantages of Ti alloy porous endplates and the mechanical and radiographic advantages of the PEEK central core, which makes it suitable for use as a single implant for intervertebral fusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04022-0.
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Affiliation(s)
- Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Hung Lin
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu, Taiwan
| | - Jane S C Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu, Taiwan
| | - Hsin-I Huang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu, Taiwan
| | - Hong-Jen Lai
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Hsinchu, 31040, Taiwan
| | - Ming-Hsueh Lee
- Department of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 61363, Taiwan. .,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Chih-Yu Chen
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Orthopedics, Shuang-Ho Hospital, Taipei Medical University, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
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Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1285-1295. [PMID: 33555365 DOI: 10.1007/s00586-021-06748-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
AIM Interbody cages are commonly used to augment interbody fusion. Commonly used materials include titanium (Ti) and polyetheretherketone (PEEK), with their inherent differences. The aim of this study is to perform a systematic review and meta-analysis to compare between the various clinical and radiological outcomes of Ti and PEEK interbody spinal cages. METHODS A systematic review and meta-analysis comparing clinical and radiological outcomes between Ti and PEEK interbody cages in patients undergoing spinal fusion was performed. PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials database were searched. All studies that compared the clinical and radiological outcomes of patients who underwent Ti and PEEK cages were included. Subgroup analyses was performed to differentiate between patients who had cervical and lumbar interbody fusion. RESULTS A total of 11 articles were identified, with a total of 743 patients. Spinal fusion rates at final follow-up did not differ between Ti and PEEK cages (OR 1.50, 95% CI 0.57-3.94, P = 0.41), although in patients undergoing lumbar fusion, Ti cages demonstrated superior fusion (OR 2.12, 95% CI 1.05-4.28, P = 0.04). In patients with non-infective etiologies, Ti cages had a higher rate of cage subsidence (RR 2.17, 95% CI 1.13-4.16, P = 0.02). Both types of cages had similar operating time, postoperative hematoma formation, neuropathic pain, segmental angle correction and postoperative clinical outcome improvement. CONCLUSION In non-infective lumbar spine conditions, Ti cage may be the superior option due to the higher fusion rate. LEVEL OF EVIDENCE III.
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Wang QA, Guo C, Sun MJ, Yuan F. Three-dimensional spiral CT observation of the facet joints of the lower cervical spine and its clinical significance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1536-1541. [PMID: 33515102 DOI: 10.1007/s00586-021-06743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/17/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE By observing the 3D anatomy of normal adult cervical facet joints, using the picture archiving and communication system to measure its 3D parameters and discussing its clinical significance, the aim of this study was to provide a reliable morphological basis for the design and manufacture of lower cervical facet joint interface distractors. METHODS We selected 200 patients who underwent cervical spine 3D spiral computed tomography (CT) examination in the imaging department of our hospital from September 2019 to May 2020 and whose spiral CT images showed no cervical spinal canal stenosis, cervical disc herniation, obvious bone hyperplasia, or infection. The anterior and posterior diameters of the facet joints on both sides of the cervical spine, the space between the joints, and the left and right diameters were measured on the sagittal, cross-sectional and coronal planes after reconstruction with 3D spiral CT. RESULTS The anterior and posterior diameters of the facet joints of the cervical spine, the space between the joints, and the left and right diameters all increased from top to bottom along the cervical spine. The 3D parameters of the C2-3~C6-7 segments were significantly different between the male and female groups. CONCLUSION The anteroposterior diameter, joint space interval, and left and right diameter of cervical facet joints are different in each segment and between the sexes. The lower cervical facet joint interface fusion device designed according to the measurement results can fully meet the needs of most patients.
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Affiliation(s)
- Qiu An Wang
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Chong Guo
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Ma Ji Sun
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Feng Yuan
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China.
