Biomechanical Analysis of Biodegradable Cervical Plates Developed for Anterior Cervical Discectomy and Fusion

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Abstract

Study Design

In-vitro biomechanical investigation.

Purpose

To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels.

Overview of Literature

Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear.

Methods

A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4–C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5–C6 segment) and adjacent (C4–C5 segment) levels.

Results

The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models.

Conclusions

The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.

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Most cited references 28

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Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves.

T Oda, K Nibu, Shail Vasavada … (2001)

The mechanical properties of multilevel human cervical spines were investigated by applying pure rotational moments to each specimen and measuring multidirectional intervertebral motions. To document intervertebral main and coupled motions of the cervical spine in the form of load-displacement curves. Although a number of in vivo and in vitro studies have attempted to delineate normal movement patterns of the cervical spine, none has explored the complexity of the whole cervical spine as a three-dimensional structure. Sixteen human cadaveric specimens (C0-C7) were used for this study. Pure rotational moments of flexion-extension, bilateral axial torque, and bilateral lateral bending were applied using a specially designed loading fixture. The resulting intervertebral motions were recorded using stereophotogrammetry and depicted as a series of load-displacement curves. The resulting load-displacement curves were found to be nonlinear, and both rotation and translation motions were coupled with main motions. With flexion-extension moment loading, the greatest degree of flexion occurred at C1-C2 (12.3 degrees), whereas the greatest degree of extension was observed at C0-C1 (20.2 degrees). With axial moment loading, rotation at C1-C2 was the largest recorded (56.7 degrees). With lateral bending moments, the average range of motion for all vertebral levels was 7.9 degrees. The findings of the present study are relevant to the clinical practice of examining motions of the cervical spine in three dimensions and to the understanding of spinal trauma and degenerative diseases.

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Incidence of dysphagia after anterior cervical spine surgery: a prospective study.

Jung Yoo, Michael Lee, Rajesh Bazaz (2002)

A prospective longitudinal study was conducted to evaluate dysphagia after anterior cervical spine surgery. To evaluate the incidence and natural history of dysphagia after anterior cervical spine surgery, and to identify risk factors for the development of postoperative dysphagia. The literature contains only retrospective evaluations of postoperative dysphagia. A wide range of incidence has been reported in these studies. Altogether, 249 consecutive patients undergoing anterior cervical spine surgery were eligible for the study. These patients were contacted 1, 2, 6, and 12 months after the procedure to evaluate swallowing. Risk factors such as age, gender, procedure type, hardware use, and number and location of surgical levels addressed were assessed. Dysphagia incidences of 50.2%, 32.2%, 17.8%, and 12.5% were found at 1, 2, 6, and 12 months, respectively. At 6 months after the procedure, only 4.8% of the patients were experiencing moderate or severe dysphagia. Patient age, type of procedure (corpectomy vs. discectomy or primary vs. revision), hardware presence, and location of surgical levels were not statistically significant risk factors for the development of postoperative dysphagia. Female gender was significant for increased risk of dysphagia at 6 months. Surgery at multiple disc levels increased the risk of postoperative dysphagia at 1 and 2 months. The etiology of the dysphagia in most of the patients was unknown. However, vocal cord paresis was identified in 1.3% of the patients at 12 months. Dysphagia after anterior cervical spine surgery is a common early finding. However, it decreases significantly by 6 months. The minority of patients experience moderate or severe symptoms by 6 months after the procedure. Female gender and multiple surgical levels could be identified as risk factors for the development of postoperative dysphagia.

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Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment.

Anthony Frempong-Boadu, Latimer Kells, B Osborn … (2002)

Swallowing difficulties and dysphonia may occur in patients undergoing anterior cervical discectomy and fusion. The etiology and incidence of these abnormalities, however, are not well defined. In view of this, we performed a prospective, objective analysis of swallowing function and vocal cord approximation in patients undergoing anterior cervical discectomy and fusion. Twenty-three consecutive patients (22 male and one female, mean age 59 years) undergoing anterior cervical discectomy and fusion had standardized modified barium swallow study and videolaryngoendoscopy performed preoperatively and again at 1 week and 1 month postoperatively. Eleven patients (48%) had radiographic evidence of preoperative swallowing abnormalities. The majority of these patients had myelopathic rather than radicular findings (p = 0.03). None, however, had symptoms of swallowing dysfunction. Among these patients, one had worse function postoperatively, three had improvement, and function remained unchanged in seven. The preoperative swallowing assessment was normal in 12 patients (52%). Postoperative radiographic swallowing abnormalities were demonstrated in eight of these patients (67%). Preoperative vocal cord movement was normal in all patients. Postoperatively, vocal cord paresis was detected in two patients. The paresis was transient in one and permanent in the other. Age, previous medical history, operation duration, and spinal level decompressed were not significantly associated with the incidence of swallowing dysfunction. There was, however, a tendency for patients undergoing multilevel surgery to demonstrate an increased incidence of swallowing abnormalities on postoperative radiographic studies. In addition, soft tissue swelling was more frequent in patients whose swallowing function was worse postoperatively (p = 0.007). Postoperative voice and swallowing dysfunction are common complications of anterior cervical discectomy and fusion, although in the majority of patients these abnormalities are not symptomatic. Patients undergoing multilevel procedures are at an increased risk for these complications, in part because of soft tissue swelling in the neck.

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Author and article information

Journal

Journal ID (nlm-ta): Asian Spine J

Journal ID (iso-abbrev): Asian Spine J

Journal ID (publisher-id): ASJ

Title: Asian Spine Journal

Publisher: Korean Society of Spine Surgery

ISSN (Print): 1976-1902

ISSN (Electronic): 1976-7846

Publication date (Print): December 2018

Publication date (Electronic): 16 October 2018

Volume: 12

Issue: 6

Pages: 1092-1099

Affiliations

[1 ]Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea

[2 ]Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

[3 ]Department of Neurosurgery, Yonsei Barun Hospital, Seoul, Korea

Author notes

Corresponding author: Dong Ah Shin Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2150, Fax: +82-2-393-9979, E-mail: cistern@ 123456yuhs.ac

Article

Publisher ID: asj-2018-12-6-1092

DOI: 10.31616/asj.2018.12.6.1092

PMC ID: 6284132

PubMed ID: 30322246

SO-VID: e4063d92-5ad7-4234-a207-7eed5f59b031

License:

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/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 January 2018

Date revision received : 4 March 2018

Date accepted : 17 April 2018

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Biomechanical Analysis of Biodegradable Cervical Plates Developed for Anterior Cervical Discectomy and Fusion

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Abstract

Study Design

Purpose

Overview of Literature

Methods

Results

Conclusions

Related collections

Orthopedics

Most cited references 28

Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves.

Incidence of dysphagia after anterior cervical spine surgery: a prospective study.

Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment.

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Article

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Comments

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Cited by 4

Most referenced authors 316