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Biomechanical analysis of anterior cervical fusion

Chunpeng Ren, Yueming Song, Youdi Xue, Xi Yang, Chunguang Zhou
BACKGROUND: Recently, polylactide is the most popular material used to made bioabsorbable cages, but too fast degradation and osteolysis around the cage have been reported in the literature. This study evaluated the fusion effect, biomechanical stability and histological characteristics of a novel bioabsorbable multi-amino acid copolymer/nano-hydroxyapatite/calcium sulphate (MAACP/n-HA/CS) interbody cage in a goat model of anterior cervical discectomy and fusion (ACDF). METHODS: A total of 24 goats underwent C3/C4 discectomy and fusion with three groups of intervertebral implants: MAACP/n-HA/CS cage group (n = 8), titanium cage group (n = 8) and autologous tricortical iliac crest bone group (n = 8)...
April 10, 2017: World Neurosurgery
I David Kaye, Alan S Hilibrand
PURPOSE OF REVIEW: The precise etiology of adjacent segment disease following cervical spine surgery is controversial. Theories for development include inevitable changes secondary to the natural progression of the degenerative cascade and changes secondary to altered biomechanics of the fused cervical spine. Motion preserving techniques, such as cervical disc arthroplasties (CDA), have been introduced with the hopes of reducing the rates of adjacent segment pathology. Recently, 7-year data from the investigational device exemption (IDE) studies have been published...
March 23, 2017: Current Reviews in Musculoskeletal Medicine
Chao Chen, Xiaolin Zhang, Xinlong Ma
BACKGROUND: The durability of cervical disc arthroplasties (CDA) may vary significantly because of different designs and implanting techniques of the devices. Nevertheless, the comparative durability remains unknown. OBJECTIVES: We aimed to assess the durability of CDAs in at least 2-year follow-up. We analyzed the classifications and causes of secondary surgical procedures, as well as the structural designs of the devices that might influence the durability. METHODS: PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from the inception of each database to September 2015 using the following Keywords: "cervical disc replacement" OR "cervical disc arthroplasty" AND "randomized controlled trial (RCT)...
February 2017: Medicine (Baltimore)
Fan Zhang, Hao-Cheng Xu, Bo Yin, Xin-Lei Xia, Xiao-Sheng Ma, Hong-Li Wang, Jun Yin, Ming-Hao Shao, Fei-Zhou Lyu, Jian-Yuan Jiang
OBJECTIVES: To evaluate the biomechanical characteristics of endplate-conformed cervical cages by finite element method (FEM) analysis and cadaver study. METHODS: Twelve specimens (C2 -C7 ) and a finite element model (C3 -C7 ) were subjected to biomechanical evaluations. In the cadaver study, specimens were randomly assigned to intact (I), endplate-conformed (C) and non-conformed (N) groups with C4-5 discs as the treated segments. The morphologies of the endplate-conformed cages were individualized according to CT images of group C and the cages fabricated with a 3-D printer...
August 2016: Orthopaedic Surgery
Cheng-Cheng Yu, Ding-Jun Hao, Yu-Li Ma, Da-Geng Huang, Hou-Kun Li, Hang Feng, Qian Hou
BACKGROUND Cervical disc replacement (CDR) has been widely used to restore and maintain mobility and function of the treated and adjacent motion segments. Posterior longitudinal ligament (PLL) resection has been shown to be efficient in anterior cervical decompression and fusion. However, less is known about the biomechanical effect of PLL removal versus preservation in cervical disc arthroplasty. MATERIAL AND METHODS Three motion segments of 24 ovine cervical spines (C2-C5) were evaluated in a robotic spine system with axial compressive loads of 50 N...
May 31, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Y Yan, K M Bell, R A Hartman, J Hu, W Wang, J D Kang, J Y Lee
BACKGROUND CONTEXT: Various modifications to standard "rigid" anterior cervical plate designs (constrained plate) have been developed that allow for some degree of axial translation and/or rotation of the plate (semi-constrained plate)-theoretically promoting proper load sharing with the graft and improved fusion rates. However, previous studies about rigid and dynamic plates have not examined the influence of simulated muscle loading. PURPOSE: The objective of this study was to compare rigid, translating, and rotating plates for single-level corpectomy procedures using a robot testing system with follower load...
January 2017: European Spine Journal
Matthew F Gornet, J Kenneth Burkus, Mark E Shaffrey, Perry J Argires, Hui Nian, Frank E Harrell
OBJECT This study compared the safety and efficacy of treatment with the PRESTIGE LP cervical disc versus a historical control anterior cervical discectomy and fusion (ACDF). METHODS Prospectively collected PRESTIGE LP data from 20 investigational sites were compared with data from 265 historical control ACDF patients in the initial PRESTIGE Cervical Disc IDE study. The 280 investigational patients with single-level cervical disc disease with radiculopathy and/or myelopathy underwent arthroplasty with a low-profile artificial disc...
