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Barot K, Ruiz-Cardozo MA, Singh S, Trevino G, Kann MR, Brehm S, Bui T, Joseph K, Patel R, Hardi A, Yahanda AT, Jauregui JJ, Cadieux M, Pennicooke B, Molina CA. A Meta-Analysis of Surgical Outcomes in 25727 Patients Undergoing Anterior Cervical Discectomy and Fusion or Anterior Cervical Corpectomy and Fusion for Cervical Deformity. Global Spine J 2024:21925682241270100. [PMID: 39091072 DOI: 10.1177/21925682241270100] [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: 08/04/2024] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To evaluate which cervical deformity correction technique between anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) produces better clinical, radiographic, and operative outcomes. METHODS We conducted a meta-analysis comparing studies involving ACDF and ACCF. Adult patients with either original or previously treated cervical spine deformities were included. Two independent reviewers categorized extracted data into clinical, radiographic, and operative outcomes, including complications. Clinical assessments included patient-reported outcomes; radiographic evaluations examined C2-C7 Cobb angle, T1 slope, T1-CL, C2-7 SVA, and graft stability. Surgical measures included surgery duration, blood loss, hospital stay, and complications. RESULTS 26 studies (25727 patients) met inclusion criteria and were extracted. Of these, 14 studies (19077 patients) with low risk of bias were included in meta-analysis. ACDF and ACCF similarly improve clinical outcomes in terms of JOA and NDI, but ACDF is significantly better at achieving lower VAS neck scores. ACDF is also more advantageous for improving cervical lordosis and minimizing the incidence of graft complications. While there is no significant difference between approaches for most surgical complications, ACDF is favorable for reducing operative time, intraoperative blood loss, and length of hospital stay. CONCLUSIONS While both techniques benefit cervical deformity patients, when both techniques are feasible, ACDF may be superior with respect to VAS neck scores, cervical lordosis, graft complications and certain perioperative outcomes. Further studies are recommended to address outcome variability and refine surgical approach selection.
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Affiliation(s)
- Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Som Singh
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael R Kann
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rujvee Patel
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julio J Jauregui
- Becker Medical Library, Washington University School of Medicine, Saint Louis, MO, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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Xu C, Bai X, Ruan D, Zhang C. Comparative finite element analysis of posterior short segment fixation constructs with or without intermediate screws in the fractured vertebrae for the treatment of type a thoracolumbar fracture. Comput Methods Biomech Biomed Engin 2024; 27:1398-1409. [PMID: 37553841 DOI: 10.1080/10255842.2023.2243360] [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: 06/23/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
Six-screw short-segment posterior fixation for thoracolumbar fractures, which involves intermediate screws at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure. Yet, little is known about the mechanisms and biomechanical responses by which intermediate screws at the fracture vertebrae enhance fixation strength. The objective of this study was to investigate the biomechanical properties that are associated with the augmentation of intermediate screws in relation to the severity of type A thoracolumbar fracture using finite element analysis. Short-segment stabilization models with or without augmentation screws at fractured vertebrae were established based on finite element model of moderate compressive fractures, severe compressive fractures and burst fractures. The spinal stiffness, stresses at the implanted hardware, and axial displacement of the bony defect were measured and compared under mechanical loading conditions. All six-screw stabilization showed a decreased range of motion in extension, lateral bending, and axial rotation compared to the traditional four-screw fixation models. Burst thoracolumbar fracture benefited more from augmentation of intermediate screws at the fracture vertebrae. The stress of the rod in six-screw models increased while decreased that of pedicle screws. Our results suggested that patients with more unstable fractures might achieve greater benefits from augmentation of intermediate screws at the fracture vertebrae. Augmentation of intermediate screws at the fracture vertebrae is recommended for patients with higher wedge-shaped or burst fractures to reduce the risk of hardware failure and postoperative re-collapse of injured vertebrae.
