Preliminary results in anterior cervical discectomy and fusion with the uncovertebral joint fusion cage in a goat model

Shen, Yanchang; Yang, Yi; Líu, Hao; Wu, Tingkui; Ma, Litai; Chen, Lin; Hu, Lidan; Ding, Chen; Xiao, Rong; Wang, Beiyu; Meng, Yang; Hong, Ying

doi:10.1186/s12891-021-04412-4

Cited by 5 publications

(7 citation statements)

References 37 publications

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“…As the target fusion area was different between the 2 groups in this trial, we adopted the definition of fusion as "interspinous mobility of £1 mm and formation of a bone bridge in the target area," which evaluated both the local fusion and stability of the operatively treated segment. In a previous goat study 21 , the UJF fusion rate was much higher than the ESF fusion rate at 12 and 24 weeks postoperatively. Micro-CT and bone tissue analysis revealed that osteogenesis in the uncovertebral joint was greater than that in the end-plate space 21 .…”

Section: Discussionmentioning

confidence: 64%

“…In a previous goat study 21 , the UJF fusion rate was much higher than the ESF fusion rate at 12 and 24 weeks postoperatively. Micro-CT and bone tissue analysis revealed that osteogenesis in the uncovertebral joint was greater than that in the end-plate space 21 . The goat cervical spine resembles the human cervical spine anatomically, making it suitable for spine-related research [29][30][31] .…”

Section: Discussionmentioning

confidence: 64%

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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: 64%

Section: Discussionmentioning

confidence: 64%

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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“…Therefore, it is necessary to adopt a more rational and individual approach in estimating the maximum stress to failure loads, and we aim to perform relevant targeted optimizations in future studies. In our previous goat model research (Shen et al, 2021), no screw loosening, screw breakage, cage displacement, or subsidence was observed for the uncovertebral joint fusion cage during the 6 months of follow-up. In our prospective, randomized, controlled trial study, there were no cage subsidence and displacement, screw loosening, and fracture in the uncovertebral joint fusion cage group during the 6-month follow-up.…”

Section: Cage Subsidencementioning

confidence: 72%

“…Therefore, we postulated that uncovertebral joint fusion might have potential advantages in cervical spine interbody fusion and designed a novel uncovertebral joint fusion cage. In our previous goat model research ( Shen et al, 2021 ), 75.0% (9/12) of the goats in the uncovertebral joint fusion cage group were evaluated as achieving fusion at 12 weeks when compared to 41.7% (5/12) in the non-profile cage group. Additionally, the fusion grading scores of the uncovertebral joint fusion cage group were significantly higher than those of the non-profile cage group, both at 12 and 24 weeks ( p < 0.05), without increasing serious complications during the 6 months of follow-up.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Yang²,

Shen³

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.

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“…Although no significant difference was observed in the fusion rate at 12 months, their results showed that fusion rates at 3 and 6 months after ACDF were much higher in the UJF group than in the ESF group (UJF versus ESF: 66.7% versus 13.2% at 3 months, 94.1% versus 66.7% at 6 months). Based on a previously published goat study 3 , the authors speculated that the reasons for these results were due to several factors. The uncovertebral joint had several anatomical advantages over ESF: a narrower gap, higher mechanical load, better osteogenic potential, and better blood supply, which could be advantageous for earlier cervical fusion.…”

Section: Commentarymentioning

confidence: 99%

Value of “Early Fusion”: Is Faster Fusion Beneficial for Patients Undergoing Anterior Cervical Decompression and Fusion?

Togawa

2023

Journal of Bone and Joint Surgery

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Since the first reports of ventral approaches to cervical disc pathology were introduced in the 1950s 1,2 , anterior cervical discectomy and fusion (ACDF) has become one of the most common procedures performed by spine surgeons for patients with symptomatic cervical spondylosis. A solid osseous fusion is necessary to achieve good clinical results. Spine surgeons have been trying to modify their own procedures using a variety of interbody fusion materials, such as structural autograft, allograft, titanium, polyetheretherketone (PEEK), or carbon fiber-reinforced polymer, with or without non-structural autograft or allograft. Although a number of clinical investigations have been performed evaluating how to achieve solid fusion, attention has not been focused on the time to fusion.Sheng et al. performed a prospective randomized controlled trial (RCT) and showed that cervical fusion could be achieved earlier after uncovertebral joint fusion (UJF) compared with end plate space fusion (ESF) for patients with single-level cervical spondylosis. Although no significant difference was observed in the fusion rate at 12 months, their results showed that fusion rates at 3 and 6 months after ACDF were much higher in the UJF group than in the ESF group (UJF versus ESF: 66.7% versus 13.2% at 3 months, 94.1% versus 66.7% at 6 months). Based on a previously published goat study 3 , the authors speculated that the reasons for these results were due to several factors. The uncovertebral joint had several anatomical advantages over ESF: a narrower gap, higher mechanical load, better osteogenic potential, and better blood supply, which could be advantageous for earlier cervical fusion. If early fusion can be achieved by UJF in ACDF, it may be possible to avoid issues with prolonged cervical bracing, such as cervical stiffness, dysphagia, and pressure ulcer, and to increase patient satisfaction and quality of life. It is also beneficial, especially for active patients (athletes), to return to play faster. Thus, the authors propose a new concept that the UJF can provide advantages over conventional ESF for the ACDF procedure.On the other hand, it is well known that the spinal fusion rate is dependent on the radiographic fusion criteria. Although Sheng et al. used relatively strict fusion criteria (both "interspinous mobility of £1 mm and formation of a bone bridge in the target area" confirmed by computed tomography [CT] had to be met simultaneously), a recent systematic literature review of osseous fusion after anterior cervical discectomy identified fusion rates for ESF of 51.1% at 3 months and 78.3% at 6 months, which are higher than those in the study by Sheng et al. (13.2% at 3 months and 66.7% at 6 months) 4 . Although the study was a prospective RCT, it was performed in a single center. It is still unclear whether the early fusion can be achieved when different spine surgeons are conducting the procedure using this new device in the same manner. Different surgical exposure, different graft materials, and/or different implant bed...

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Preliminary results in anterior cervical discectomy and fusion with the uncovertebral joint fusion cage in a goat model

Cited by 5 publications

References 37 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 performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Value of “Early Fusion”: Is Faster Fusion Beneficial for Patients Undergoing Anterior Cervical Decompression and Fusion?

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