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Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study

Neurospine 2021년 18권 1호 p.188 ~ 196
de Andrada Pereira Bernardo, Heller Joshua E., Lehrman Jennifer N., Sawa Anna G. U., Kelly Brian P.,
소속 상세정보
 ( de Andrada Pereira Bernardo ) - St. Joseph’s Hospital and Medical Center Barrow Neurological Institute
 ( Heller Joshua E. ) - Thomas Jefferson University
 ( Lehrman Jennifer N. ) - St. Joseph’s Hospital and Medical Center Barrow Neurological Institute
 ( Sawa Anna G. U. ) - St. Joseph’s Hospital and Medical Center Barrow Neurological Institute
 ( Kelly Brian P. ) - St. Joseph’s Hospital and Medical Center Barrow Neurological Institute

Abstract


Objective: Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.

Methods: Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2?7 cadaveric specimens intact and after discectomy (C3?6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance.

Results: All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3?6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion.

Conclusion: All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.

키워드

Spine; Rotation; Range of motion; Cadaver; Diskectomy; Allografts

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