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Affiliation(s)
- Cheng Xu
- Department of Orthopaedic Surgery, The Sixth Medical Center, General Hospital of PLA, Beijing, China
| | - Xuedong Bai
- Department of Orthopaedic Surgery, The Sixth Medical Center, General Hospital of PLA, Beijing, China
| | - Dike Ruan
- Department of Orthopaedic Surgery, The Sixth Medical Center, General Hospital of PLA, Beijing, China
| | - Chao Zhang
- Department of Orthopaedic Surgery, The Sixth Medical Center, General Hospital of PLA, Beijing, China
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Zhong W, Tang K, Quan Z. A novel nanohydroxyapatite/polyamide 66 strut for reducing subsidence after one-level anterior cervical corpectomy and fusion: a finite-element study. Eur J Med Res 2024; 29:375. [PMID: 39030641 PMCID: PMC11264631 DOI: 10.1186/s40001-024-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/14/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The aim of this study is to introduce a novel nanohydroxyapatite/polyamide 66(n-HA/PA66)n strut to improve biomechanical performance and reduce subsidence. METHODS One validated intact and 2 ACCF-simulated C3-C7 cervical spine models were developed (old strut: Group A, new strut: Group B). In the ACCF models, C5 underwent corpectomy and was fixed by an anterior cervical plate. Screw angles were categorized as 1 (0 ) and 2 (45 ) and divided into 4 groups, A1, A2, B1 and B2, for each model. An axial force of 74 N and a moment couple of 1.0 Nm were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on the screw-vertebra interface, strut, and strut-endplate interface were recorded and analysed. RESULTS There was no significant difference in ROM between Group A and Group B during bending, extension and rotation under 74 N axial pressure. The stress concentration on the strut body in Group A was higher than that in Group B. The peak stress values at the screw-vertebral interface in Groups A1 and A2 were higher than those in Groups B1 and B2, except for during extension and lateral bending. Under axial pressure, the peak stress values at the strut body-endplate interface during bending, extension and rotation were lower in the A1 and A2 groups than in the B1 and B2 groups. The Group B model showed much higher graft stress than the Group A model. CONCLUSIONS Based on finite-element analysis, compared with the old strut, the novel strut showed better biomechanical performance at the screw-vertebra interface.
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Affiliation(s)
- Weiyang Zhong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China.
| | - Ke Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Zhengxue Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
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Zhao HH, Xu HW, Wang SJ, Hu T, Wu DS. Anterior cervical discectomy and fusion with a zero-profile VA spacer device: a clinical and radiological study with two-year follow-up. J Orthop Surg Res 2024; 19:51. [PMID: 38212759 PMCID: PMC10782712 DOI: 10.1186/s13018-024-04539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to compare clinical and radiological outcomes of the anterior cervical discectomy and fusion (ACDF) with a novel zero-profile variable-angle (Zero-P VA) spacer and a traditional poly-ether-ether-ketone (PEEK) cage and plate system in cases pertaining to cervical radiculopathy/myelopathy. There are two conventional types of ACDF procedures aimed at treating symptomatic cervical spondylosis. The first one involves an uninstrumented "stand-alone" approach utilizing bone graft/cage, while the second incorporates bone graft/cage in conjunction with a front plate positioned before the vertebral bodies. Both procedures have their own inherent advantages and disadvantages. The Zero-P VA spacer, however, represents a unique synthesis by amalgamating the advantages of both traditionally typical procedures. Notably, this spacer can potentially circumvent the issue related to prevertebral soft-tissue disturbance and reduce the occurrence of dysphagia. METHODS Using our surgical database, the authors systematically conducted a retrospective analysis encompassing all patients who underwent single-level ACDF between January 2018 and January 2019, with a minimum two-year follow-up. Patients either received a Zero-P VA implant or PEEK cage coupled with plating. The Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) for arm and neck pain were documented. Dysphagia was evaluated using the Eating Assessment Tool-10 (ETA-10). Additional parameters such as cervical alignment, fusion rate and the incidence of postoperative complications were assessed. RESULTS According to the outcomes of the statistical analysis, there was no substantial disparity that emerged in the advancements observed in the JOA and VAS metrics between the two study cohorts. Noteworthy, however, the ETA-10 scores were statistically significantly reduced in the Zero-P VA group compared to the cage and plating group (p < 0.05). At the final follow-up, there were no statistically significant differences in the height of the operated segment, Cobb angle of the fused segment, C2-C7 Cobb angle and fusion rate between the two groups (p > 0.05). However, postoperative complications were slightly lower in patients with the Zero-P VA group (7.69%) as compared to the cage and plating group (16.67%). CONCLUSION The clinical outcomes observed with the Zero-P VA spacer used for single-level ACDF were found to be satisfactory. The performance of this device is comparable or even superior to the traditional cage and plating method in preventing postoperative dysphagia and mitigating potential complications associated with the use of a plate.
