scholarly journals Anterior Cervical Discectomy, Corpectomy with MRI Compatible Titanium Plate and Screw Fixation Under Neurophysiological Monitoring, Experience of 27 Years

2022 ◽  
pp. 320-326
Author(s):  
PK Upadhyay ◽  
G Tiwary ◽  
K Upadhyay ◽  
Kritika U
Keyword(s):  
Screw Fixation ◽  
Anterior Cervical Discectomy ◽  
Neurophysiological Monitoring ◽  
Titanium Plate ◽  
Cervical Discectomy

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

2014 ◽  
Vol 20 (5) ◽  
pp. 485-491 ◽  
Author(s):  
Vincent C. Traynelis ◽  
Jonathan Sherman ◽  
Eric Nottmeier ◽  
Vaneet Singh ◽  
Kirk McGilvray ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Clinical Success ◽  
Axial Rotation ◽  
Anterior Cervical Discectomy ◽  
Screw Placement ◽  
Success Rates ◽  
Lateral Bending ◽  
Cervical Discectomy ◽  
Flexion Extension ◽  
Standard Plate

Object The clinical success rates of anterior cervical discectomy and fusion (ACDF) procedures are substantially reduced as more cervical levels are included in the fusion procedure. One method that has been proposed as an adjunctive technique for multilevel ACDF is the placement of screws across the facet joints (“transfacet screws”). However, the biomechanical stability imparted by transfacet screw placement (either unilaterally or bilaterally) has not been reported. Therefore, the purpose of this study was to determine the acute stability conferred by implementation of unilateral and bilateral transfacet screws to an ACDF construct. Methods Eight C2–T1 fresh-frozen human cadaveric spines (3 female and 5 male; mean age 50 years) were tested. Three different instrumentation variants were performed on cadaveric cervical spines across C4–7: 1) ACDF with an intervertebral spacer and standard plate/screw instrumentation; 2) ACDF with an intervertebral spacer and standard plate/screw instrumentation with unilateral facet screw placement; and 3) ACDF with an intervertebral spacer and standard plate/screw instrumentation with bilateral facet screw placement. Kinetic ranges of motion in flexion-extension, lateral bending, and axial rotation at 1.5 Nm were captured after each of these procedures and were statistically analyzed for significance. Results All 3 fixation scenarios produced statistically significant reductions (p < 0.05) in all 3 bending planes compared with the intact condition. The addition of a unilateral facet screw to the ACDF construct produced significant reductions at the C4–5 and C6–7 levels in lateral bending and axial rotation but not in flexion-extension motion. Bilateral facet screw fixation did not produce any statistically significant decreases in flexion-extension motion compared with unilateral facet screw fixation. However, in lateral bending, significant reductions at the C4–5 and C5–6 levels were observed with the addition of a second facet screw. The untreated, adjacent levels (C2–3, C3–4, and C7–1) did not demonstrate significant differences in range of motion. Conclusions The data demonstrated that adjunctive unilateral facet screw fixation to an ACDF construct provides significant gains in stability and should be considered a potential option for increasing the likelihood for obtaining a successful arthrodesis for multilevel ACDF procedures.

scholarly journals Biomechanical Effect of Plate-to-Disc Distance on Surgical and Adjacent Segment in C5/C6 Anterior Cervical Discectomy and Fusion - A Finite Element Analysis

2020 ◽  
Author(s):  
Yuan Xue ◽  
Xing Guo ◽  
Jiaming Zhou ◽  
Yueyang Tian ◽  
Liang Kang
Keyword(s):  
Finite Element ◽  
Intervertebral Disc ◽  
Bone Graft ◽  
Anterior Cervical Discectomy ◽  
Von Mises Stress ◽  
Adjacent Segment ◽  
Titanium Plate ◽  
Cervical Discectomy ◽  
Cage Subsidence ◽  
Biomechanical Effect

Abstract Background: The PDD is an important factor affecting the degeneration of adjacent segments after ACDF. However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different Plate-to-Disc Distance (PDD) on surgical segment and adjacent segment following C5/C6 anterior cervical discectomy and fusion (ACDF). Methods: We constructed 10 preoperative finite element models (FEM) of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of Plate-to-Disc titanium plates: L, long PDD (10 mm); S, short PDD (0 mm); and N, PDD (5 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed.Results: The von Mises stress of C4/C5 and C6/C7 intervertebral discs have no significant differences (P>0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions: The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, that may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.

