Biomechanical Comparison of Integrated Fixation Cage Versus Anterior Cervical Plate and Cage in Anterior Cervical Corpectomy and Fusion (ACCF): A Finite Element Analysis

Ouyang, Pengrong; Teng, Li; He, Xijing; Gao, Zhongyang; Cai, Xuan; Zhang, Jin

doi:10.12659/msm.913630

Cited by 20 publications

(19 citation statements)

References 35 publications

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“…Therefore, the results obtained from the models described in this study should be interpreted with caution. It was not possible to completely duplicate the findings from in vivo studies using FE analysis [33]. Despite the above limitations, this study effectively demonstrated the biomechanical changes associated with the different shapes of cages in ACPC by maintaining the consistency of the experimental conditions of each ACPC model.…”

Section: Discussionmentioning

confidence: 94%

Biomechanical Comparison of Optimal Shapes for the Cervical Intervertebral Fusion Cage for C5–C6 Cervical Fusion Using the Anterior Cervical Plate and Cage (ACPC) Fixation System: A Finite Element Analysis

2019

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BackgroundThe fifth and sixth cervical vertebrae (C5–C6) represent the high-risk segment requiring surgical correction in cervical spondylosis. Anterior cervical discectomy and fusion (ACDF) of C5–C6 includes an intervertebral fusion cage to maintain foraminal height and is combined with anterior plate fixation. The shape of the intervertebral cage can affect the postoperative outcome, including the rates of fusion, subsidence, and neck pain. This study aimed to use finite element (FE) parametric analysis to compare biomechanical properties of changes in intervertebral cage shape for C5–C6 cervical fusion using the anterior cervical plate and cage (ACPC) fixation system.Material/MethodsFive shapes were designed for cervical intervertebral cages, square, oval, kidney-shaped, clover-shaped, and 12-leaf-shaped. The performance was evaluated following implantation into the validated normal C5–C6 FE model using simulation with five physiological conditions. The indicators included the maximum von Mises stress of the endplates, the fusion cages, and the cervical vertebrae. The postoperative subsidence-resistance properties were determined, including the interior stress responses of the intervertebral cages and the surrounding tissues. The fusion-promoting properties were evaluated by the interior stress responses of the bone grafts.ResultsThe optimal shape of the cervical intervertebral cage was the 12-leaf-shape for postoperative subsidence resistance. The kidney shape for the cervical intervertebral cage was optimal for postoperative fusion.ConclusionsFE analysis identified the optimal cervical intervertebral cage design for ACPC fixation of C5–C6. This method may be useful for future developments in the design of spinal implants.

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Section: Discussionmentioning

confidence: 94%

Biomechanical Comparison of Optimal Shapes for the Cervical Intervertebral Fusion Cage for C5–C6 Cervical Fusion Using the Anterior Cervical Plate and Cage (ACPC) Fixation System: A Finite Element Analysis

2019

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“…With 3 or more level fusions, it is difficult to maintain lordotic alignment during surgery; Second, postoperative lordosis changes are likely lower because of the few remaining mobile segments after a 3-level arthrodesis; Third, all patients underwent ACDF with rigid plate augmentation. The anterior plate and screw system has a limited length and rigid motion even if the anterior cervical plate system provides immediate segmental stability, fixation strength, thereby increasing the fusion rate [29]. Taken together, these mechanisms explain the difficulty in achieving lordosis in 3-level arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion

Shin

2019

Neurospine

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This study aimed to assess the influence of a fused segment on cervical range of motion (ROM) and adjacent segmental kinematics and determine whether increasing number of fusion levels causes accelerated adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF). Methods: A total of 165 patients treated with ACDF were recruited for assessment, and they were divided into 3 groups based on the number of fusion levels. Radiological measurements and clinical outcomes included visual analogue scale (VAS) and Neck Disability Index (NDI) assessed preoperatively and at ≥ 2 years of follow-up. Results: ASD occurred in 41 of 165 patients who underwent ACDF (1-level, 12 of 78 [15.38%]; 2-level, 14 of 49 [28.57%]; 3-level, 15 of 38 [39.47%]; p = 0.015) at final follow-up (mean, 31.9 months). Significant differences were found in reduction of global ROM based on the number of fusion levels (p < 0.001). The upper adjacent segment ROM increased over time (p = 0.004); however, lower segment ROM did not. Three-level ACDF did not obtain greater amounts of lordosis than did 1-or 2-level ACDF (p = 0.003). Postoperative neck VAS scores and NDI were significantly higher for 3-level ACDF than for 1-or 2-level ACDF (p = 0.033 and p = 0.001). Conclusion: ASD occurred predominantly in multilevel cervical fusion, more frequently in the upper segment of the prior fusion and as the number of fusion levels increased. Patients who underwent multilevel fusion had greater reduction of global ROM and increased compensatory motion at the upper adjacent segment. Three-level ACDF did not appear to restore cervical lordosis significantly compared with 1-or 2-level arthrodesis.

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“…The FEA modeling method has been described in our previous study [9]. Briefly, the computed tomography (CT) images of the lower cervical spine were obtained from a healthy man (aged 31 years, 76 kg, and 177 cm) at 1-mm intervals.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of 1-Level Corpectomy and 2-Level Discectomy for Cervical Spondylotic Myelopathy: A Finite Element Analysis

Ouyang

et al. 2020

Med Sci Monit

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Background: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are effective treatments for cervical spondylotic myelopathy (CSM), but it is unclear which is better. In this study, we compared the biomechanical properties of 2-level ACDF and 1-level ACCF. Material/Methods: An intact C3-C7 cervical spine model was developed and validated, then ACDF and ACCF simulation models were developed. We imposed 1.0 Nm moments and displacement-controlled loading on the C3 superior endplate. The range of motions (ROMs) of surgical and adjacent segments and von Mises stresses on endplates, fixation systems, bone-screw interfaces, and bone grafts were recorded. Results: ACDF and ACCF significantly reduced the surgical segmental ROMs to the same extent. ACCF induced much lower stress peaks in the fixation system and bone-screw interfaces and higher stress peaks on the bone graft. ACDF induced much lower stress peaks on the C4 inferior endplate and equivalent stress on the C6 superior endplate. There was no difference in the ROMs of surgical and adjacent segments and the intradiscal stress of adjacent levels between ACDF and ACCF. Conclusions: Both ACDF and ACCF can provide satisfactory spinal stability. ACDF may be beneficial for subsidence resistance due to the lower stress peaks on the endplate. The ACCF may perform better in long-term stability and bone fusion owing to the lower stress peaks in the fixation system and bone-screw interfaces, and higher stress peaks in the bone graft.

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Biomechanical Comparison of Integrated Fixation Cage Versus Anterior Cervical Plate and Cage in Anterior Cervical Corpectomy and Fusion (ACCF): A Finite Element Analysis

Cited by 20 publications

References 35 publications

Biomechanical Comparison of Optimal Shapes for the Cervical Intervertebral Fusion Cage for C5–C6 Cervical Fusion Using the Anterior Cervical Plate and Cage (ACPC) Fixation System: A Finite Element Analysis

Biomechanical Comparison of Optimal Shapes for the Cervical Intervertebral Fusion Cage for C5–C6 Cervical Fusion Using the Anterior Cervical Plate and Cage (ACPC) Fixation System: A Finite Element Analysis

Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion

Biomechanical Comparison of 1-Level Corpectomy and 2-Level Discectomy for Cervical Spondylotic Myelopathy: A Finite Element Analysis

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