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Affiliation(s)
- Hai-Hong Zhao
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Hao-Wei Xu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Shan-Jin Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Tao Hu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
| | - De-Sheng Wu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
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Factors influencing cage subsidence in anterior cervical corpectomy and discectomy: a systematic review. 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; 32:957-968. [PMID: 36708398 DOI: 10.1007/s00586-023-07530-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Various factors have been examined in relation to cage subsidence risk, including cage material, cage geometry, bone mineral density, device type, surgical level, bone graft, and patient age. The present study aims to compare and synthesize the literature of both clinical and biomechanical studies to evaluate and present the factors associated with cage subsidence. METHODS A comprehensive search of the literature from January 2003 to December 2021 was conducted using the PubMed and ScienceDirect databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following the screening for inclusion and exclusion criteria, a total of 49 clinical studies were included. Correlations between clinical and biomechanical studies are also discussed. RESULTS Patients treated with the cage and plate combination had a lower subsidence rate than patients with the stand-alone cage. Overall, Polyetheretherketone material was shown to have a lower subsidence rate than titanium and other materials. The subsidence rate was also higher when the surgery was performed at levels C5-C7 than at levels C2-C5. No significant correlation was found between age and cage subsidence clinically. CONCLUSIONS Cage subsidence increases the stress on the anterior fixation system and may cause biomechanical instability. Severe cage subsidence decreases the Cobb angle and intervertebral height, which may cause destabilization of the implant system, such as screw/plate loosening or breakage of the screw/plate. Various factors have been shown to influence the risk of cage subsidence. Examining clinical research alongside biomechanical studies offers a more comprehensive understanding of the subject.
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Sun X, Zhang Q, Cao L, Wang J, Huang J, Liu Y, Zhang Y, Song Z, Tang W, Chen Y, Sun S, Lu S. Biomechanical effects of hybrid constructions in the treatment of noncontinuous cervical spondylopathy: a finite element analysis. J Orthop Surg Res 2023; 18:57. [PMID: 36658557 PMCID: PMC9854215 DOI: 10.1186/s13018-023-03537-7] [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: 07/04/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery. METHODS Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05). RESULTS In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2. CONCLUSIONS Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration. TRIAL REGISTRATION This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).
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Affiliation(s)
- Xiangyao Sun
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China ,Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Qingming Zhang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Li Cao
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Juyong Wang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Jiang Huang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Yuqi Liu
- grid.413259.80000 0004 0632 3337Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Yang Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, The Seventh Medical Center of PLA General Hospital, Beijing, 100191 China
| | - Zelong Song
- grid.216938.70000 0000 9878 7032Nankai University School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, The PLA General Hospital, Beijing, 100000 China
| | - Wei Tang
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Yunqiang Chen
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Siyuan Sun
- grid.169077.e0000 0004 1937 2197Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN 47907 USA
| | - Shibao Lu
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
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Wu T, Chen H, Sun Y, Xia T, Zhou F, Lu WW. Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case. Front Bioeng Biotechnol 2022; 10:950839. [PMID: 36159686 PMCID: PMC9500315 DOI: 10.3389/fbioe.2022.950839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Little research has been reported on evaluating the safety of the fixation construct in cervical kyphosis correction. In this study, we proposed a principal-strain criterion to evaluate the safety of the fixation construct and validated the modeling method against a retrospective case of anterior cervical discectomy fusion (ACDF). From C2 to T2 vertebra bodies, fixation instruments were reconstructed and positioned as per postoperative computed tomography (CT) scans. Head weight (HW) and various moments estimated from isometric strength data were imposed onto the C2. The postoperative stability of non-surgical segments, deformations surrounding the screw trajectories, and contact slipping on zygapophysial joints were analyzed. The model was validated against the reality that the patient had a good fusion and deformity correction. The ACDF restricted the range of motions (ROMs) of cervical segments and lent stability to vertebra fusion, no failure was found in the finite element (FE) model of cervical vertebrae. The deformation surrounding the screw trajectories were concentrated to the lateral sides of trajectories, recommending that the shape of the anterior cervical plate conforming to the curvature of the vertebra and screws fully inserted into vertebrae reduced the deformation concentration around the screw trajectories.