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Gabr MA, Touko E, Yadav AP, Karikari I, Goodwin CR, Groff MW, Ramirez L, Abd-El-Barr MM. Improved Dysphagia Outcomes in Anchored Spacers Versus Plate-Screw Systems in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2020; 10:1057-1065. [PMID: 32875838 PMCID: PMC7645096 DOI: 10.1177/2192568219895266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To perform a systematic review of clinical outcomes between stand-alone anchored spacers and traditional cages with plate fixation for dysphagia and pseudoarthrosis using data from clinical trials. METHODS Our search protocol was added to PROSPERO register and systematic review using PRISMA method was performed. Then, we systematically searched for studies addressing stand-alone anchored spacers in patients who underwent ACDF. Mean Neck Disability Index (NDI), dysphagia incidence % (Dinc%), and Swallowing-Quality of Life (SQOL) scores during preoperative, immediate postoperative and last follow-up visits were extracted. Chi-square and analysis of variance (ANOVA) tests were used for statistical comparisons (P ≤ .05). RESULTS The initial search generated 506 articles in CENTRAL and 40 articles in MEDLINE. Finally, 14 articles were included. Total number of patients was 1173 (583 anchored stand-alone and 590 plate). Dinc% scores were statistically significantly lower in the stand-alone anchored spacer compared to the plate-screw construct (P ≤ .05). ANOVA showed no statistically significant difference in the comparisons of SQOL. On the other hand, NDI scores were statistically significantly lower in baseline of stand-alone anchored spacer and the plate-screw construct compared with both immediate postoperative and last follow-up visits (P ≤ .05). CONCLUSIONS Our study results revealed that the stand-alone anchored spacers were associated with less dysphagia in the immediate and last follow-up.
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Affiliation(s)
| | | | | | | | | | - Michael W. Groff
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Muhammad M. Abd-El-Barr
- Duke University Medical Center, Durham, NC, USA,Muhammad M. Abd-El-Barr, Division of Neurosurgery, Duke University Medical Center, 200 Trent Drive, DUMC 3807, Durham, NC 27710, USA.
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Zhou C, Li G, Wang C, Wang H, Yu Y, Tsai TY, Cha T. In vivo intervertebral kinematics and disc deformations of the human cervical spine during walking. Med Eng Phys 2020; 87:63-72. [PMID: 33461675 DOI: 10.1016/j.medengphy.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
The kinematics of the cervical spine during various functional neck motions has been widely reported. However, no data has been reported on the cervical intervertebral kinematics during walking, the most frequently performed daily functional activity. In this study, we evaluated cervical kinematics and disc deformation of asymptomatic subjects during a gait cycle using a dual fluoroscopic imaging system. Our measurements showed that the vertical translation of the cervical spine (1.6 ± 0.1 Hz) occurred at twice the frequency of the gait cycle (0.8 ± 0.1 Hz). The overall ranges of motion (ROMs) of the entire (C2-T1) cervical spine were 5.0 ± 3.1° in the flexion-extension rotation, 3.4 ± 1.0° in the lateral-bending rotation, and 5.8 ± 2.1° in the axial-twisting rotation during walking. Each intervertebral disc (measured at the disc centre location) dynamically deformed in its axial direction in a range of 16.2 ± 5.7% ~ 23.7 ± 8.7% (without significant differences among different segment levels, p > 0.05), similar to the ranges of shear deformations of the same disc (p > 0.05, except for the C7-T1 disc, where p = 0.010). These data could be useful for improvements of diagnosis and treatment methods of cervical pathologies.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA.
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Haiming Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA
| | - Yan Yu
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Bongers MER, Ogink PT, Chu KF, Patel A, Rosenthal B, Shin JH, Lee SG, Hornicek FJ, Schwab JH. The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection: surgical technique and outcomes. J Neurosurg Spine 2020; 34:283-292. [PMID: 33157532 DOI: 10.3171/2020.6.spine20521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reconstruction of the mobile spine following total en bloc spondylectomy (TES) of one or multiple vertebral bodies in patients with malignant spinal tumors is a challenging procedure with high failure rates. A common reason for reconstructive failure is nonunion, which becomes more problematic when using local radiation therapy. Radiotherapy is an integral part of the management of primary malignant osseous tumors in the spine. Vascularized grafts may help prevent nonunion in the radiotherapy setting. The authors have utilized free vascularized fibular grafts (FVFGs) for reconstruction of the spine following TES. The purpose of this article is to describe the surgical technique for vascularized reconstruction of defects after TES. Additionally, the outcomes of consecutive cases treated with this technique are reported. METHODS Thirty-nine patients were treated at the authors' tertiary care institution for malignant tumors in the mobile spine using FVFG following TES between 2010 and 2018. Postoperative union, reoperations, complications, neurological outcome, and survival were reported. The median follow-up duration was 50 months (range 14-109 months). RESULTS The cohort consisted of 26 males (67%), and the median age was 58 years. Chordoma was the most prevalent tumor (67%), and the lumbar spine was most affected (46%). Complete union was seen in 26 patients (76%), the overall complication rate was 54%, and implant failure was the most common complication, with 13 patients (33%) affected. In 18 patients (46%), one or more reoperations were needed, and the fixation was surgically revised 15 times (42% of reoperations) in 10 patients (26%). A reconstruction below the L1 vertebra had a higher proportion of implant failure (67%; 8 of 12 patients) compared with higher resections (21%; 5 of 24 patients) (p = 0.011). Graft length, number of resected vertebrae, and docking the FVFG on the endplate or cancellous bone was not associated with union or implant failure on univariate analysis. CONCLUSIONS The FVFG is an effective reconstruction technique, particularly in the cervicothoracic spine. However, high implant failure rates in the lumbar spine have been seen, which occurred even in cases in which the graft completely healed. Methods to increase the weight-bearing capacity of the graft in the lumbar spine should be considered in these reconstructions. Overall, the rates of failure and revision surgery for FVFG compare with previous reports on reconstruction after TES.
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Affiliation(s)
| | - Paul T Ogink
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Anuj Patel
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | - Brett Rosenthal
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Sang-Gil Lee
- 4Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Francis J Hornicek
- 5Department of Orthopedic Surgery, Orthopedic Oncology Service, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Joseph H Schwab
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
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Osteogenic potential of human adipose derived stem cells (hASCs) seeded on titanium trabecular spinal cages. Sci Rep 2020; 10:18284. [PMID: 33106587 PMCID: PMC7589498 DOI: 10.1038/s41598-020-75385-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
Spine degenerative conditions are becoming increasingly prevalent, affecting about 5.7% of the population in Europe, resulting in a significant reduction of life's quality. Up to now, many materials have been used in manufacturing cage implants, used as graft substitutes, to achieve immediate and long-term spinal fixation. Particularly, titanium and its alloys are emerging as valuable candidates to develop new types of cages. The aim of this in vitro study was to evaluate the adhesion, proliferation and osteogenic differentiation of adipose derived mesenchymal stem cells (ASCs) seeded on trabecular titanium cages. ASCs adhered, proliferated and produced an abundant extracellular matrix during the 3 weeks of culture. In the presence of osteogenic medium, ASCs differentiated into osteoblast-like cells: the expression of typical bone genes, as well as the alkaline phosphatase activity, was statistically higher than in controls. Furthermore, the dispersive spectrometry microanalysis showed a marked increase of calcium level in cells grown in osteogenic medium. Plus, our preliminary data about osteoinduction suggest that this titanium implant has the potential to induce the ASCs to produce a secretome able to trigger a shift in the ASCs phenotype, possibly towards the osteogenic differentiation, as illustrated by the qRT-PCR and ALP biochemical assay results. The trabecular porous organization of these cages is rather similar to the cancellous bone structure, thus allowing the bone matrix to colonize it efficiently; for these reasons we can conclude that the architecture of this cage may play a role in modulating the osteoinductive capabilities of the implant, thus encouraging its engagement in in vivo studies for the treatment of spinal deformities and diseases.
