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Zhang X, Yang Y, Shen YW, Zhang KR, Ma LT, Ding C, Wang BY, Meng Y, Liu H. Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis. Front Bioeng Biotechnol 2023; 11:931202. [PMID: 36970630 PMCID: PMC10031026 DOI: 10.3389/fbioe.2023.931202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.
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Huang W, Tian Y, Wang H, Zou F, Ma X, Jiang J, Li R. Comparative analysis of the biomechanics of anterior cervical discectomy and fusion with multiple segmental plates fixation versus single multilevel plate fixation: a finite element study. BMC Musculoskelet Disord 2022; 23:848. [PMID: 36071416 PMCID: PMC9450340 DOI: 10.1186/s12891-022-05796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to compare the biomechanical differences between anterior cervical discectomy and fusion (ACDF) with multiple-level separate plates and conventional long plates by using finite element analysis. METHODS The following four finite element models were created to simulate various fixations: (1) C4-6 ACDF with multiple plates, (2) C4-6 ACDF with a single plate, (3) C3-6 ACDF with multiple plates, and (4) C3-6 ACDF with a single plate. The maximum Von-mises stress of the cage and fixation, compressive force of the adjacent intervertebral discs and range of motion (ROM) of different segments in the four models were calculated and analyzed. RESULTS For C4-6 ACDF, the maximum Von-mises stress of the cage and fixation was lower in the multiple plate fixation model in all motion states. Similarly, for the C3-6 ACDF models, the peak stress of the C3-4 and C5-6 cages was lower with multiple plates fixation in all motions but the stress of the C4-5 cage in the multiple plates model was slightly higher in flexion, bending and rotation. Besides, applying multiple plates in C3-6 ACDF models resulted in a decreased maximum stress of the fixation under different motions except for bending. In both the C4-6 ACDF and C3-6 ACDF models, the ROM values of the adjacent motion segments were lower in the multiple plates models in extension, bending and rotation. In the C4-6 ACDF models, the peak stress on the adjacent intervertebral discs in the multiple plates models was slightly smaller. In C3-6 ACDF models, the maximum stress on the adjacent intervertebral discs was larger in the single-plate model under flexion, bending and rotation movements. CONCLUSION Multiple plates fixation has a positive effect on increasing stiffness and maintaining the ROM of adjacent segments, indicating lower risk of construct failure and adjacent segment degeneration. Further studies are required to confirm its efficacy in clinical practice.
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Affiliation(s)
- Weibo Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Ye Tian
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China.
| | - Ruoyu Li
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China.
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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: 13] [Impact Index Per Article: 6.5] [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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Sun X, Sun S, Zhang T, Kong C, Wang W, Lu S. Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis. J Orthop Surg Res 2020; 15:36. [PMID: 32005193 PMCID: PMC6995191 DOI: 10.1186/s13018-020-1549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Biomechanical characteristics of noncontinuous ACDF and noncontinuous CDA in the treatment of noncontinuous cervical degenerative disc disease were still unclear. The aim of this research is to compare the differences between these two kinds of treatment methods and to verify the effectiveness of Prodisc-C in noncontinuous CDA. Methods Eight FEMs of the cervical spine (C2–C7) were built based on CT images of 8 mild CDDD volunteers. In the arthroplasty group, we inserted Prodisc-C at C3/4 and C5/6. In the fusion group, CoRoent® Contour and NuVasive® Helix ACP were implanted at C3/4 and C5/6. Initial loads of 75 N were used to simulate the head weight and muscle forces. The application of 1.0 N m moment on the top on the C2 vertebra was used to create motion in all directions. Statistical analyses were performed using STATA version 14.0 (Stata Corp LP, College Station, Texas, USA). Statistical significance was set at P < 0.05. Results The IDPs in C2/3 (P < 0.001, P = 0.005, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the intact group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. In addition, the IDPs in C2/3 (P < 0.001, P = 0.001, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the arthroplasty group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. Contact forces of facet joints in C2/3 (P = 0.010) in the arthroplasty group was significantly less than that in the intact group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the arthroplasty group was significantly less than that in the fusion group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the intact group were significantly less than that in the fusion group. Conclusions Noncontinuous CDA could preserve IDP and facet joint forces at the adjacent and intermediate levels to maintain the kinematics of cervical spine near preoperative values. However, noncontinuous ACDF would increase degenerative risks at adjacent and intermediate levels. In addition, the application of Prodisc-C in noncontinuous CAD may have more advantages than that of Prestige LP.
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Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China. .,Charité - Universitätsmedizin Berlin, Berlin, 113353, Germany.
| | - Siyuan Sun
- Department of Interdisciplinary Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Tongtong Zhang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.,Department of Orthopaedics, ChuiYang Liu Hospital affiliated to Tsinghua University, Beijing, 100020, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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Implant Design and the Anchoring Mechanism Influence the Incidence of Heterotopic Ossification in Cervical Total Disc Replacement at 2-year Follow-up. Spine (Phila Pa 1976) 2019; 44:1471-1480. [PMID: 31568185 DOI: 10.1097/brs.0000000000003098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time. SUMMARY OF BACKGROUND DATA The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication. METHODS Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO. RESULTS The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%. CONCLUSION These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time. LEVEL OF EVIDENCE 3.