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Affiliation(s)
- Tianchi Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - Hongyu Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Tian Xia
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feifei Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- *Correspondence: Feifei Zhou,
| | - William W. Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
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Biomechanical behaviour of tension-band-reconstruction titanium plate in open-door laminoplasty: a study based on finite element analysis. BMC Musculoskelet Disord 2022; 23:851. [PMID: 36076212 PMCID: PMC9454233 DOI: 10.1186/s12891-022-05804-w] [Citation(s) in RCA: 5] [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] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate and evaluate the biomechanical behaviour of tension-band-reconstruction (TBR) and ordinary titanium plates in open-door laminoplasty by finite element (FE) analysis. METHODS TBR titanium plate and ordinary titanium plate were implanted into a validated finite element model of healthy adult cervical vertebrae. Among them, 5 ordinary titanium plate were used in model A, 2 TBR titanium plates and 3 ordinary titanium plates were used in model B, and 5 TBR titanium plates were used in model C. The same loading conditions was applied identically to all models. Range of motion (ROM) of the vertebral body, stress distribution of the titanium plate and intradiscal pressure (IDP) were compared in flexion, extension, lateral bending and rotation. RESULTS The ROM of model B and C was similar in flexion and extension, and both were smaller than that of model A. The highest von Mises stress in the titanium plate appears is in model C. The IDP in C2/3 was significantly higher than that in other segments in flexion. There was no significant difference in IDP among three models in left lateral bending and left axial rotation. CONCLUSION Application of TBR titanium plate in open-door laminoplasty can reduced ROM in flexion, extension and axial rotation of the cervical vertebrae. But the increase of stress in TBR titanium plate could lead to higher risk of adverse events such as titanium plate deformation. Moreover, compared with complete TBR titanium plate, the combination of TBR titanium plate for C3 and C7 with ordinary titanium plate for the other vertebrae largely reduce the stress of the titanium plates by ensuring stability. The proposed FE model (C2-T1) exhibits a great potential in evaluating biomechanical behaviour of TBR titanium plate for open-door laminoplasty.
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Anatomical and Imaging Study on the Optimum Entry Point and Trajectory for Anterior Transpedicular Root Screw Placement into the Lower Cervical Spine. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8159570. [PMID: 35983525 PMCID: PMC9381211 DOI: 10.1155/2022/8159570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
Objective To study the optimum entry point and trajectory for anterior transpedicular root screw (ATPRS) placement into the lower cervical spine (LCS), so as to provide a basis for clinical application. Methods A retrospective analysis of cervical CT images of patients who underwent cervical CT examination in the Spinal Surgery of Ningbo No. 6 Hospital from January 2020 to August 2021 was conducted. The data were obtained and modeled. On the coronal plane, the vertebral body (VB) between the anterior midline of cervical vertebral segments C3-7 and the left P line (by drawing the line parallel to the anterior midline of the VB at the intersection of the anterior edge of the Luschka's joint and the upper endplate) was equally divided into 9 zones (a-i). The ideal entry point and path of cervical ATPRS were designed and recorded. Additionally, 7 cadaveric specimens were selected, and the screw placement parameters were regenerated according to the above methods for screw placement. Results Zone i of each segment, with the longest screw length, was the best area for screw placement. In all patients, the horizontal angles of vertebrae C3-7 in zones a, d, and g, zones b, e, and h, and zones c, f, and i showed a gradually decreasing trend. The sagittal angle range of C3-7 in all patients showed a gradually increasing trend in zones a-c, d-f, and g-i. The distance from the anterior midline of C3-7 to the P line increased in all patients, and the distance was longer in males than in females, with statistical significance. Pedicle screws were successfully inserted in all the 7 cadaveric specimens. Conclusions ATPRS placement can be used for LCS internal fixation, and the precise screw placement parameters can be simulated by the software, which provides theoretical basis for its future clinical application.
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Wang Z, Mei J, Feng X, Deng C, Tian X, Lv J, Sun L. Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion. J Orthop Surg Res 2022; 17:355. [PMID: 35842647 PMCID: PMC9287865 DOI: 10.1186/s13018-022-03239-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Study design This study was a retrospective review. Objective To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration.