scholarly journals Biomechanical Comparison of a New Memory Compression Alloy Plate versus Traditional Titanium Plate for Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jiantao Liu ◽  
Runqing Wang ◽  
Hongbo Wang ◽  
Yanbiao Wang ◽  
Dongbo Lv ◽  
...  
Keyword(s):  
Finite Element ◽  
Anterior Cervical Discectomy ◽  
Plate Versus ◽  
Segmental Motion ◽  
Titanium Plate ◽  
Alloy Plate ◽  
Cervical Discectomy ◽  
Memory Compression ◽  
Flexion Extension ◽  
The Impact

Objective. To compare the biomechanical properties of a new memory compression alloy plate and traditional titanium plate after anterior cervical discectomy and fusion (ACDF). Methods. A finite element model of the C3-7 segments was developed and validated. The C5-6 disc was removed, and an intervertebral cage made of peek material was implanted. Then, a new memory compression alloy plate composed of Ti-Ni memory alloy and a traditional titanium plate were integrated at the C5-6 segment. All models were subjected to a load of 73.6 N to simulate the head weight and 1 Nm of flexion-extension, lateral bending, and axial rotation. The range of segmental motion (ROM) and stress on the prostheses, adjacent discs, and endplates were analyzed. Results. Compared with intact status, ACDF with the new prothesis and traditional titanium plate reduced the ROM of C5-6 in six directions by 95.2%-100% and increased that of adjacent discs (C4-5 and C6-7) by 4.8%-112.5%. Adjacent disc stress peaks were higher for the traditional titanium plate (0.7-4.2 MPa) than for the new prosthesis (0.6-4.1 MPa). Endplate stress peaks were the highest in ACDF with the new prosthesis (15.6-53.3 MPa), followed by ACDF with traditional titanium plate (5.0-29.4 MPa). Stress peaks were significantly lower for the new prothesis (12.8-52.3 MPa) than for the traditional titanium plate (397.0-666.1 MPa). Conclusions. The new prosthesis improved the immediate stability of the surgical site and had an elastic modulus that was smaller than that of traditional titanium plate, making it conducive to reducing stress shielding and the impact on the adjacent intervertebral disc.

scholarly journals Surgical anatomy of microsurgical 3-level anterior cervical discectomy and fusion C4–C7

2020 ◽  
Author(s):  
Domagoj Gajski ◽  
Alicia R. Dennis ◽  
Kenan I. Arnautovic
Keyword(s):  
Perioperative Complications ◽  
Surgical Anatomy ◽  
Upper Extremities ◽  
Anterior Cervical Discectomy ◽  
Microsurgical Anatomy ◽  
Titanium Plate ◽  
Cervical Discectomy ◽  
Bone Allografts ◽  
Upper And Lower Extremities ◽  
Previously Treated

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, frequently used for the treatment of cervical spine degenerative diseases. It was first described in 1958 [1,2]. Interestingly, to our knowledge, 3-level ACDF has not been previously published as a peer-reviewed video case with detailed description of intraoperative microsurgical anatomy [3-7]. In this video, we present the case of a 33-year-old male who presented with a combination of myelopathy (hyperreflexia and long tract signs in the upper and lower extremities) and bilateral radiculopathy of the upper extremities. He had been previously treated conservatively with physical therapy and pain management for 6 months without success. We performed 3-level microsurgical ACDF from C4 to C7. All 3 levels were decompressed, and bone allografts were placed to achieve intervertebral body fusion. A titanium plate was utilized from C4 to C7 for internal fixation. The patient was discharged home on the first postoperative day. His pain, numbness and tingling resolved, as well as his myelopathy. No perioperative complications were encountered. Herein we present the surgical anatomy of our operative technique including certain technical tips. Written consent was obtained directly from the patient.VIDEO ANNOTATIONS01:13 — opening the surgery site02:29 — positioning of retractors03:02 — start of 3-level discectomy06:04 — allograft placement and fixation08:20 — drain placement and closure