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Wu TK, Meng Y, Liu H, Wang BY, Hong Y, Rong X, Ding C, Chen H. Biomechanical effects on the intermediate segment of noncontiguous hybrid surgery with cervical disc arthroplasty and anterior cervical discectomy and fusion: a finite element analysis. Spine J 2019; 19:1254-1263. [PMID: 30742975 DOI: 10.1016/j.spinee.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND CONTEXT Surgery for cervical degenerative disc disorder (CDDD) at two noncontiguous segments is infrequent. Few studies have explored the biomechanical effects on the intermediate adjacent segment of anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA) in this situation. No study has examined biomechanical differences between ACDF and hybrid surgery (HS) constructs for noncontiguous CDDD. Differences in the biomechanical changes between the intermediate and adjacent segments are unknown. PURPOSE This study was conducted to compare the biomechanical changes resulting from noncontiguous ACDFs and HS. STUDY DESIGN A finite element analysis study. METHODS A finite element model of a healthy cervical spine (C2-C7) was constructed. Three surgical models were developed: (1) ACDF at C3/4 and C5/6 (FF), (2) ACDF at C3/4 and CDA at C5/6 (FA) and (3) CDA at C3/4 and ACDF at C5/6 (AF). A 75-N follower load with 1.0 N·m moments was applied to the top of the C2 vertebra in the intact model to simulate flexion, extension, lateral bending, and axial rotation. Surgical models achieved identical motion angles of the intact model in each direction following the displacement-control protocols. RESULTS The FF model required much higher moments than did the AF and FA models to achieve the same amount of motion. In the FF model, the motion contributions of the unfused segments were unevenly increased. The magnitude of the increased motion in the intermediate segment was larger than those in the supra- or infra-adjacent segments. The facet contact force (FCF) and intradiscal pressure (IDP) at the intermediate segment were also more susceptible to impact. In the FA and AF models, the motion contributions of the untreated levels were evenly changed, and the intermediate segment did not experience additive motion, FCF, or IDP. The segment adjacent to the level of ACDF had greater FCF and IDP than did the segment adjacent to the level of CDA in the two HS constructs. CONCLUSIONS HS constructs resulted in less altered biomechanics and kinematics of the untreated levels and showed no additive biomechanical effects on the intermediate segments compared with ACDF at noncontiguous levels. However, the effects were associated with the relative location of the ACDF and CDA levels. CLINICAL SIGNIFICANCE This study provides a biomechanical rationale for the use of HS to treat patients with noncontiguous CDDD.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
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Abstract
STUDY DESIGN A nonrandomized, prospective, and single-center clinical trial of the ProDisc Vivo prosthesis. OBJECTIVE The aim of this study was to investigate the clinical and radiological results of a refined total cervical disc replacement (cTDR), the ProDisc Vivo, with two years of follow-up (FU). The incidence of implant-related complications was recorded as a secondary outcome variable. SUMMARY OF BACKGROUND DATA Previous generations of the ProDisc artificial cervical disc replacement generate high primary stability due to keel-based designs with opening of the anterior cortex during the implantation and subsequent high rates of heterotopic ossifications. METHODS Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires. The radiological outcome included the range of motion (ROM) and the occurrence of heterotopic ossifications. The incidence of implant-related complications with new implant design was recorded as a secondary outcome variable. RESULTS A total of 55 patients received a single-level treatment with the ProDisc Vivo cTDR between C3/4 and C6/7, with a follow-up rate of 78%. The clinical outcome scores improved in all parameters significantly (P = 0.0001) (NDI: 68.3 → 17.4; VAS arm: 6.3 → 1.4; VAS neck: 4.9 → 1.6). The ROM of the index-segment did not show a significant change (P = 0.26) (7.9° → 9.2°). Heterotopic ossifications at the index segment was found as grade 0 in 58%, grade 1 in 22%, grade 2 in 10%, grade 3 (with functional impairment of the prosthesis) in 7%, and grade 4 in 3% of the cases. We observed three implant-related complications (5.5%), with two implant dislocations anteriorly and one low-grade infect. CONCLUSION cTDR with ProDisc Vivo demonstrated a significant and sustained improvement of all clinical outcome parameters. A less invasive implantation mechanism with lower primary stability of the cTDR might be a reason for a higher dislocation rate than the keel-based previous generation ProDisc C. LEVEL OF EVIDENCE 4.