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Affiliation(s)
- Zhiqiang Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jun Mei
- Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoning Feng
- Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chen Deng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Xuefeng Tian
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Junqiao Lv
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Lin Sun
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Zhang KR, Yang Y, Ma LT, Qiu Y, Wang BY, Ding C, Meng Y, Rong X, Hong Y, Liu H. Biomechanical Effects of a Novel Anatomic Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion: A Finite Element Analysis. Front Bioeng Biotechnol 2022; 10:881979. [PMID: 35814021 PMCID: PMC9263189 DOI: 10.3389/fbioe.2022.881979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The traditional titanium mesh cage (TTMC) has become common as a classical instrument for Anterior Cervical Corpectomy and Fusion (ACCF), but a series of complications such as cage subsidence, adjacent segment degeneration (ASD), and implant-related complications by using the TTMC have often been reported in the previous literature. The aim of this study was to assess whether a novel anatomic titanium mesh cage (NTMC) could improve the biomechanical condition after surgery. Methods: The NTMC model consists of two spacers located on both sides of the TTMC which match the anatomic structure between the endplates by measuring patient preoperative cervical computed tomography (CT) data. The ranges of motion (ROMs) of the surgical segments and the stress peaks in the C6 superior endplates, titanium mesh cage (TMC), screw–bone interface, anterior titanium plate, and adjacent intervertebral disc were compared. Results: Compared with the TTMC, the NTMC reduced the surgical segmental ROMs by 89.4% postoperatively. The C6 superior endplate stress peaks were higher in the TTMC (4.473–23.890 MPa), followed by the NTMC (1.923–5.035 MPa). The stress peaks on the TMC were higher in the TTMC (47.896–349.525 MPa), and the stress peaks on the TMC were lower in the NTMC (17.907–92.799 MPa). TTMC induced higher stress peaks in the screw–bone interface (40.0–153.2 MPa), followed by the NTMC (14.8–67.8 MPa). About the stress peaks on the anterior titanium plate, the stress of TTMC is from 16.499 to 58.432 MPa, and that of the NTMC is from 12.456 to 34.607 MPa. Moreover, the TTMC induced higher stress peaks in the C3/4 and C6/7 intervertebral disc (0.201–6.691 MPa and 0.248–4.735 MPa, respectively), followed by the NTMC (0.227–3.690 MPa and 0.174–3.521 MPa, respectively). Conclusion: First, the application of the NTMC can effectively decrease the risks of TMC subsidence after surgery. Second, in the NTMC, the stresses at the anterior screw-plate, bone–screw, and TMC interface are much less than in the TTMC, which decreased the risks of instrument-related complications after surgery. Finally, increases in IDP at adjacent levels are associated with the internal stresses of adjacent discs which may lead to ASD; therefore, the NTMC can effectively decrease the risks of ASD.
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Affiliation(s)
- Ke-rui Zhang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Li-tai Ma
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Bei-yu Wang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hao Liu,
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12
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Li XH, She LJ, Zhang W, Cheng XD, Fan JP. Biomechanics of extreme lateral interbody fusion with different internal fixation methods: a finite element analysis. BMC Musculoskelet Disord 2022; 23:134. [PMID: 35139843 PMCID: PMC8829978 DOI: 10.1186/s12891-022-05049-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/20/2022] [Indexed: 01/03/2023] Open
Abstract
Background Establishing a normal L3–5 model and using finite element analysis to explore the biomechanical characteristics of extreme lateral interbody fusion (XLIF) with different internal fixation methods. Method The L3–5 CT image data of a healthy adult male volunteer were selected to establish a normal lumbar finite element model (M0). The range of motion (ROM) of L3–4 and L4–5, under flexion, extension, left bending, right bending, left rotation, and right rotation, together with L3–4 disc pressure was analyzed. Then the L4–5 intervertebral disc was excised and implanted with a cage, supplemented by different types of internal fixation, including lateral two-hole plate model (M1), lateral four-hole plate model (M2), VerteBRIDGE plating model (M3), lateral pedicle model (M4), posterior unilateral pedicle screw model (M5) and posterior bilateral pedicle screw model (M6). The ROM,the maximum stress value of the cage, and the maximum stress value of the intervertebral disc of L3–4 were analyzed and studied . Results The ROM of L3–4 and L4-L5 segments in the validation model under various motion states was basically consistent with previous reports. The lumbar finite element model was validated effectively. After XLIF-assisted internal fixation, the range of activity in L3–4 segments of each internal fixation model was greater than that of the normal model under various working conditions, among which the M5、M6 model had the larger range of activity in flexion and extension. After the internal fixation of L4–5 segments, the mobility in M1-M6 was significantly reduced under various motion patterns. In terms of flexion and extension, the posterior pedicle fixation model (M5、M6) showed a significant reduction,followed by M2. The maximal von mises cage stress of M1 was obviously greater than that of other models (except the left bending). Compared with M0, the intervertebral disc stress of M1-M6 at L3–4 segments was increased. Conclusions It is recommended that the posterior bilateral pedicle screw model is the first choice, followed by the lateral four-hole plate model for fixation during XLIF surgery. However, it is still necessary to be aware of the occurrence of adjacent segment degeneration (ASD) in the later stage.
