Skip to main content
main-content

21.01.2017 | Original Article | Ausgabe 4/2017

European Spine Journal 4/2017

Cement-augmented screws in a cervical two-level corpectomy with anterior titanium mesh cage reconstruction: a biomechanical study

Zeitschrift:
European Spine Journal > Ausgabe 4/2017
Autoren:
Sebastian Hartmann, Claudius Thomé, Anja Tschugg, Johannes Paesold, Pujan Kavakebi, Werner Schmölz

Abstract

Study design

Biomechanical investigation.

Purpose

Cervical two-level corpectomies with anterior-only instrumentation are associated with a high rate of implant-related complications. These procedures, therefore, often require an additional dorsal instrumentation to prevent screw loosening. Cement augmentation of the anterior screws in two-level corpectomies might stabilize the construct, so that a second dorsal procedure could be avoided. To evaluate the screw anchorage in cervical anterior-only procedures, an ex vivo evaluation of the range of motion (ROM) in two-level corpectomies (C4 and C5), with and without cement augmentation of the anterior screws, was carried out in this study.

Methods

Twelve human cervical cadaveric spines (C2–T1) were divided into two groups of six specimens each. Corpectomies were performed in C4 and C5, with grafting and anterior instrumentation with and without cement augmentation of the anterior screw-and-plate system (0.3–0.5 mL cement/screw). Flexibility tests with pure moments (1.5 Nm) were carried out before and after three cyclic loading periods of 5000 cycles with increasing eccentric forces (100, 200, and 300 N).

Results

After corpectomy and instrumentation, the control group and the augmented group showed a significant reduction in ROM in comparison with the native states with average ROMs of 49% (±17%) and 24% (±10%), respectively (P = 0.006). The ROM in the control group increased significantly in all motion directions in the course of cyclic loading and approached native values after the third cyclic loading period, with an overall ROM of 78% (±22%). In contrast, the augmented group maintained a significantly decreased ROM in all motion directions during cyclic loading, with a final ROM of 32% (±14%) after the third period of cyclic testing. Inter-group comparison demonstrated a significant difference between the two groups in the course of cyclic loading. The cement-augmented group outperformed the control group in all motion directions, with a significantly lower ROM after all three cyclic loading periods.

Conclusions

A two-level corpectomy with cement-augmentation results in a significantly reduced ROM. In comparison with the conventional anterior screw-and-plate fixation, it represents a significantly stabilized two-level anterior construct. This might be a treatment option for patients with a two-level corpectomy associated with reduced bone mineral density, to avoid an additional dorsal instrumentation.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Weitere Produktempfehlungen anzeigen
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 4/2017

European Spine Journal 4/2017 Zur Ausgabe
  1. Das kostenlose Testabonnement läuft nach 14 Tagen automatisch und formlos aus. Dieses Abonnement kann nur einmal getestet werden.

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise