Maintenance of Interbody Space in One- and Two-Level Anterior Cervical Interbody Fusion

Kao, Feng-Chen; Niu, Chi‐Chien; Chen, Lih-Huei; Lai, Po‐Liang; Chen, Wen-Jer

doi:10.1097/01.blo.0000142626.90278.9e

Cited by 76 publications

(62 citation statements)

References 36 publications

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“…But cage subsidence or migration was also observed resulting in disc height collapse and kyphotic deformity [11]. In addition to a high fusion rate, successful treatment depends on maintenance of interspace height and segmental angle [9]. Furthermore, metallic cages are radioopaque, which prevents the observation of trabecular bone formation, and radiographic determination of fusion has been debated.…”

Section: Discussionmentioning

confidence: 99%

Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

Liao

Niu

Chen

et al. 2007

International Orthopaedics (SICO

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103

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From July 2004 to June 2005, 19 patients with 25 discs underwent anterior cervical discectomy and interbody fusion (ACDF) in which polyetheretherketone (PEEK) cages were filled with freeze-dried cancellous allograft bone. This kind of bone graft was made from femoral condyle that was harvested during total knee arthroplasty. Patient age at surgery was 52.9 (28-68) years. All patients were followed up at least 1 year. We measured the height of the disc and segmental sagittal angulation by pre-operative and post-operative radiographs.

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Section: Discussionmentioning

confidence: 99%

Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

Liao

Niu

Chen

et al. 2007

International Orthopaedics (SICO

Self Cite

103

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“…[45][46][47][48] The loss of the construct height will result in loss of sagittal balance and can potentially alter the biomechanics of the adjacent level. The importance of this sagittal balance on the rate of adjacent level degeneration has been demonstrated in the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. Keywords: cervical endplate; fatigue; cyclic testing; biomechanics; subsidence Anterior cervical fusion has traditionally been a predictable and reliable surgical technique for treatment of multiple spinal pathologies. [1][2][3] The success has been due to factors that are addressed by the surgical procedure: the removal of the pathologic process; the decompression of the neural elements; the correction of sagittal balance; and the stabilization of the motion segment. Maintenance of sagittal balance and continued stabilization of the motion segment following anterior reconstruction is essential in obtaining a successful clinical outcome. Subsidence of an interbody graft or construct prior to bony fusion can be detrimental to sagittal balance and/or stabilization of the motion segment resulting in recurrent foraminal stenosis.Options available for reconstructing the anterior cervical column include a structural autograft, a structural allograft, a carbon fiber cage, a PEEK cage, a titanium mesh cage, or a trabecular metal spacer. Material properties and interface geometries vary, but the devices function similarly by providing mechanical integrity and stability to the construct while bony fusion takes place. Independent of the device, settling occurs following anterior interbody fusion, 4-6 the amount of which is affected by intraoperative endplate injury or removal, osteoporosis, and the cross-sectional area of the implant. 7,8 Obtaining contact between the endplate and implant surfaces is technically challenging, and a certain amount of settling occurs early post-operatively. With bony implants, additional settling occurs as the graft is resorbed prior to bone fusion. The amount of settling is often <1 mm. Other causes of post-op...

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“…However, despite of continuous improvements of both surgical techniques and implants, some postoperative complications still occur and cause long-term morbidity. Among them, subsidence of the implant into the vertebral endplate is relatively common and leads to gradual loss of anterior column height and cervical lordosis, loss of foraminal height, neuroforaminal stenosis, and recurrence of radiculopathy [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Sagittal geometry of the middle and lower cervical endplates

et al. 2013

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Purpose Construct subsidence is a relatively common complication following anterior cervical fusion. Its occurrence has been revealed to be closely related to endplateimplant contact interface. But current literature focusing on the anatomy of cervical endplate is very scarce. The purpose of this morphometric study was to analyse the sagittal geometry, especially the concavity and slope, of vertebral endplates from C3 to C7 by employing data from CT scans. Methods Reformatted CT scans of 97 individuals were analyzed and endplate concavity depth, endplate concavity apex location, as well as endplate slope were measured in midsagittal plane. Those specific parameters were compared among different age and gender groups. Meanwhile, comparison between superior and inferior endplate of each vertebra was also performed. Results Age and gender did not influence endplate concavity depth, endplate concavity apex location, or endplate slope significantly (P [ 0.05). Endplate concavity depths of superior endplates (range 0.9-1.2 mm) were significantly smaller than those of inferior endplates (range 2.1-2.7 mm). Endplate concavity apex was always located in the posterior half of the endplate, with the superior one ranged from 56 to 67 % and the inferior one 52 to 57 %. Average endplate slopes of superior endplates were between 4.5°and 9.0°, and average inferior endplate slopes ranged from 4.5°to 7.5°. Among all measured segments, C5 had the largest endplate slope values, while C7 the least. Conclusions Superior endplate is more flat than its inferior counterpart in middle and lower cervical spine, and the concavity apex is always located in the posterior half of the endplate. Endplate slope is correlated with cervical curvature, greater slope implying more significant lordosis. These sagittal endplate geometrical parameters should be taken into consideration when investigating implant subsidence following anterior cervical fusion.

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Maintenance of Interbody Space in One- and Two-Level Anterior Cervical Interbody Fusion

Cited by 76 publications

References 36 publications

Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Sagittal geometry of the middle and lower cervical endplates

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