July 31, 2015: Journal of Neurosurgery. Spine
Aria Nouri, Lindsay Tetreault, Juan J Zamorano, Chandan B Mohanty, Michael G Fehlings
Study Design Prospective study. Objective To evaluate the prevalence of Klippel-Feil syndrome (KFS) in a prospective data set of patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM) and to evaluate if magnetic resonance imaging (MRI) features in patients with KFS are more pronounced than those of non-KFS patients with CSM. Methods A retrospective analysis of baseline MRI data from the AOSpine prospective and multicenter CSM-North American study was conducted. All the patients presented with at least one clinical sign of myelopathy and underwent decompression surgery...
August 2015: Global Spine Journal
Ivan Cheng, Eric B Sundberg, Alex Iezza, Derek P Lindsey, K Daniel Riew
Study Design In vitro testing. Objective To determine whether long cervical and cervicothoracic fusions increase the intradiscal pressure at the adjacent caudal disk and to determine which thoracic end vertebra causes the least increase in the adjacent-level intradiscal pressure. Methods A bending moment was applied to six cadaveric cervicothoracic spine specimens with intact rib cages. Intradiscal pressures were recorded from C7-T1 to T9-10 before and after simulated fusion by anterior cervical plating and posterior thoracic pedicle screw constructs...
August 2015: Global Spine Journal
George A C Mendes, Curtis A Dickman, Nestor G Rodriguez-Martinez, Samuel Kalb, Neil R Crawford, Volker K H Sonntag, Mark C Preul, Andrew S Little
OBJECT The primary disadvantage of the posterior cervical approach for atlantoaxial stabilization after odontoidectomy is that it is conducted as a second-stage procedure. The goal of the current study is to assess the surgical feasibility and biomechanical performance of an endoscopic endonasal surgical technique for C1-2 fixation that may eliminate the need for posterior fixation after odontoidectomy. METHODS The first step of the study was to perform endoscopic endonasal anatomical dissections of the craniovertebral junction in 10 silicone-injected fixed cadaveric heads to identify relevant anatomical landmarks...
May 2015: Journal of Neurosurgery. Spine
Heiko Koller, Werner Schmoelz, Juliane Zenner, Alexander Auffarth, Herbert Resch, Wolfgang Hitzl, Davud Malekzadeh, Lukas Ernstbrunner, Martina Blocher, Michael Mayer
INTRODUCTION: A high rate of complications in multilevel cervical surgery with corpectomies and anterior-only screw-and-plate stabilization is reported. A 360°-instrumentation improves construct stiffness and fusion rates, but adds the morbidity of a second approach. A novel ATS-technique (technique that used anterior transpedicular screw placement) was recently described, yet no study to date has analyzed its performance after fatigue loading. Accordingly, the authors performed an analysis of construct stiffness after fatigue testing of a cervical 2-level corpectomy model reconstructed using a novel anterior transpedicular screw-and-plate technique (ATS-group) in comparison to standard antero-posterior instrumentation (360°-group)...
December 2015: European Spine Journal
Matti Scholz, Philipp Schleicher, Simone Pabst, Frank Kandziora
STUDY DESIGN: In vitro biomechanical analysis of different multilevel cervical fixation techniques. OBJECTIVE: To compare the multilevel stability of a cervical anchored spacer (AS) with established fixation techniques. SUMMARY OF BACKGROUND DATA: To avoid plate-related complications, for example, dysphagia zero-profile AS has been developed. The use of these new zero-profile implants for treatment of cervical degenerative disc disease is widely accepted after encouraging biomechanical results for single-level instrumentation...
April 1, 2015: Spine
Fan Ding, Zhiwei Jia, Yaohong Wu, Chao Li, Qing He, Dike Ruan
STUDY DESIGN: A retrospective analysis. OBJECTIVE: This study aimed to compare the safety and efficacy between the fusion-nonfusion hybrid construct (HC: anterior cervical corpectomy and fusion plus artificial disc replacement, ACCF plus cADR) and anterior cervical hybrid decompression and fusion (ACHDF: anterior cervical corpectomy and fusion plus discectomy and fusion, ACCF plus ACDF) for 3-level cervical degenerative disc diseases (cDDD). SUMMARY OF BACKGROUND DATA: The optimal anterior technique for 3-level cDDD remains uncertain...
November 1, 2014: Spine
Brandon D Lawrence, Alpesh A Patel, Andrew Guss, W Ryan Spiker, Darrel S Brodke
STUDY DESIGN: Biomechanical evaluation. OBJECTIVE: To evaluate the kinematic and load-sharing differences of dynamic anterior cervical plates when placed in-line at 0° and off-axis at 20°. SUMMARY OF BACKGROUND DATA: The use of dynamic anterior cervical plating systems has recently gained popularity due to the theoretical benefit of improved load sharing with graft subsidence. Occasionally, due to anatomical restraints, the anterior cervical plate may be placed off-axis in the coronal plane...