Investigating the utility of intraoperative neurophysiological monitoring for anterior cervical discectomy and fusion: analysis of over 140,000 cases from the National (Nationwide) Inpatient Sample data set

2019 ◽  
Vol 31 (1) ◽  
pp. 76-86 ◽  
Author(s):  
Jetan H. Badhiwala ◽  
Farshad Nassiri ◽  
Christopher D. Witiw ◽  
Alireza Mansouri ◽  
Saleh A. Almenawer ◽  
...  
Keyword(s):  
Propensity Score ◽  
Nationwide Inpatient Sample ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Anterior Cervical Discectomy ◽  
Hospital Charges ◽  
Neurophysiological Monitoring ◽  
Matched Cohort ◽  
Cervical Discectomy ◽  
Multilevel Fusion

OBJECTIVEIntraoperative neurophysiological monitoring (IONM) is a useful adjunct in spine surgery, with proven benefit in scoliosis-correction surgery. However, its utility for anterior cervical discectomy and fusion (ACDF) is unclear, as there are few head-to-head comparisons of ACDF outcomes with and without the use of IONM. The authors sought to evaluate the impact of IONM on the safety and cost of ACDF.METHODSThis was a retrospective analysis of data from the National (Nationwide) Inpatient Sample of the Healthcare Cost and Utilization Project from 2009 to 2013. Patients with a primary procedure code for ACDF were identified, and diagnosis codes were searched to identify cases with postoperative neurological complications. The authors performed univariate and multivariate logistic regression for postoperative neurological complications with use of IONM as the independent variable; additional covariates included age, sex, surgical indication, multilevel fusion, Charlson Comorbidity Index (CCI) score, and admission type. They also conducted propensity score matching in a 1:1 ratio (nearest neighbor) with the use of IONM as the treatment indicator and the aforementioned variables as covariates. In the propensity score–matched cohort, they compared neurological complications, length of stay (LOS), and hospital charges (in US dollars).RESULTSA total of 141,007 ACDF operations were identified. IONM was used in 9540 cases (6.8%). No significant association was found between neurological complications and use of IONM on univariate analysis (OR 0.80, p = 0.39) or multivariate regression (OR 0.82, p = 0.45). By contrast, age ≥ 65 years, multilevel fusion, CCI score > 0, and a nonelective admission were associated with greater incidence of neurological complication. The propensity score–matched cohort consisted of 18,760 patients who underwent ACDF with (n = 9380) or without (n = 9380) IONM. Rates of neurological complication were comparable between IONM and non-IONM (0.17% vs 0.22%, p = 0.41) groups. IONM and non-IONM groups had a comparable proportion of patients with LOS ≥ 2 days (19% vs 18%, p = 0.15). The use of IONM was associated with an additional $6843 (p < 0.01) in hospital charges.CONCLUSIONSThe use of IONM was not associated with a reduced rate of neurological complications following ACDF. Limitations of the data source precluded a specific assessment of the effectiveness of IONM in preventing neurological complications in patients with more complex pathology (i.e., ossification of the posterior longitudinal ligament or cervical deformity).

scholarly journals The Effect of Bi-Cortical Screw Fixation for Subsidence and Cervical Alignment in Patients Undergoing Single-Level Anterior Cervical Discectomy and Fusion

The Nerve ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. 41-48
Author(s):  
Woong Han ◽  
Byoung Gwan Moon ◽  
Deok Ryeong Kim ◽  
Jae Hoon Kim ◽  
Hee In Kang ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Cervical Alignment ◽  
Single Level ◽  
Cortical Screw

scholarly journals Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xing Guo ◽  
Jiaming Zhou ◽  
Yueyang Tian ◽  
Liang Kang ◽  
Yuan Xue
Keyword(s):  
Finite Element ◽  
Intervertebral Disc ◽  
Bone Graft ◽  
Anterior Cervical Discectomy ◽  
Von Mises Stress ◽  
Adjacent Segment ◽  
Titanium Plate ◽  
Cervical Discectomy ◽  
Cage Subsidence ◽  
Biomechanical Effect

Abstract Background The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF. Methods We constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed. Results The von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.

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