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Affiliation(s)
- Xiao-Hua Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Li-Jun She
- Department of Tuberculosis, The Fifth Hospital of Shijiazhuang, No.42 Tanan Road, Shijiazhuang, 050000, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China.
| | - Xiao-Dong Cheng
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Jin-Peng Fan
- Department of Orthopedic Surgery, Shijiazhuang First Hospital, No. 365 Jianhua South Street, Shijiazhuang, 050000, China
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Ji H, Xie X, Zhuang S, Zhang C, Xie L, Wu X. Comparative analysis of three types of titanium mesh cages for anterior cervical single-level corpectomy and fusion in term of postoperative subsidence. Am J Transl Res 2020; 12:6569-6577. [PMID: 33194053 PMCID: PMC7653575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
A titanium mesh cage (TMC) is a common device used for interbody fusion in anterior cervical corpectomy and fusion (ACCF) surgery, with postoperative subsidence being a common complication. Among the many influencing factors, there is a paucity of research on the end-covers of the TMC. A total of 62 patients with cervical spondylotic myelopathy were treated with single-level ACCF. TMC without end-covers (group A), traditional TMC with end-covers (group B) and new TMC with end-covers (group C) were used as the fusion device. We evaluated the surgery time, intraoperative blood loss, postoperative drainage volume, postoperative fusion, falling height of the fused segment, cervical curvature and severe subsidence rate (the number of falling height of the fused segment > 3 mm/total surgical cases in the group). In addition, the Japanese Orthopaedic Association score was used for neurological status assessment and a 10-point Visual Analog Scale for postoperative neck pain. The results showed that the falling height of the fused segment in group A (1.9 ± 0.6 mm) was significantly greater than in group B (0.9 ± 0.2 mm) and group C (0.8 ± 0.3 mm). The area of the end-covers increased gradually in group A, group B and group C, while the severe subsidence rate of group A (8/20, 40%), group B (5/22, 23%) and group C (2/20, 10%) gradually decreased. The surgery time and blood loss in group B (116.4 ± 12.2 min, 183.5 ± 36.4 mL) were higher than those in group A (90.22 ± 5.60 min, 110.4 ± 20.8 mL) and group C (92.8 ± 8.47 min, 114 ± 24.0 mL). These results showed that there was a correlation between the postoperative subsidence and the end-covers of TMC. The larger the end-cover area was, the lower the severe postoperative subsidence rate was. In addition, the design of the end-covers extending inward was more conducive to the operation.
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Affiliation(s)
- Hangyu Ji
- School of Medicine, Southeast UniversityNanjing, China
| | - Xinhui Xie
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Suyang Zhuang
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Cong Zhang
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Linghan Xie
- School of Medicine, Southeast UniversityNanjing, China
| | - Xiaotao Wu
- School of Medicine, Southeast UniversityNanjing, China
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
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14
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Hartmann S, Thomé C, Abramovic A, Lener S, Schmoelz W, Koller J, Koller H. The Effect of Rod Pattern, Outrigger, and Multiple Screw-Rod Constructs for Surgical Stabilization of the 3-Column Destabilized Cervical Spine - A Biomechanical Analysis and Introduction of a Novel Technique. Neurospine 2020; 17:610-629. [PMID: 33022166 PMCID: PMC7538352 DOI: 10.14245/ns.2040436.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Anterior-only reconstructions for cervical multilevel corpectomies are prone to fail under continuous mechanical loading. This study sought to define the mechanical characteristics of different constructs in reducing a range of motion (ROM) of the 3-column destabilized cervical spine, including posterior cobalt-chromium (CoCr)-rods, outrigger-rods (OGR), and a novel triple rod construct using lamina screws (6S3R). The clinical implications of biomechanical findings are discussed in depth from the perspective of the challenges surgeons face cervical deformity correction.
