Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw)

Kwon, Ji-Won; Bang, Sun Hee; Park, Taehyun; Lee, Sung–Jae; Lee, Hwan Mo; Lee, Soo Bin; Lee, Byung Ho; Moon, Seong-Hwan

doi:10.1016/j.clinbiomech.2020.01.018

Cited by 11 publications

(20 citation statements)

References 28 publications

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“…In addition, our FEM model only included an allograft spacer-vertebral body fusion model; it did take into account the immediate postoperative status of the allograft spacer-vertebral body interface before bony fusion occurs. Additionally, a 3D intact cervical FE model validated by range of motion (ROM) was utilized in the present study [9,10]. This approach confirmed that the kinematics of the developed FEM reflected real soft tissue functions.…”

Section: Effect Of Posterior Fixation Constructs On the Subsidence Risupporting

confidence: 59%

“…A previously validated three-dimensional intact cervical spinal segment model of C3-6 in a 54-year-old male subject was used [9,10]. The geometrical data of the multi-segmental cervical model were reconstructed from computed tomography (CT) images.…”

Section: Fem Of An Intact Cervical Spinementioning

confidence: 99%

“…In addition, the stability of the allograft spacer and bone was confirmed by measuring the Peak von Mises Stress (PVMS) of the allograft spacer and the maximum principle strain of the peri-screw bone. To confirm the subsidence potential of the treatment devices, the PVMS of the bone surface in contact with the treatment device was analyzed assuming a bone yield stress ratio of 16.3 MPa [9,29].…”

Section: Loading and Boundary Conditionsmentioning

confidence: 99%

“…In a clinical setting, asymmetrical cervical pedicle screw placement is not uncommon and depends on both the vertebral artery anomaly and the pedicle anatomy [4,5]. Although there are a few biomechanical studies that describe posterior fixation methods with LMS and posterior PS [6][7][8][9], the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Lee

Park

et al. 2020

Applied Sciences

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Background: There are a few biomechanical studies that describe posterior fixation methods with pedicle screws (PS) and lateral mass screws (LMS); the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown. Methods: Finite element model (FEM) analyses were used to investigate the effects of a hybrid technique using posterior PS and LMS. Stress distribution and subsidence risk from a combination of screws under hybrid motion control conditions, including flexion, extension, axial rotation, and lateral bending, were investigated to evaluate the biomechanical characteristics of different six-screw combinations. Findings: The load sharing on the allograft spacer in flexion mode was highest in the LMS model (74.6%) and lowest in the PS model (35.1%). The likelihood of subsidence of allograft spacer on C6 was highest in the screws from the distal LMS (type 5) model during flexion and extension (4.902 MPa, 30.1% and 2.189 MPa, 13.4%). In lateral bending, the left unilateral LMS (type 4) model screws on C5 (3.726 MPa, 22.9%) and C6 (2.994 MPa, 18.4%) yielded the greatest subsidence risks, because the lateral bending forces were supported by the LMS. In counterclockwise axial rotation, the left unilateral LMS (type 4) model screws on C5 (3.092 MPa, 19.0%) and C6 (3.076 MPa, 18.9%) demonstrated the highest subsidence risks. Conclusion: The asymmetrical ipsilateral use of LMS and posterior PS in lateral bending and axial rotation demonstrated the lowest stability and greatest subsidence risk. We recommend bilateral symmetrical insertion of LMS or posterior PS and posterior PS on distal vertebrae for increased stability and reduced risk of allograft spacer subsidence.

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Section: Effect Of Posterior Fixation Constructs On the Subsidence Risupporting

confidence: 59%

Section: Fem Of An Intact Cervical Spinementioning

confidence: 99%

Section: Loading and Boundary Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Lee

Park

et al. 2020

Applied Sciences

Self Cite

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“…In patients with cervical spondylotic myelopathy, the number of symptoms and involved levels, symptom duration, and frequency of surgery performed via a posterior approach were found to substantially increase with older age [2][3][4]. In some patients, surgical management is further complicated by the presence of osteoporosis [5], as well as other factors (such as certain traumatic injuries, metastatic disease, and revision surgery) that require stronger fixation techniques [6,7]. Although lateral mass screws can provide safe stabilization, various studies have demonstrated that this mode of fixation is biomechanically inferior to that using pedicle screws, particularly in patients with osteoporosis [8].…”

Section: Introductionmentioning

confidence: 99%

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Kwon

Arreza

Suguitan

et al. 2022

JCM

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This study describes a new and safe freehand cervical pedicle screw insertion technique using preoperative computed tomography (CT) morphometric measurements as a guide and a medial pedicle pivot point (MPPP) during the procedure. This study included 271 pedicles at 216 cervical spine levels (mean: 4.75 pedicles per patient). A pedicle diameter (PD) ≥ 3.5 mm was the cut-off for pedicle screw fixation. The presence and grade of perforation were detected using postoperative CT scans, where perforations were graded as follows: 0, no perforation; 1, perforation < 0.875 mm; 2, perforation 0.875–1.75 mm; and 3, perforation > 1.75 mm. The surgical technique involved the use of an MPPP, which was the point at which the lines representing the depth of the lateral mass and total length of the pedicle intersected, deep in the lateral mass. The overall success rate was 96.3% (261/271, Grade 0 or 1 perforations). In total, 54 perforations occurred, among which 44 (81.5%) were Grade 1 and 10 (18.5%) were Grade 2. The most common perforation direction was medial (39/54, 72.2%). The freehand technique for cervical pedicle screw fixation using the MPPP may allow for a safe and accurate procedure in patients with a PD ≥3.5 mm.

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Biomechanical comparison of the angle of inserted screws and the length of anterior cervical plate systems with allograft spacers

Kwon

Bang

Kwon

et al. 2020

Clinical Biomechanics

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Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw)

Cited by 11 publications

References 28 publications

Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Biomechanical comparison of the angle of inserted screws and the length of anterior cervical plate systems with allograft spacers

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