December 1, 2014: Spine
J Kenneth Burkus, Vincent C Traynelis, Regis W Haid, Praveen V Mummaneni
OBJECT: The authors assess the long-term safety and efficacy of cervical disc replacement with the Prestige Cervical Disc in a prospective, randomized, multicenter trial at 7 years of follow-up. METHODS: At 31 investigational sites, 541 patients with single-level cervical disc disease with radiculopathy were randomized to 1 of 2 treatment groups: 276 investigational group patients underwent anterior cervical discectomy and arthroplasty with the Prestige disc, and 265 control group patients underwent anterior cervical discectomy and fusion...
October 2014: Journal of Neurosurgery. Spine
Dorothea Daentzer, Elmar Willbold, Katharina Kalla, Ivonne Bartsch, Waseem Masalha, Maximiliane Hallbaum, Christof Hurschler, Theresa Kauth, Daniel Kaltbeitzel, Christian Hopmann, Bastian Welke
STUDY DESIGN: An experimental study using a sheep cervical spine interbody fusion model. OBJECTIVE: First, to compare anterior cervical discectomy and fusion of an experimental bioabsorbable cage consisting of a magnesium alloy and a polymer (poly-ε-caprolactone, PCL) with an autologous tricortical iliac crest bone graft. Second, to determine the degradation kinetics of the cage, assess the 2 fusion devices for biomechanical stability, and determine their histological characteristics...
September 15, 2014: Spine
Aniruddh N Nayak, Matthew I Stein, Chris R James, Roger B Gaskins, Andres F Cabezas, Maxwell Adu-Lartey, Antonio E Castellvi, Brandon G Santoni
BACKGROUND CONTEXT: Despite an increase in the clinical use of no-profile anchored interbody cages (AIC) for anterior cervical discectomy and fusion (ACDF) procedures, there is little published biomechanical data describing its stabilizing effect relative to the traditional anterior plating technique over two contiguous levels. PURPOSE: To biomechanically compare the acute stability conferred by a stand-alone interbody fusion device with three integrated fixation screws ("anchored cage") with a traditional six-hole rigid anterior plate in a two contiguous levels (C4-C5+C5-C6) fusion construct...
December 1, 2014: Spine Journal: Official Journal of the North American Spine Society
Jon Park, Jun Jae Shin, Jesse Lim
OBJECTIVE: The objective of this study was designed to compare 2-level cervical disc surgery (2-level anterior cervical discectomy and fusion [ACDF] or disc arthroplasty) and hybrid surgery (ACDF/arthroplasty) in terms of postoperative adjacent-level intradiscal pressure (IDP) and facet contact force (FCF). METHODS: Twenty-four cadaveric cervical spines (C3-T2) were tested in various modes, including extension, flexion, and bilateral axial rotation, to compare adjacent-level IDP and FCF after specified treatments as follows: 1) C5-C6 arthroplasty using ProDisc-C (Synthes Spine, West Chester, Pennsylvania, USA) and C6-C7 ACDF, 2) C5-C6 ACDF and C6-C7 arthroplasty using ProDisc-C, 3) 2-level C5-C6/C6-C7 disc arthroplasties, and 4) 2-level C5-C6/C6-C7 ACDF...
December 2014: World Neurosurgery
Vincent C Traynelis, Jonathan Sherman, Eric Nottmeier, Vaneet Singh, Kirk McGilvray, Christian M Puttlitz, Patrick Devin Leahy
OBJECT The clinical success rates of anterior cervical discectomy and fusion (ACDF) procedures are substantially reduced as more cervical levels are included in the fusion procedure. One method that has been proposed as an adjunctive technique for multilevel ACDF is the placement of screws across the facet joints ("transfacet screws"). However, the biomechanical stability imparted by transfacet screw placement (either unilaterally or bilaterally) has not been reported. Therefore, the purpose of this study was to determine the acute stability conferred by implementation of unilateral and bilateral transfacet screws to an ACDF construct...
May 2014: Journal of Neurosurgery. Spine
Haines Paik, Daniel G Kang, Ronald A Lehman, Mario J Cardoso, Rachel E Gaume, Divya V Ambati, Anton E Dmitriev
BACKGROUND CONTEXT: Some postoperative complications after anterior cervical fusions have been attributed to anterior cervical plate (ACP) profiles and the necessary wide operative exposure for their insertion. Consequently, low-profile stand-alone interbody spacers with integrated screws (SIS) have been developed. Although SIS constructs have demonstrated similar biomechanical stability to the ACP in single-level fusions, their role as a stand-alone device in multilevel reconstructions has not been thoroughly evaluated...
August 1, 2014: Spine Journal: Official Journal of the North American Spine Society
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