Methods Three-column deficient cervical spinal models were produced based on reconstructed computed tomography scans. The corpectomy defect between C3 and C7 end-level vertebrae was restored with anterior titanium (Ti) mesh-cage. The ROM was evaluated in a customized 6-degree of freedom spine tester. Tests were performed with different rod materials (Ti vs. CoCr), varying diameter rods (3.5 mm vs. 4.0 mm), with and without anterior plating, and using different construct patterns: bilateral rod fixation (standard-group), OGR-group, and 6S3R-Group. Construct stability was expressed in changes and differences of ROM (°).
Results The largest reduction of ROM was noticed in the 6S3R-group compared to the standard- and the OGR-group. All differences observed were emphasized with an increasing number of corpectomy levels and if anterior plating was not added. For all simulated 1-, 2-, and 3-level corpectomy constructs, the OGR-group revealed decreased ROM for all motion directions compared to the standard-group. An increase of construct stiffness was also recorded for increased rod diameter (4.0 mm) and stiffer rod material (CoCr), though these effects lacked behind the more advanced construct pattern.
Conclusion A novel reconstructive technique, the 6S3R-construct, was shown to outperform all other constructs and might resemble a new standard of reference for advanced posterior fixation.
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Affiliation(s)
- Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliane Koller
- Department of Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Heiko Koller
- Department of Neurosurgery, Rechts der Isar, Technische Universität München, Germany
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Ouyang P, Li J, He X, Dong H, Zang Q, Li H, Jin Z. Biomechanical Comparison of 1-Level Corpectomy and 2-Level Discectomy for Cervical Spondylotic Myelopathy: A Finite Element Analysis. Med Sci Monit 2020; 26:e919270. [PMID: 32020914 PMCID: PMC7020763 DOI: 10.12659/msm.919270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are effective treatments for cervical spondylotic myelopathy (CSM), but it is unclear which is better. In this study, we compared the biomechanical properties of 2-level ACDF and 1-level ACCF. MATERIAL AND METHODS An intact C3-C7 cervical spine model was developed and validated, then ACDF and ACCF simulation models were developed. We imposed 1.0 Nm moments and displacement-controlled loading on the C3 superior endplate. The range of motions (ROMs) of surgical and adjacent segments and von Mises stresses on endplates, fixation systems, bone-screw interfaces, and bone grafts were recorded. RESULTS ACDF and ACCF significantly reduced the surgical segmental ROMs to the same extent. ACCF induced much lower stress peaks in the fixation system and bone-screw interfaces and higher stress peaks on the bone graft. ACDF induced much lower stress peaks on the C4 inferior endplate and equivalent stress on the C6 superior endplate. There was no difference in the ROMs of surgical and adjacent segments and the intradiscal stress of adjacent levels between ACDF and ACCF. CONCLUSIONS Both ACDF and ACCF can provide satisfactory spinal stability. ACDF may be beneficial for subsidence resistance due to the lower stress peaks on the endplate. The ACCF may perform better in long-term stability and bone fusion owing to the lower stress peaks in the fixation system and bone-screw interfaces, and higher stress peaks in the bone graft.
