Finite Element Analysis of Cervical Facetectomy

Voo, Liming; Kumaresan, Srirangam; Yoganandan, Narayan; Pintar, Frank A.; Cusick, Joseph F.

doi:10.1097/00007632-199705010-00006

Cited by 67 publications

(59 citation statements)

References 13 publications

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“…another foraminotomy technique, keyhole laminoforaminotomy, is also an effective surgical option for treatment of foraminal CDHs, but it requires partial resection of the facet joints, and therefore there is risk of instability in case of aggressive facet resection (48).…”

mentioning

confidence: 99%

Empty bladed peek cage for interbody fusion after acd

Gök

Onen²,

Yıldırım³

et al. 2014

Turkish Neurosurgery

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ABSTRACTassociated with uncontrolled fusion and cervical kyphosis, particularly in cases with 2 and 3 level CDH (30).On the other hand, the addition of a disc prosthesis after ACD has some theoretical advantages, including motion preservation, and reduced rate of adjacent segment disease. However, adjacent segment problem, heterotopic ossification and high cost related problems remain (45, 50).another technique, anterior cervical foraminotomy, is an effective technique, particularly for foraminal herniations. There is, however, a risk of injury to the vertebral artery and █ InTRODuCTIOnCervical disc herniation (CDH) is an important disorder affecting health care. Many surgical treatment modalities have been used to treat CDH, including anterior cervical discectomy (ACD) (30, 39,41), anterior cervical discectomy and fusion (ACDF) (1, 3, 6, 8-10, 16, 25-27, 29, 31, 35, 36, 38, 43, 46, 47), anterior foraminotomy (32, 42), keyhole foraminotomy (12, 18,40, 49), and arthroplasty (5, 19,36,41). Each approach has its advantages and disadvantages. ACD has been used for many years and has encouraging results in one level cases with a stable cervical spine. However, long term results of ACD are AIM: Cervical disc herniation (CDH) can be treated using different anterior and posterior methods. Anterior cervical discectomy and fusion (ACDF) is currently gold standard and provides bony fusion and good clinical outcome. Recently many studies reported good clinical and radiological outcomes in cases who underwent anterior cervical discectomy (ACD) and reconstruction with empty cage. This study aimed to review our results after cervical microdiscectomy reconstructed with empty polyether ether ketone (pEEk) cage. MATERIAl and METhODS:Twenty-five cases with single level CDH who underwent microdiscectomy were included to this study. Reconstruction was performed using empty bladed cervical PEEK cages. Clinical (Visual analogue scale (VAS) and Odom scores) and radiological results (intervertebral disc and foraminal heights, mean cervical spine lordosis angle, and fusion rate) were reviewed one day and one year after surgery.RESulTS: There were 18 males and 7 females, aged between 25 and 54 years (mean: 40.8). Mean neck and arm VAS scores reduced from 2.9 to 1.4, and from 7.2 to 1.8, respectively. Odom scores were found to be 1.6 and 1.4 at 1 st day and one year postoperatively, respectively. Subsidence was seen in three cases (12%). There was no significant change in heights of neural foramina and intervertebral discs, and no change in cervical spine lordosis, when compared postoperative 1 st day and one year radiographs. Fusion was detected in 92% of cases in one year.COnCluSIOn: Bladed cervical cages are safe with almost no risk of dislocation. Empty cages provide acceptable rates of fusion and subsidence.

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confidence: 99%

Empty bladed peek cage for interbody fusion after acd

Gök

Onen²,

Yıldırım³

et al. 2014

Turkish Neurosurgery

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“…Several studies have shown that resection of more than 50% of the facet joint is associated with increased instability postoperatively. 18,65 Voo et al found that facet resections exceeding 50% in the cervical spine result in significant increases in annulus stresses and segmental mobility. 65 In our case series, 94.1% of patients presented with additional degenerative disc disease and 58.8% with spondylolisthesis, and all patients except one underwent a fusion procedure accordingly.…”

Section: Discussionmentioning

confidence: 99%

“…18,65 Voo et al found that facet resections exceeding 50% in the cervical spine result in significant increases in annulus stresses and segmental mobility. 65 In our case series, 94.1% of patients presented with additional degenerative disc disease and 58.8% with spondylolisthesis, and all patients except one underwent a fusion procedure accordingly. These findings, combined with the fact that synovial cysts are typically a disease of the elderly and oftentimes seen at the cervicothoracic junction, point to underlying spinal instability as a culprit.…”

Section: Discussionmentioning

confidence: 99%

The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis

Bydon

Lin

Ramos

et al. 2014

SPI

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Object This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs. Methods The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study. Results Seventeen patients underwent surgical treatment for CSCs at our institution: 3 patients (17.6%) had atlantoaxial cysts and 14 (82.3%) had subaxial cysts. Of the 17 patients, 16 underwent a decompression and fusion; most patients experienced symptom resolution at last follow-up, and there were no cyst recurrences. A total of 54 articles (including the current series) and 101 patients were included in the meta-analysis. The mean age at presentation was 64 ± 13.9 years, and the most common symptoms were motor and sensory deficits. Forty-one patients (40.6%) presented with atlantoaxial cysts, and 60 (59.4%) with subaxial cysts. There were no significant differences between groups in terms of presenting symptoms, Nurick scores, surgical treatment, or surgical outcomes. Fifty-two patients (51.4%) underwent surgical decompression without fusion, while 49 patients (48.6%) underwent fusion. The preoperative Nurick scores were significantly lower in the fused group (p = 0.001), with an average score of 1.32 compared with 2.75 in the nonfused group. After a mean follow-up of 16.5 months, a difference of means analysis between final and preoperative Nurick scores revealed that patients who received a decompression alone improved on average 1.66 points (95% CI 1.03–2.29) compared with 0.8 points (95% CI 0.23–1.39) in the fused group (p = 0.004). However, there was no statistically significant difference in symptom resolution between the groups, and the rate of cyst recurrence was found to be 0%. Conclusions In this study, patients with CSCs had similar outcomes regardless of cyst location and regardless of whether they underwent decompression only or fusion. In the authors' institutional experience, 16 of 17 patients underwent fusion due to underlying spinal instability. While there were no reports of cyst recurrence in their series or in the literature in patients who only received decompression, this is likely due to the limited follow-up time available for the study population. Longer follow-up and prospective and biomechanical studies are needed to corroborate these findings.

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“…Static analyses also allow for corroboration of FE results with in vitro study load displacement results. Static analyses have been used to analyze a variety of topics including spinal column biomechanics, soft tissue effects on behavior, soft and hard tissue injuries, and even prosthetic disc replacements (Zhang et al, 2006;Voo et al, 1997;Noailly et al, 2007;Ha, 2006;Galbusera et al, 2008). As stated, static element analyses lend themselves well to validation of cervical spine finite element models.…”

Section: Cervical Spine Analysismentioning

confidence: 99%

“…Modeling IVD must be approached in a different manner than the vertebral bodies as CT scans do not provide soft tissue data. Cryomicrotomy images can be used as an alternative to fill in the missing soft tissue data (Yoganandan, Kumaresan and Pintar, 2001;Voo et al, 1997). An alternative to employing cryomicrotomy is to model intervertebral discs in reference to their interaction with related solid bodies (Yoganandan, Kumaresan and Pintar, 2001).…”

Section: Intervertebral Disc Modelingmentioning

confidence: 99%