Murphy Timothy P, Tran Jeremy D, Colantonio Donald F, Le Anthony H, Fredericks Donald R, Roach William B, Chung Joon, Pisano Alfred J, Wagner Scott C, Helgeson Melvin D
Department of Orthopaedics, Walter Reed National Military Medical Center.
Department of Surgery, Uniformed Services University of the Health Sciences.
Clin Spine Surg. 2025 Feb 1;38(1):E1-E6. doi: 10.1097/BSD.0000000000001630. Epub 2024 Apr 23.
Cadaveric, biomechanic study.
To compare the range of motion profiles of the cervical spine following one-level anterior cervical discectomy and fusion (ACDF) constructs instrumented with either an interbody cage and anterior plate or integrated fixation cage in a cadaveric model.
While anterior plates with interbody cages are the most common construct of fixation in ACDF, newer integrated cage-plate devices seek to provide similar stability with a decreased implant profile. However, differences in postoperative cervical range of motion between the 2 constructs remain unclear.
Six cadaveric spines were segmented into 2 functional spine units (FSUs): C2-C5 and C6-T2. Each FSU was nondestructively bent in flexion-extension (FE), right-left lateral bending (LB), and right-left axial rotation (AR) at a rate of 0.5°/s under a constant axial load until a limit of 2-Nm was reached to evaluate baseline range of motion (ROM). Matched pairs were then randomly assigned to undergo instrumentation with either the standard anterior cage and plate (CP) or the integrated fixation cage (IF). Following instrumentation, ROM was then remeasured as previously described.
For CP fixation, ROM increased by 61.2±31.7% for FE, 36.3±20.4% for LB, and 31.7±19.1% for AR. For IF fixation, ROM increased by 64.2±15.5% for FE, 56.7±39.8% for LB, and 94.5±65.1% for AR. There was no significant difference in motion between each group across FE, LB, and AR.
This biomechanical study demonstrated increased motion in both the CP and IF groups relative to the intact, un-instrumented state. However, our model showed no differences in ROM between CP and IF constructs in any direction of motion. These results suggest that either method of instrumentation is a suitable option for ACDF with respect to constructing stiffness at time zero.
尸体生物力学研究。
在尸体模型中比较采用椎间融合器和前路钢板或一体化固定融合器进行单节段颈椎间盘切除融合术（ACDF）后颈椎的活动度情况。
虽然椎间融合器加前路钢板是ACDF中最常用的固定方式，但新型的一体化融合器-钢板装置试图在减少植入物外形的情况下提供相似的稳定性。然而，这两种固定方式术后颈椎活动度的差异仍不明确。
将6具尸体脊柱分成2个功能脊柱单元（FSUs）：C2-C5和C6-T2。每个FSU在恒定轴向载荷下以0.5°/秒的速度在屈伸（FE）、左右侧屈（LB）和左右轴向旋转（AR）方向进行无损弯曲，直至达到2牛米的极限，以评估基线活动度（ROM）。然后将配对的样本随机分配接受标准前路融合器和钢板（CP）或一体化固定融合器（IF）植入。植入后，按照之前描述的方法重新测量ROM。
对于CP固定，FE方向ROM增加61.2±31.7%，LB方向增加36.3±20.4%，AR方向增加31.7±19.1%。对于IF固定，FE方向ROM增加64.2±15.5%，LB方向增加56.7±39.8%，AR方向增加94.5±65.1%。在FE、LB和AR方向上，两组之间的活动度没有显著差异。
这项生物力学研究表明，相对于完整、未植入的状态，CP组和IF组的活动度均增加。然而，我们的模型显示，在任何运动方向上，CP和IF固定方式之间的ROM没有差异。这些结果表明，就初始构建刚度而言，这两种植入方法都是ACDF的合适选择。