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Kapoor S, Shah S, Salem K, Quraishi N. Peri-Implant Vertebral Body Fracture in a Cervical Integrated Cage Screw Construct: A Case Report of a Rare Complication. JBJS Case Connect 2020; 10:e19.00634. [PMID: 33512933 DOI: 10.2106/jbjs.cc.19.00634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old woman underwent C5-6 anterior cervical discectomy and fusion for progressive cervical myelopathy using an intergrated cage screw construct. Five weeks postoperatively, she presented with neck pain, worsening gait, and weakness after a slight jerk, with imaging showing peri-implant transverse fracture in the C6 vertebral body across the site of Caspar distractor pins and tips of the integrated cage screws. She was treated conservatively with hard collar with close observation, and at 6 months, she was asymptomatic with complete fracture union on imaging. CONCLUSION Peri-implant fracture in a cervical integrated cage screw construct is a rare complication, with biomechanical implications to the pathogenesis, which shows good clinical outcome to conservative treatment.
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Affiliation(s)
- Saurabh Kapoor
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
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Schnitzer M, Hudák R, Sedlačko P, Rajťúková V, Findrik Balogová A, Živčák J, Kula T, Bocko J, Džupon M, Ižaríková G, Karásek M, Filip V, Ivančová E, Šajty M, Szedlák P, Somoš A. A comparison of experimental compressive axial loading testing with a numerical simulation of topologically optimized cervical implants made by selective laser melting. J Biotechnol 2020; 322:33-42. [PMID: 32673686 DOI: 10.1016/j.jbiotec.2020.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022]
Abstract
In recent years, the number of cervical interventions has increased. The stress shielding effect is a serious complication in cervical spine interventions. Topological optimization is based on finite element method structural analysis and numerical simulations. The generated design of cervical implants is made from Ti6Al4V powder by selective laser melting while the optimized cage is numerically tested for compressive axial loading and the results are compared with experimental measurement. Additive manufacturing technologies and new software possibilities in the field of structural analysis, which use the finite element method tools, help to execute implant topological optimization that is useful for clinical practice. The inner structures of the implant would be impossible to make by conventional manufacturing technologies. The resulting implant design, after modification, must fulfill strict application criteria for the area of cervical spine with respect to its material and biomechanical properties. The aim of this work was to alter the mechanical properties of the cervical intervertebral cage to address the clinical concern of the stress shielding effect by topological optimization. A methodology of cervical implant compressive axial loading numerical simulation was created, and subsequent experimental testing was done to obtain real material properties after a selective laser melting process. The weight of the optimized implant was reduced by 28.92 %. Results of the experimental testing and numerical simulation of topologically optimized design showed 10-times lower stiffness compared to the solid cage design, and the real yield strength of the optimized structure is 843.8 MPa based on experimental results.
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Affiliation(s)
- Marek Schnitzer
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Radovan Hudák
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Peter Sedlačko
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Viktória Rajťúková
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Alena Findrik Balogová
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Jozef Živčák
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Tomáš Kula
- Department of Applied Mechanics and Mechanical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Jozef Bocko
- Department of Applied Mechanics and Mechanical Engineering, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Miroslav Džupon
- Institute of Materials Research, Slovak Academy of Sciences, Košice, Slovakia.
| | - Gabriela Ižaríková
- Department of Applied Mathematics and Informatics, Faculty of Mechanical Engineering, TUKE, Košice, Slovakia.
| | - Michal Karásek
- Clinic of Traumatology at Louis Pasteur University Hospital, Košice, Slovakia.
| | - Vladimír Filip
- Clinic of Orthopedics, Traumatology and Locomotion Systems at Louis Pasteur University Hospital, Košice, Slovakia.
| | - Eleonóra Ivančová
- Clinic of Maxillo-Facial Surgery at Louis Pasteur University Hospital, Košice, Slovakia.
| | - Matej Šajty
- Centre of Preventive and Sport Medicine, Košice, Slovakia.
| | - Peter Szedlák
- Klinik für Neurochirurgie - Kopf und Schädelbasiszentrum, Vivantes Klinikum Neukölln, Berlin, Germany.
| | - Andrej Somoš
- Department of Pneumology and Phthisiology, Louis Pasteur University Hospital, Košice, Slovakia.
