Comparative Biomechanical Study of Cervical Spine Stabilisation by Cage Alone, Cage with Plate, or Plate-Cage: A Porcine Model

Hakało, Jerzy; Pezowicz, Celina; Wroński, J; Będziński, R.; Kasprowicz, Magdalena

doi:10.1177/230949900801600103

Cited by 27 publications

(18 citation statements)

References 38 publications

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“…For fusion group, we only chose ACDF with only PEEK box cage without a plate. The use of cage and plate for ACDF has several merits in respect to lordotic alignment, cage subsidence and fusion rate [17,[31][32][33], but because plate fixation increases fixation force, a stress generated in the adjacent disc, these effect can increase the possibility to get ASD rather than ACDF with cage alone [17,31]. Currently, cage made of PEEK is primarily used for ACDF due to its biomechanical similarities to those of bone [17].…”

Section: Discussionmentioning

confidence: 99%

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

et al. 2012

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Purpose It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery. Materials and methods This is a retrospective crosssectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured. Results The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2 % in the fusion group and 4.5 % in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50 %, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups. Conclusion The ASD rate of 46.5 % after ACDF or arthroplasty, and arthroplasty did not significantly lower the rate of ASD. ASD occurred in patients who had preexisting ASD and in patients who also had other segment degeneration. ASD may be associated with a natural history of cervical spondylosis rather than arthrodesis.

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Section: Discussionmentioning

confidence: 99%

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

et al. 2012

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“…Consistent with our data, the biomechanical reports also showed discectomy causes instability in ACDF biomechanical/clinical models. [28] The other changed variable of the results is that an increase in the displacement amounts of right/ left lateral bending was observed in the present study (P , 0.05). Nevertheless, some authors stated that discectomy had the least impact on lateral bending.…”

Section: Discussionmentioning

confidence: 52%

“…Nevertheless, some authors stated that discectomy had the least impact on lateral bending. [28] However, more reliable studies concerning right or left lateral bending must be performed on human cadavers because of the fact that uncovertebral joints that limit lateral flexion are not present in sheep.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of multilevel discectomy and excision of posterior longitudinal ligament: An in vitro study in sheep

et al. 2009

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“…Preoperative radicular weakness was present in 18 patients (36%) and the mean medical research council (MRC) strength score preoperatively was 4.5/5±0.88. The mean duration of symptoms (in general) preoperatively was 3.69 months (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Resultsmentioning

confidence: 99%

“…9,[11][12][13]16 Different rates of cage subsidence are present in published literature. In their study, Gercek et al, 9 found a very high rate of cage subsidence of 62.5% with loss of disc space height and subsequent foraminal stenosis and suggested that this could lead to recurrence of symptoms although it actually happened in only one patient.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Subsidence in Stand-Alone Cervical Cage: Incidence, Risk Factors and Effects on Clinical and Radiological Picture

Hamada¹,

AbouZeid²

2015

Egyptian Spine Journal

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Background Data: Anterior Cervical Discectomy and Fusion is the gold standard for treating cervical degenerative disc disease associated with radiculopathy and/or myelopathy. When indicated, surgery can achieve neural tissue decompression and biomechanical stabilization through bony fusion. One of the known complications of stand-alone anterior cervical cage is cage subsidence. Published literature however, contains mixed results in terms of rate of cage subsidence, loss of lordosis and its clinical effects. Purpose: We report our experience in stand-alone anterior cervical cage, our subsidence rate and its effect on loss of lordosis and clinical picture Study Design: Retrospective clinical case study. Patients and Methods: we inserted seventy-two cervical cages (in fifty patients), who had Anterior Cervical Discectomy and Fusion using a stand-alone polyetheretherketone (PEEK) cage under our care. We recorded the self-reported Visual Analogue Score for arm and neck pain and measured the total intervertebral height/disc space or cage ratio, segmental Cobb angle, the distance between the anterior rim of the cage and the anterior vertebral body line, superior or inferior end plate violation and anterior or posterior cage migration on lateral X ray film preoperatively and on each follow up visit (day 1, 7-21 days, 3, and 6 months). Results: Our cage subsidence rate in the studied sample was 23.6% in 6 months (17 out of 62 cages subsided). We found a statistically significant correlation between immediate postoperative disc height and subsidence (the more distraction we applied to the disc space the more likely subsidence would happen). Cage subsidence did not increase the incidence of recurrence of radicular, myelopathic symptoms or neck pain although it resulted in significant loss of the segmental Cobb angle. Conclusions: Disc space over-distraction in stand-alone anterior cervical cage significantly increases the risk of subsidence. Subsidence significantly affects the segmental Cobb angle but not the clinical outcome. (2015ESJ077)

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Comparative Biomechanical Study of Cervical Spine Stabilisation by Cage Alone, Cage with Plate, or Plate-Cage: A Porcine Model

Cited by 27 publications

References 38 publications

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

Biomechanical analysis of multilevel discectomy and excision of posterior longitudinal ligament: An in vitro study in sheep

Evaluation of Subsidence in Stand-Alone Cervical Cage: Incidence, Risk Factors and Effects on Clinical and Radiological Picture

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