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Yu CC, Liu P, Huang DG, Jiang YH, Feng H, Hao DJ. A new cervical artificial disc prosthesis based on physiological curvature of end plate: a finite element analysis. Spine J 2016; 16:1384-1391. [PMID: 27345748 DOI: 10.1016/j.spinee.2016.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/28/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN The study aimed to build a new cervical artificial disc C3-C7 segment prosthesis, and perform a biomechanical comparison between the new prosthesis and the Prestige LP prosthesis using a three-dimensional non-linear finite element (FE) model. PURPOSE The study compared the biomechanical differences between the new cervical artificial disc prosthesis based on the physiological curvature of the end plate and the Prestige LP prosthesis after artificial disc replacement. BACKGROUND CONTEXT There has been no prior research on artificial disc prostheses based on the physiological curvature of the end plate; studies of biomechanical changes after cervical disc arthroplasty (CDR) are few. METHODS An FE model of the C3-C7 segments was developed and validated. A new cervical artificial disc prosthesis based on the physiological curvature of the end plate and the Prestige LP prosthesis were integrated at the C5-C6 segment into the validated FE model. All models were subjected to a follower load of 73.6 N and a 1 Nm in flexion-extension, lateral bending, and axial torsion. The segmental range of motion (ROM) and stress on the prostheses were analyzed. RESULTS The ROM in most segments after CDR with new cervical artificial disc prosthesis was more similar to that of the normal cervical spine than the Prestige LP prosthesis. However, there was no significant difference between the two prostheses. The stress on the new artificial disc was significantly less than that in the Prestige LP prosthesis. CONCLUSIONS There was no significant difference in ROM in all segments after CDR for the two prostheses. The stress on the new cervical artificial disc prosthesis based on the physiological curvature of the end plate was significantly less than that in the Prestige LP prosthesis. The new artificial disc prosthesis is feasible and effective, and can reduce the implant-bone interface stress on the end plate, which may be one of the causes of prosthesis subsidence.
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Affiliation(s)
- Cheng-Cheng Yu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China
| | - Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China
| | - Yong-Hong Jiang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China
| | - Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi 710054, China.
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Provaggi E, Leong JJH, Kalaskar DM. Applications of 3D printing in the management of severe spinal conditions. Proc Inst Mech Eng H 2016; 231:471-486. [PMID: 27658427 DOI: 10.1177/0954411916667761] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The latest and fastest-growing innovation in the medical field has been the advent of three-dimensional printing technologies, which have recently seen applications in the production of low-cost, patient-specific medical implants. While a wide range of three-dimensional printing systems has been explored in manufacturing anatomical models and devices for the medical setting, their applications are cutting-edge in the field of spinal surgery. This review aims to provide a comprehensive overview and classification of the current applications of three-dimensional printing technologies in spine care. Although three-dimensional printing technology has been widely used for the construction of patient-specific anatomical models of the spine and intraoperative guide templates to provide personalized surgical planning and increase pedicle screw placement accuracy, only few studies have been focused on the manufacturing of spinal implants. Therefore, three-dimensional printed custom-designed intervertebral fusion devices, artificial vertebral bodies and disc substitutes for total disc replacement, along with tissue engineering strategies focused on scaffold constructs for bone and cartilage regeneration, represent a set of promising applications towards the trend of individualized patient care.
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Affiliation(s)
- Elena Provaggi
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK
| | - Julian J H Leong
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK.,2 Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deepak M Kalaskar
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK
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Yu CC, Hao DJ, Huang DG, Qian LX, Feng H, Li HK, Zhao SC. Biomechanical Analysis of a Novel Prosthesis Based on the Physiological Curvature of Endplate for Cervical Disc Replacement. PLoS One 2016; 11:e0158234. [PMID: 27355319 PMCID: PMC4927058 DOI: 10.1371/journal.pone.0158234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/12/2016] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Biomechanical analysis of a novel prosthesis based on the physiological curvature of endplate was performed. OBJECTIVE To compare the biomechanical differences between a novel prosthesis based on the physiological curvature of the endplate and the Prestige LP prosthesis after cervical disc replacement (CDR). SUMMARY OF BACKGROUND DATA Artificial disc prostheses have been widely used to preserve the physiological function of treated and adjacent motion segments in CDR, while most of those present a flat surface instead of an arcuate surface which approximately similar to anatomic structures in vivo. We first reported a well-designed artificial disc prosthesis based on the physiological curvature of the endplate. METHODS Three motion segments of 24 ovine cervical spines (C2-5) were evaluated in a robotic spine system with axial compressive loads of 50N. Testing conditions were as follows: 1) intact, 2) C3-4 CDR with artificial disc prosthesis based on the physiological curvature of the endplate, and 3) C3-4 CDR with the Prestige LP prosthesis. The range of motion (ROM) and the pressures on the inferior surface of the two prostheses were recorded and analyzed. RESULTS As compared to the intact state, the ROM of all three segments had no significant difference in the replacement group. Additionally, there was no significant difference in ROM between the two prostheses. The mean pressure on the novel prosthesis was significantly less than the Prestige LP prosthesis. CONCLUSION ROM in 3 groups (intact group, CDR group with novel prosthesis and CDR group with Prestige LP) showed no significant difference. The mean pressure on the inferior surface of the novel prosthesis was significantly lower than the Prestige LP prosthesis. Therefore, the novel artificial disc prosthesis is feasible and effective, and can reduce the implant-bone interface pressure on the endplate, which may be one possible reason of prosthesis subsidence.
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Affiliation(s)
- Cheng-Cheng Yu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
- * E-mail:
| | - Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Li-Xiong Qian
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Hou-Kun Li
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Song-Chuan Zhao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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