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Jain A, Marrache M, Harris A, Puvanesarajah V, Neuman BJ, Buser Z, Wang JC, Yoon ST, Meisel HJ. Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2020; 10:775-783. [PMID: 32707023 PMCID: PMC7383799 DOI: 10.1177/2192568219883256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE Our primary objective was to compare reported fusion rates after anterior cervical discectomy and fusion (ACDF) using structural allograft versus polyetheretherketone (PEEK) interbody devices in patients with cervical spine degeneration. Our secondary objectives were to compare differences in rates of subsidence and reoperation and in patient-reported outcomes between the 2 groups. METHODS Through a systematic review of the English-language literature using various databases, we identified 4702 articles. After we applied inclusion and exclusion criteria, 14 articles (7 randomized controlled trials, 4 prospective studies, and 3 retrospective studies) reporting fusion rates of structural allograft or PEEK interbody devices were eligible for our analysis. No randomized controlled trials compared outcomes of structural allograft versus PEEK interbody devices. Extracted data included authors, study years, study designs, sample sizes, patient ages, duration of follow-up, types of interbody devices used, fusion rates, definition of fusion, reoperation rates, subsidence rates, and patient-reported outcomes. RESULTS Fusion rates were 82% to 100% for allograft and 88% to 98% for PEEK interbody devices. The reported data were insufficient to perform meta-analysis. Structural allograft had the highest reported rate of reoperation (14%), and PEEK interbody devices had the highest reported subsidence rate (18%). Patient-reported outcomes improved in both groups. There was insufficient high-quality evidence to compare the associations of various PEEK modifications with fusion rates. CONCLUSION Fusion rates were similar between structural allograft and PEEK interbody devices when used for ACDF for cervical spine degeneration. Currently, there is insufficient high-quality evidence to assess associations of PEEK modifications with fusion rates. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Amit Jain, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, JHOC 5223, Baltimore, MD 21287, USA.
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian J. Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S. Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany
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Comparison of Different Hybrid Techniques for the Treatment of Multilevel Cervical Degenerative Disc Disease–Analysis of Prospectively Collected Clinical, Radiologic, and Psychological Parameters. World Neurosurg 2020; 140:e112-e120. [DOI: 10.1016/j.wneu.2020.04.182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/27/2022]
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Sun S, Zhuang X, Liu Y. Radiological and Clinical Outcomes of a Disc-Limited Intervertebral Distraction Technique Applied in Anterior Cervical Discectomy and Fusion-A Proposed Method to Assist Cage Selection. World Neurosurg 2020; 142:e357-e363. [PMID: 32652283 DOI: 10.1016/j.wneu.2020.06.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Inappropriate intervertebral height restoration caused by nonoptimal choice of cage size is common in anterior cervical discectomy and fusion. The purpose of this study was to evaluate the radiological and clinical outcomes of cervical intervertebral distraction performed in prediscectomy under the strain limitation of the intact disc in a procedure defined as disc-limited intervertebral distraction. METHODS A total of 61 patients were enrolled. Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale score for neck pain were evaluated. The parameters of the degenerative intervertebral space height, mean value of the adjacent intervertebral space heights, preoperative and postoperative day 3 segmental height, regional sagittal alignment and global sagittal alignment were measured on plain radiographs. The change in the degenerative intervertebral space height, postoperative day 3 degenerative intervertebral space height, and intervertebral distraction ratio were calculated according to the parameters measured on radiographs. RESULTS The change in the degenerative intervertebral space height and distraction ratio in the study group were both significantly lower than those in the control group (both P < 0.001). In the study group, there was no significant difference between postoperative day 3 degenerative intervertebral space height and mean value of the adjacent intervertebral space heights (P = 0.752). The Japanese Orthopaedic Association score improved significantly in both groups, with similar recovery rates. There were significant differences in neck pain score and Neck Disability Index between the groups at the 3 days and 1 month follow-ups (P < 0.001). CONCLUSIONS Disc-limited intervertebral distraction is beneficial in avoiding overestimation of the cage size when performing anterior cervical discectomy and fusion and physiologically restoring intervertebral space height.
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Affiliation(s)
- Shuo Sun
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun City, PR China
| | - Xinming Zhuang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun City, PR China
| | - Yi Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun City, PR China.
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