Journal article
Biomechanical evaluation comparing zero-profile devices versus fixed profile systems in a cervical hybrid decompression model: a biomechanical in vitro study
SPINE JOURNAL, v 20(4), pp 657-664
Apr 2020
PMID: 31634616
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND CONTEXT: The use of zero-profile devices and the need for posterior fixation in conjunction with a cervical hybrid decompression model have yet to be investigated. PURPOSE: To compare the biomechanics of zero-profile and fixed profile cervical hybrid constructs composed of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). Fixed profile devices included anterior plating, whereas zero-profile devices included integrated screws. STUDY DESIGN: In vitro cadaveric biomechanical study. METHODS: Twelve fresh-frozen cadaveric spines (C2-C7) were divided into two groups of equal bone mineral density, fixed profile versus zero profile (n=6). Groups were instrumented from C3-C6 with either (1) an expandable ACCF device and a static ACDF spacer with an anterior plate (Hybrid-AP) or (2) a zero-profile ACCF spacer with adjacent zero-profile ACDF spacer (HybridZ). Motion was captured for the (1) intact condition, (2) a hybrid model with lateral mass screws (LMS), (3) a hybrid model without LMS, and (4) a hybrid model without LMS following simulated repetitive loading (fatigue). RESULTS: Hybrid-AP with LMS reduced motion in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) by 77%, 88%, and 82%, respectively, compared with intact. Likewise, Hybrid-Z with LMS exhibited the greatest reduction in motion relative to intact in FE, LB, and AR by 90%, 95%, and 66%, respectively. Following simulated in vivo fatiguing, an increase in motion was observed for both groups in all planes, particularly during Hybrid-Z postfatigue condition where motion increased relative to intact by 29%. Overall, biomechanical equivalency was observed between Hybrid-AP and Hybrid-Z groups (p>.05). Three (50%) of the Hybrid-Z group specimens exhibited signs of implant migration from the inferior endplate during testing. CONCLUSIONS: Fixed profile systems using an anterior plate for supplemental fixation is biomechanically more favorable to maintain stability and prevent dislodgement. Dislodgement of 50% of the Hybrid-Z group without LMS emphasizes the necessity for posterior fixation in a zero-profile cervical hybrid decompression model. (C) 2019 Elsevier Inc. All rights reserved.
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Details
- Title
- Biomechanical evaluation comparing zero-profile devices versus fixed profile systems in a cervical hybrid decompression model: a biomechanical in vitro study
- Publication Details
- SPINE JOURNAL, v 20(4), pp 657-664
- Publisher
- ELSEVIER SCIENCE INC; NEW YORK
- Number of pages
- 0
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000523189900017
- Scopus ID
- 2-s2.0-85075379507
- Other Identifier
- 991021860683804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Orthopedics