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Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion
STUDY DESIGN: This study compares four cervical endplate removal procedures, validated by finite element models. PURPOSE: To characterize the effect of biomechanical strength and increased contact area on the maximum von Mises stress, migration, and subsidence between the cancellous bone, endplate,...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Society of Spine Surgery
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633244/ https://www.ncbi.nlm.nih.gov/pubmed/35263829 http://dx.doi.org/10.31616/asj.2021.0424 |
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author | Lin, Maohua Paul, Rudy Shapiro, Stephen Z. Doulgeris, James O’Connor, Timothy E. Tsai, Chi-Tay Vrionis, Frank D. |
author_facet | Lin, Maohua Paul, Rudy Shapiro, Stephen Z. Doulgeris, James O’Connor, Timothy E. Tsai, Chi-Tay Vrionis, Frank D. |
author_sort | Lin, Maohua |
collection | PubMed |
description | STUDY DESIGN: This study compares four cervical endplate removal procedures, validated by finite element models. PURPOSE: To characterize the effect of biomechanical strength and increased contact area on the maximum von Mises stress, migration, and subsidence between the cancellous bone, endplate, and implanted cage. OVERVIEW OF LITERATURE: Anterior cervical discectomy and fusion (ACDF) has been widely used for treating patients with degenerative spondylosis. However, no direct correlations have been drawn that incorporate the impact of the contact area between the cage and the vertebra/endplate. METHODS: Model 1 (M1) was an intact C2C6 model with a 0.5 mm endplate. In model 2 (M2), a cage was implanted after removal of the C4–C5 and C5–C6 discs with preservation of the osseous endplate. In model 3 (M3), 1 mm of the osseous endplate was removed at the upper endplate. Model 4 (M4) resembles M3, except that 3 mm of the osseous endplate was removed. RESULTS: The range of motion (ROM) at C2C6 in the M2–M4 models was reduced by at least 9° compared to the M1 model. The von Mises stress results in the C2C3 and C3C4 interbody discs were significantly smaller in the M1 model and slightly increased in the M2–M3 and M3–M4 models. Migration and subsidence decreased from the M2–M3 model, whereas further endplate removal increased the migration and subsidence as shown in the transition from M3 to M4. CONCLUSIONS: The M3 model had the least subsidence and migration. The ROM was higher in the M3 model than the M2 and M4 models. Endplate preparation created small stress differences in the healthy intervertebral discs above the ACDF site. A 1 mm embedding depth created the best balance of mechanical strength and contact area, resulting in the most favorable stability of the construct. |
format | Online Article Text |
id | pubmed-9633244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Korean Society of Spine Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-96332442022-11-14 Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion Lin, Maohua Paul, Rudy Shapiro, Stephen Z. Doulgeris, James O’Connor, Timothy E. Tsai, Chi-Tay Vrionis, Frank D. Asian Spine J Basic Study STUDY DESIGN: This study compares four cervical endplate removal procedures, validated by finite element models. PURPOSE: To characterize the effect of biomechanical strength and increased contact area on the maximum von Mises stress, migration, and subsidence between the cancellous bone, endplate, and implanted cage. OVERVIEW OF LITERATURE: Anterior cervical discectomy and fusion (ACDF) has been widely used for treating patients with degenerative spondylosis. However, no direct correlations have been drawn that incorporate the impact of the contact area between the cage and the vertebra/endplate. METHODS: Model 1 (M1) was an intact C2C6 model with a 0.5 mm endplate. In model 2 (M2), a cage was implanted after removal of the C4–C5 and C5–C6 discs with preservation of the osseous endplate. In model 3 (M3), 1 mm of the osseous endplate was removed at the upper endplate. Model 4 (M4) resembles M3, except that 3 mm of the osseous endplate was removed. RESULTS: The range of motion (ROM) at C2C6 in the M2–M4 models was reduced by at least 9° compared to the M1 model. The von Mises stress results in the C2C3 and C3C4 interbody discs were significantly smaller in the M1 model and slightly increased in the M2–M3 and M3–M4 models. Migration and subsidence decreased from the M2–M3 model, whereas further endplate removal increased the migration and subsidence as shown in the transition from M3 to M4. CONCLUSIONS: The M3 model had the least subsidence and migration. The ROM was higher in the M3 model than the M2 and M4 models. Endplate preparation created small stress differences in the healthy intervertebral discs above the ACDF site. A 1 mm embedding depth created the best balance of mechanical strength and contact area, resulting in the most favorable stability of the construct. Korean Society of Spine Surgery 2022-10 2022-03-11 /pmc/articles/PMC9633244/ /pubmed/35263829 http://dx.doi.org/10.31616/asj.2021.0424 Text en Copyright © 2022 by Korean Society of Spine Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Basic Study Lin, Maohua Paul, Rudy Shapiro, Stephen Z. Doulgeris, James O’Connor, Timothy E. Tsai, Chi-Tay Vrionis, Frank D. Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title | Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title_full | Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title_fullStr | Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title_full_unstemmed | Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title_short | Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion |
title_sort | biomechanical study of cervical endplate removal on subsidence and migration in multilevel anterior cervical discectomy and fusion |
topic | Basic Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633244/ https://www.ncbi.nlm.nih.gov/pubmed/35263829 http://dx.doi.org/10.31616/asj.2021.0424 |
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