Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Zhang, Xiang; Yang, Yi; Shen, Yanchang; Zhang, Ke-Rui; Ma, Litai; Ding, Chen; Wang, Beiyu; Meng, Yang; Líu, Hao

doi:10.3389/fbioe.2023.931202

Cited by 4 publications

(5 citation statements)

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“…Higher early fusion rates in the uncovertebral joint may be due to the following. First, the gap between the uncovertebral joints (2 mm) is smaller than the end plate space (5 to 8 mm) 20 , which allows for faster bone healing 33 . Second, the uncovertebral joint is under higher stress in the degenerated cervical spine and is more prone to bone or osteophyte formation 34 .…”

Section: Discussionmentioning

confidence: 99%

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Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery

Sheng

Yang

Ding

et al. 2023

Journal of Bone and Joint Surgery

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Background:The uncovertebral joint is a potential region for anterior cervical fusion. Currently, we are aware of no clinical trials on human uncovertebral joint fusion (UJF). The purpose of this study was to compare the time it took to achieve osseous union/fusion and the clinical efficacy of UJF to end plate space fusion (ESF)—i.e., traditional anterior cervical discectomy and fusion (ACDF)—in anterior cervical surgery.Methods:Patients with single-level cervical spondylosis were recruited from April 2021 through October 2022 and randomly divided into the UJF and ESF groups, with 40 patients in each group. Autologous iliac bone was used for bone grafting in both groups. The primary outcome was the early fusion rate at 3 months postoperatively. Secondary outcomes included the prevalence of complications and patient-reported outcome measures (PROMs), including the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and visual analog scale (VAS) scores for arm and neck pain.Results:A total of 74 patients (92.5%) with an average age of 49.8 years (range, 26 to 65 years) completed the trial and were included in the analysis. There was no significant difference between the 2 groups at baseline. The operative duration and intraoperative blood loss were also comparable between the 2 groups. The fusion rate in the UJF group was significantly higher than that in the ESF group at 3 months (66.7% compared with 13.2%, p < 0.0001) and 6 months (94.1% compared with 66.7%, p = 0.006) after the operation. No significant difference was found in the fusion rate between the 2 groups 12 months postoperatively. Overall, the PROMs significantly improved after surgery in both groups and did not differ significantly between the groups at any follow-up time point. The prevalence of complications was not significantly different between the 2 groups.Conclusions:In our study of anterior cervical fusion surgery, we found that the early fusion rate after UJF was significantly higher than that after ESF.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…Such a gap is a potential fusion area; nevertheless, it is often overlooked in most spine centers. The "bone creep" distance required for uncovertebral joint fusion (UJF) is shorter than that for ESF 20 , which may make it easier to achieve fusion. Previous anatomical research 20 and a goat model study 21 have preliminarily shown the advantages of UJF.…”

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confidence: 99%

Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery

Sheng

Yang

Ding

et al. 2023

Journal of Bone and Joint Surgery

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“…The robot was programmed to apply three continuous loading‒unloading cycles of the applied moment along each primary axis of motion to simulate flexion-extension (FE), lateral bending (LB), and axial rotation (AR). An axial preload of 75 N was administered on the C2 vertebra to simulate head weight ( Rong et al, 2017 ; Wu et al, 2019 ; Wang et al, 2021 ; Wo et al, 2021 ; Lu et al, 2022 ; Zhang et al, 2023 ). All of the specimens were subjected to three cycles of FE, LB, and AR under a nondestructive pure moment of ±2.0 N·m, and the data of the third cycle were used for the analysis ( Zheng et al, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study

Abudouaini,

Wu,

Meng

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is a most frequently used surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration (ASD) rate after ACDF surgery. We creatively designed an elastically deformable cervical implant to reduce the postoperative stress concentration. In this study, we aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical devices.Methods: Biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2–C7) and randomly divided into four groups according to implant types: intact group, Zero-P VA fusion (ACDF) group, the novel cervical implant group and Pretic-I artificial cervical disc (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments and micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments.Results: There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decrease some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups.Conclusion: While the newly developed elastically deformable cervical implant does not completely maintain ROM like the artificial cervical disc, it surpasses the fusion device with regards to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe adjacent segment degeneration after fusion surgery but no indication for artificial cervical disc surgery.

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“…Xiang Zhang ' s team conducted a biomechanical performance evaluation of the assembled joint fusion devices in single-level ACDF and compared them with the Zero-P device. The results showed that the range of motion (ROM) for the fused segments was close to zero in both models, but the motion in the unfused segment unevenly increased [35]. Tingxin Zhang et al evaluated the clinical effectiveness of Zero-P in anterior decompression and fusion compared to cervical anterior plates.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Effects of Anterior Decompression and Fusion With Cervical Two-Segments Different Internal Fixation Systems: A Finite Element Study

Li,

Yu,

Chao

et al. 2024

IEEE Access

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One of the traditional surgical approaches for treating cervical spondylosis is anterior cervical discectomy and fusion (ACDF). The conventional titanium plate fixation method and the Zero-P internal fixation method are now the two most used anterior internal fixing techniques. Although these two fixation procedures have been clinically validated in part, their systematic theoretical analysis is still insufficient, and there are several flaws in the application comparison of double-segments cervical spine. The finite element simulation approach is used in this work to perform surgical simulation and stress analysis on two internal fixation methods. Firstly, we established a finite element model of the C3-C7 segments of the lower cervical spine and completed the validity verification of the model. Secondly, a finite element model of the internal fixation surgical method between Zero-P and traditional titanium plates was established. Finally, the cervical spine mobility and the stress of the internal fixation system under different postoperative movements were calculated. The results demonstrate that following typical titanium plate surgery, there is stress concentration in the intervertebral disc endplate, but the simulation results after Zero-P surgery are rather stable. The theoretical life of Zero-P fastening screws is rather limited, and typical titanium plates are prone to fatigue failure around the nail holes. The breadth of the Zero-P cage and the fusion site modification during surgery have a direct influence on the contact between the cervical spine and the instrument following surgery, which is also a major cause of edge fatigue failure.

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Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Cited by 4 publications

References 95 publications

Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery

Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery

Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study

Biomechanical Effects of Anterior Decompression and Fusion With Cervical Two-Segments Different Internal Fixation Systems: A Finite Element Study

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