Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine

Aghayev, Kamran; Doulgeris, James; Gonzalez-Blohm, Sabrina A.; Eleraky, Mohammed; Lee, William; Vrionis, Frank D.

doi:10.1016/j.clinbiomech.2013.10.016

Cited by 19 publications

(13 citation statements)

References 11 publications

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Section: Discussionmentioning

confidence: 88%

“…The superiority of the SOR with anterior plating and posterior standard instrumentation supports the clinical rationale of adding a plate whenever an anterior corpectomy is done as a simple measure to increase stability in all planes. [2][3][4]6,19,25,26,58,59 The use of 2 cross-links was shown to improve ROM reduction of 3-column injuries in AR in biomechanical studies. However, the use of a single cross-link for a 2-column injury did not improve stiffness in AR.…”

Section: B C D E F Amentioning

confidence: 99%

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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

et al. 2020

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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), OGRgroup, 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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Section: Discussionmentioning

confidence: 88%

Section: B C D E F Amentioning

confidence: 99%

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

et al. 2020

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“…To further warrant the model bio-fidelity, the flexionextension ROM of C2-T1 postoperative FE models with different T1 tilts was evaluated against published data under pure flexion-extension loadings (without gravity) (Aghayev et al, 2014;Hartmann et al, 2015). Similar to the experimental loading Frontiers in Bioengineering and Biotechnology frontiersin.org conditions (Aghayev et al, 2014;Hartmann et al, 2015), T1 inferior endplate was fixed for all the degrees of freedom, while C2 and C3 vertebrae were rigidly attached to avoid relative motion during loadings (Figure 1). Pure moments of 1.5 Nm and 2.0 Nm in flexion-extension were applied to the C2 superior endplate of C2-T1 FE models with different T1 tilts.…”

Section: Rom Validation For C2-t1 Postoperative Fe Modelsmentioning

confidence: 99%

Biomechanical influence of T1 tilt alteration on adjacent segments after anterior cervical fusion

Wei

Du²,

et al. 2022

Front. Bioeng. Biotechnol.

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Background: Anterior cervical fusion (ACF) has become a standard treatment approach to effectively alleviate symptoms in patients with cervical spondylotic myelopathy and radiculopathy. However, alteration of cervical sagittal alignment may accelerate degeneration at segments adjacent to the fusion and thereby compromise the surgical outcome. It remains unknown whether changes in T1 tilt, an important parameter of cervical sagittal alignment, may cause redistribution of biomechanical loading on adjacent segments after ACF surgery.Objective: The objective was to examine the effects of T1 tilt angles on biomechanical responses (i.e.range of motion (ROM) and intradiscal VonMises stress) of the cervical spine before and after ACF.Methods: C2–T1 FE models for pre- and postoperative C4–C6 fusion were constructed on the basis of our previous work. Varying T1 tilts of −10°, −5°, 0°, 5°, and 10° were modeled with an imposed flexion–extension rotation at the T1 inferior endplate for the C2–T1 models. The flexion–extension ROM and intradiscal VonMises stress of functional spinal units were compared between the pre- and postoperative C2–T1 FE models of different T1 tilts.Results: The spinal segments adjacent to ACF demonstrated higher ROM ratios after the operation regardless of T1 tilt. The segmental ROM ratio distribution was influenced as T1 tilt varied and loading conditions, which were more obvious during displacement-control loading of extension. Regardless of T1 tilt, intradiscal VonMises stress was greatly increased at the adjacent segments after the operation. As T1 tilt increased, intradiscal stress at C3–C4 decreased under 30° flexion and increased under 15° extension. The contrary trend was observed at the C6–C7 segment, where the intradiscal stress increased with the increasing T1 tilt under 30° flexion and decreased under 15° extension.Conclusion: T1 tilt change may change biomechanical loadings of cervical spine segments, especially of the adjacent segments after ACF. Extension may be more susceptible to T1 tilt change.

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“…After all, ACDF using PEEK cages is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc disease [1,3,6,7,10]. This surgical method may not be effective for spinal cord decompression when the main pathology is behind the vertebral bodies, consequently, complete neurological recovery fails [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…Cervical spondylosis is a rather common disorder of the spine and the treatment consists of decompression of the affected neural structures either by multilevel (more than 2 levels) corpectomy or preferably by multilevel discectomy [1][2][3][4][5]. Anterior cervical corpectomy that also allows thorough decompression including resection of osteophytes is usually effective in the management of cervical radiculomyelopathy secondary to cervical spondylosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical discectomy and fusion solely with peek cages in multilevel cervical spondylotic radiculomyelopathy: single center clinical experience with 58 consecutive patients

Şimşek¹

2017

Med-Science

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Aim of this study was to evaluate the efficacy and safety of fusion solely with polyetheretherketone (PEEK) cages without plates and autogenous bone graft to provide fusion in multilevel cervical spondylosis in selected cases. 58 patients with cervical discogenic disorders in 3-4 levels (38 and 20 patients respectively) underwent multilevel anterior cervical discectomy and fusion (ACDF) operations with PEEK cages for a total of 194 levels. Minimum follow up was 24 months (24-48) postoperatively. Outcome had been established in combination with the evaluation of cervical lordosis, fusion rates and neurological improvement that was assessed by Japanese Orthopedic Association (JOA) scoring system. They were assessed by radiographs, computerized tomography and magnetic resonance imaging studies. Clinical outcomes were based on the issues including length of hospital stay, blood loss, complication rates and functional outcomes. 38 patients underwent three-level, 20 patients underwent four-level operations. Fusion rate was 89.2%. Significant improvement in the JOA scores was recorded postoperatively, and Ishihara Curvature Index (ICI) was preserved. In the follow-up period, no cage migration was experienced and reoperation was not required except for one who later underwent corpectomy and anterior fusion. ACDF with the use of PEEK cages without plates proved to yield good clinical outcome and comfortable postoperative course for the patients with acceptable fusion rates.

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Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine

Cited by 19 publications

References 11 publications

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

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

Biomechanical influence of T1 tilt alteration on adjacent segments after anterior cervical fusion

Anterior cervical discectomy and fusion solely with peek cages in multilevel cervical spondylotic radiculomyelopathy: single center clinical experience with 58 consecutive patients

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