Biomechanical evaluation of a low profile, anchored cervical interbody spacer device in the setting of progressive flexion-distraction injury of the cervical spine Journal Article

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Authors: Wojewnik, B; Ghanayem, A. J.; Tsitsopoulos, P. P.; Voronov, L. I.; Potluri, T.; Havey, R. M.; Zelenakova, J.; Patel, A. A.; Carandang, G; Patwardhan, A. G.
Article Title: Biomechanical evaluation of a low profile, anchored cervical interbody spacer device in the setting of progressive flexion-distraction injury of the cervical spine
Abstract: INTRODUCTION: Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity. METHODS: Thirteen human cadaveric subaxial cervical spines (C3-C7) were tested at C5-C6 in flexion-extension, lateral bending and axial rotation in the load-control mode under +/-1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5-C6. RESULTS: The anchored spacer device with locked screw configuration significantly reduced C5-C6 flexion-extension (FE) motion from 14.8 +/- 4.2 to 3.9 +/- 1.8 degrees , lateral bending (LB) from 10.3 +/- 2.0 to 1.6 +/- 0.8, and axial rotation (AR) from 11.0 +/- 2.4 to 2.5 +/- 0.8 compared with intact under (p 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5-C6 FE motion from 10.7 +/- 1.7 to 5.5 +/- 2.5 degrees , LB from 8.3 +/- 1.4 to 2.7 +/- 1.0, and AR from 8.8 +/- 2.7 to 4.6 +/- 1.3 compared with intact (p 0.01). The ROM of the C5-C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 +/- 2.1 in FE, 2.0 +/- 1.1 in LB, and 3.3 +/- 1.4 in AR. Conversely, the ROM of the C5-C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 +/- 4.5 in FE, 5.0 +/- 1.6 in LB, and 9.5 +/- 4.6 in AR. CONCLUSIONS: The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion-distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries.
Journal Title: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Volume: 22
Issue: 1
ISSN: 1432-0932; 0940-6719
Publisher: Unknown  
Journal Place: Germany
Date Published: 2013
Start Page: 135
End Page: 141
Language: eng
DOI/URL:

10.1007/s00586-012-2446-1

10.1007/s00586-012-2446-1
Notes: ID: 13181; JID: 9301980; OID: NLM: PMC3540297 [Available on 01/01/14]; PMCR: 2014/01/01 00:00; 2012/02/22 [received]; 2012/07/13 [accepted]; 2012/04/30 [revised]; 2012/08/01 [aheadofprint]; ppublish