Biomechanical Evaluation of a Novel Total Cervical Prosthesis in a Single-Level Cervical Subtotal Corpectomy Model: An In Vitro Human Cadaveric Study

• Published in: The Journal of surgical research 2012-06, Vol.175 (1), p.76-81
• Main Authors: Wu, Zi-xiang, M.D, Han, Bao-jun, M.M, Zhao, Xiong, M.M, Kong, Liang, M.D, Liu, Da, M.D, Cui, Gene, M.D, Lei, Wei, M.D
• Format: Article
• Language: English
• Subjects: anterior cervical plating; Biomechanical Phenomena; biomechanics; Bone Plates; Cadaver; cervical spine; cervical subtotal corpectomy; Cervical Vertebrae - physiopathology; Cervical Vertebrae - surgery; Decompression, Surgical; Humans; instrumentation; Prostheses and Implants; Prosthesis Implantation; range of motion; Range of Motion, Articular; Spinal Cord Diseases - surgery; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2011.02.022

Background Anterior cervical subtotal corpectomy and fusion provides extensive decompression in the treatment of cervical myelopathy. However, early adjacent segment degeneration may arise due to the abnormal kinematics. To the best of our knowledge, this is the first report on a newly-designed total cervical prosthesis (TCP) to preserve the normal kinematics of cervical spine. The purpose of this study was to compare the cervical range of motion (ROM) of TCP with anterior cervical plating (ACP) in a single-level cervical subtotal corpectomy model. Study Design An in vitro biomechanical study of a novel total cervical prosthesis (TCP) using a cadaveric model. Materials and Methods After evaluation of the ROM of the 14 human cadaveric cervical spines (C2 -T1 ) (intact group), single-level subtotal corpectomy models at the C5 levels were performed. All specimens were randomized, instrumented with ACP ( n = 7) and TCP ( n = 7) from C4 to C6 . All specimens were tested for flexion/extension, lateral bending, and axial rotation loading. The ROM of implanted segments (C4 -C6 ) and adjacent segments (C3 /C4 and C6 /C7 ) were monitored, respectively. Results TCP was found to accurately recapitulate the preoperative ROM both in the adjacent segments (C3 /C4 and C6 /C7 ) and the implanted segments (C4 -C6 ). In the adjacent segments, no significant difference was found in ROMC3/C4 between the TCP group and the intact group in flexion, extension, and lateral bending. In the implanted segments, TCP preserved well the ROMC4-C6 , with 5.29° in flexion, 12.27° in extension, 8.95° in right lateral bending, and 7.50° in left lateral bending. In contrast, the mean ROMC4-C6 in the ACP group was lower than those in the TCP group and the intact group significantly in all directions ( P  < 0.05). In addition, compared with the ACP group, the mean ROMC3-C7 in TCP group increased by 32.6% ( P  = 0.034) in flexion, 62.9% ( P = 0.008) in extension, 24.8% ( P > 0.05) in lateral bending, and 36.0% ( P < 0.01) in rotation. Compared with the intact group, the TCP group showed moderate decrease in flexion and moderate increases in extension, lateral bending, and rotation. But no significant differences were detected ( P > 0.05). Conclusions Biomechanical analyses suggest that TCP preserves ROM in the implanted segments after cervical subtotal corpectomy. TCP will not induce compensatory motion in the adjacent segments, thus may possibly help prevent adjacent segment degeneration.