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

Authors

Bernardo de Pereira, Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Joshua E. Heller, Thomas Jefferson University, Philadelphia, PA, USA.
Jennifer N. Lehrman, Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.Follow
Anna G. Sawa, Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Brian P. Kelly, Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.Follow

Document Type

Article

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.

Keywords

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

Publication Date

3-1-2021

Publication Title

Neurospine

ISSN

2586-6583

Volume

18

Issue

1

First Page

188

Last Page

196

PubMed ID

33819945

Digital Object Identifier (DOI)

10.14245/ns.2040552.276

Recommended Citation

Pereira, Bernardo de; Heller, Joshua E.; Lehrman, Jennifer N.; Sawa, Anna G.; and Kelly, Brian P., "Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study" (2021). Translational Neuroscience. 1208.
https://scholar.barrowneuro.org/neurobiology/1208