Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
Clin Biomech (Bristol). 2020 Aug;78:105078. doi: 10.1016/j.clinbiomech.2020.105078. Epub 2020 Jun 10.
Conditions requiring cervical decompression and stabilization are commonly treated using anterior cervical discectomy and fusion using an anterior cage-plate construct. Anterior zero profile integrated cages are an alternative to a cage-plate construct, but literature suggests they may result in less motion reduction. Interfacet cages may improve integrated cage stability. This study evaluated the motion reduction of integrated cages with and without supplemental interfacet fixation. Motion reduction of integrated cages were also compared to published cage-plate results.
Seven cadaveric (C2-T1) spines were tested in flexion-extension, lateral bending, and rotation. Specimens were tested: 1) intact, 2) C6-C7 integrated cage, 3) C6-C7 integrated cage + interfacet cages, 4) additional integrated cages at C3-C4 and C4-C5, 5) C3-C4, C4-C5 and C6-C7 integrated cages + interfacet cages. Motion, lordosis, disc and neuroforaminal height were assessed.
Integrated cage at C6-C7 decreased flexion-extension by 37% (P = .06) and C3-C5 by 54% (P < .01). Integrated + interfacet cages decreased motion by 89% and 86% compared to intact (P < .05). Integrated cages increased lordosis at C4-C5 and C6-C7 (P < .01). Integrated + interfacet cages returned C3-C5 lordosis to intact values, while C6-C7 remained more lordotic (P = .02). Compared to intact, neuroforaminal height increased after integrated cages at C3-C5 (P ≤ .01) and at all levels after interfacet cages (P < .01).
Anterior integrated cages provides less stability than traditional cage-plate constructs while supplemental interfacet cages improve stabilization. Integrated cages provide more lordosis at caudal levels and increase neuroforaminal height more at cranial levels. After interfacet cages, posterior disc height and neuroforaminal height increased more at the caudal segments.
需要颈椎减压和稳定的情况通常采用前路颈椎间盘切除融合术，使用前路笼板结构进行治疗。前路零切迹一体化笼是笼板结构的替代物，但文献表明，它可能导致更少的运动减少。关节突间笼可提高一体化笼的稳定性。本研究评估了带有和不带有附加关节突间固定的一体化笼的运动减少。还将一体化笼的运动减少与已发表的笼板结果进行了比较。
对 7 个颈椎（C2-T1）标本进行了屈伸、侧屈和旋转测试。标本分别进行了以下测试：1）完整，2）C6-C7 一体化笼，3）C6-C7 一体化笼+关节突间笼，4）C3-C4 和 C4-C5 增加一体化笼，5）C3-C4、C4-C5 和 C6-C7 一体化笼+关节突间笼。评估运动、前凸角、椎间盘和神经孔高度。
C6-C7 处的一体化笼使屈伸运动减少了 37%（P=0.06），C3-C5 处减少了 54%（P<0.01）。与完整标本相比，一体化+关节突间笼的运动减少了 89%和 86%（P<0.05）。一体化笼增加了 C4-C5 和 C6-C7 的前凸角（P<0.01）。一体化+关节突间笼使 C3-C5 的前凸角恢复到完整值，而 C6-C7 仍保持更前凸（P=0.02）。与完整标本相比，一体化笼在 C3-C5 处增加了神经孔高度（P≤0.01），在所有水平处增加了关节突间笼的神经孔高度（P<0.01）。
前路一体化笼的稳定性低于传统笼板结构，而附加关节突间笼可提高稳定性。一体化笼在尾端水平提供更多的前凸角，并在头端水平增加更多的神经孔高度。使用关节突间笼后，尾段的后椎间盘高度和神经孔高度增加更多。