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Affiliation(s)
- Pengrong Ouyang
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland).,State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jialiang Li
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xijing He
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hui Dong
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Quanjin Zang
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Haopeng Li
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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16
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Wang J, Qian Z, Ren L. Biomechanical Comparison of Optimal Shapes for the Cervical Intervertebral Fusion Cage for C5-C6 Cervical Fusion Using the Anterior Cervical Plate and Cage (ACPC) Fixation System: A Finite Element Analysis. Med Sci Monit 2019; 25:8379-8388. [PMID: 31697650 PMCID: PMC6859788 DOI: 10.12659/msm.918489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The fifth and sixth cervical vertebrae (C5-C6) represent the high-risk segment requiring surgical correction in cervical spondylosis. Anterior cervical discectomy and fusion (ACDF) of C5-C6 includes an intervertebral fusion cage to maintain foraminal height and is combined with anterior plate fixation. The shape of the intervertebral cage can affect the postoperative outcome, including the rates of fusion, subsidence, and neck pain. This study aimed to use finite element (FE) parametric analysis to compare biomechanical properties of changes in intervertebral cage shape for C5-C6 cervical fusion using the anterior cervical plate and cage (ACPC) fixation system. MATERIAL AND METHODS Five shapes were designed for cervical intervertebral cages, square, oval, kidney-shaped, clover-shaped, and 12-leaf-shaped. The performance was evaluated following implantation into the validated normal C5-C6 FE model using simulation with five physiological conditions. The indicators included the maximum von Mises stress of the endplates, the fusion cages, and the cervical vertebrae. The postoperative subsidence-resistance properties were determined, including the interior stress responses of the intervertebral cages and the surrounding tissues. The fusion-promoting properties were evaluated by the interior stress responses of the bone grafts. RESULTS The optimal shape of the cervical intervertebral cage was the 12-leaf-shape for postoperative subsidence resistance. The kidney shape for the cervical intervertebral cage was optimal for postoperative fusion. CONCLUSIONS FE analysis identified the optimal cervical intervertebral cage design for ACPC fixation of C5-C6. This method may be useful for future developments in the design of spinal implants.
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Affiliation(s)
- Jiajia Wang
- College of Agricultural Equipment Engineering, Henan University of Science and Technology, Luoyang, Henan, China (mainland).,Key Laboratory of Bionic Engineering (Ministry of Education, China), Jilin University, Changchun, Jilin, China (mainland)
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering (Ministry of Education, China), Jilin University, Changchun, Jilin, China (mainland)
| | - Luquan Ren
- Key Laboratory of Bionic Engineering (Ministry of Education, China), Jilin University, Changchun, Jilin, China (mainland)
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17
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Shin JJ. Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion. Neurospine 2019; 16:589-600. [PMID: 31607093 PMCID: PMC6790739 DOI: 10.14245/ns.1938166.083] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022] Open
Abstract
Objective This study aimed to assess the influence of a fused segment on cervical range of motion (ROM) and adjacent segmental kinematics and determine whether increasing number of fusion levels causes accelerated adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF).
Methods A total of 165 patients treated with ACDF were recruited for assessment, and they were divided into 3 groups based on the number of fusion levels. Radiological measurements and clinical outcomes included visual analogue scale (VAS) and Neck Disability Index (NDI) assessed preoperatively and at ≥2 years of follow-up.
Results ASD occurred in 41 of 165 patients who underwent ACDF (1-level, 12 of 78 [15.38%]; 2-level, 14 of 49 [28.57%]; 3-level, 15 of 38 [39.47%]; p=0.015) at final follow-up (mean, 31.9 months). Significant differences were found in reduction of global ROM based on the number of fusion levels (p<0.001). The upper adjacent segment ROM increased over time (p=0.004); however, lower segment ROM did not. Three-level ACDF did not obtain greater amounts of lordosis than did 1- or 2-level ACDF (p=0.003). Postoperative neck VAS scores and NDI were significantly higher for 3-level ACDF than for 1- or 2-level ACDF (p=0.033 and p=0.001).
Conclusion ASD occurred predominantly in multilevel cervical fusion, more frequently in the upper segment of the prior fusion and as the number of fusion levels increased. Patients who underwent multilevel fusion had greater reduction of global ROM and increased compensatory motion at the upper adjacent segment. Three-level ACDF did not appear to restore cervical lordosis significantly compared with 1- or 2-level arthrodesis.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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18
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Liu N, Lu T, Wang Y, Sun Z, Li J, He X. Effects of New Cage Profiles on the Improvement in Biomechanical Performance of Multilevel Anterior Cervical Corpectomy and Fusion: A Finite Element Analysis. World Neurosurg 2019; 129:e87-e96. [DOI: 10.1016/j.wneu.2019.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 02/07/2023]
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