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Anterior cervical discectomy and fusion (ACDF) is a common neck surgery that involves removing a damaged disc to relieve pressure on the spinal cord or nerve roots, thereby reducing associated pain, numbness, weakness, or tingling
.
At the same time, fusion surgery is performed to remove the damaged disc from between the bones of the two vertebrae
.
Fusion involves placing a bone graft or "cage" and/or implant in place of the disc to stabilize and strengthen the area
.
Postoperative use of an ACDF cage is important both for cervical alignment and for maintaining disc height
.
However, few studies have examined the impact of underlying cancellous or "sponge" bone contact when carrying heavy objects from cages
.
In addition, it is not clear whether a cage with screws is the best option for long-term fusion because the fretting or sliding distance of the cage and the sinking or penetration still occur repeatedly
.
Florida Atlantic University's School of Engineering and Computer Science researchers collaborated with Frank Vrionis, MD, senior author of the study and director of the Marcus Neuroscience Institute (part of Baptist Health); and professor of surgery, Florida State University, Schmidt School of Medicine, was the first to evaluate the effects of cage migration and subsidence on range of motion using variable angle screws
.
The Marcus Neuroscience Institute's center is located on the Boca Raton Regional Hospital campus, with satellite locations at Bethesda Hospitals in Boynton Beach and Deerfield Beach
.
In this study, the researchers developed 5 finite element models from cervical spine models
.
The first model is a complete spine model, and the second model is a modified model with the addition of a cage and two layers of static slabs
.
The other three models are modified models, employing the same cage insert and two-stage dynamic plate
.
By comparing fretting and sinking, they compared the biomechanical properties of ACDF cages, implant cages, and associated hardware with and without screws
.
Findings published in the Journal of Spine, World Journal of Neurosurgery, and Asian Spine Journal demonstrate that the cage-stud and anterior-plate combination model reduces implanted cage fretting and sinking in ACDFs of two or more grades has good potential in terms of risk
.
This approach can increase structural stiffness and reduce the incidence of clinical and fusion failure after ACDF, thereby reducing the need for revision surgery or supplemental posterior rejoining
.
"Anterior cervical discectomy and fusion are widely used to treat patients with spinal disorders, where cages are a key component in achieving satisfactory fusion outcomes
.
Risk factors for cage migration are multifactorial, including patient factors, radiological characteristics, Surgical technique and postoperative factors," Frionis said
.
"Our results showed that the plate used in our study provided directional stability and achieved good fusion, suggesting good clinical outcomes for patients with degenerative cervical spine disease
.
"
Vrionis further explained that due to the biomechanical stability of the current structure, there is no need for a stiff collar, which is commonly used by other surgeons
.
.
Source: Florida Atlantic University
"Furthermore, in more than 100 clinical cases, there was no evidence of pseudarthrosis or loss of fusion, a complication of anterior cervical disc surgery," Vrionis said
.
In multistage applications, lower screw rotation angles resulted in better biomechanical properties and lower incidence of migration and subsidence than higher rotation angles, regardless of load
.
The researchers suggest that the underlying mechanism may be due to the cage screw fixed to the bone and the constrained base of the C5 vertebral body making it more rigid
.
"Our research aims to develop a platform for the next generation of patient-specific spine surgery by combining intelligent image processing, artificial intelligence techniques/machine learning, finite element simulation and 3D printing to help surgeons design surgical plans for each patient, said study co-author Professor Chi-Tay Tsai,Ph.D.
Department of Marine and Mechanical Engineering, Fudan University, Director of Spine Biomechanics Laboratory
.
The researchers demonstrated that under all load conditions, cage screws were better at preventing sinking than cage screws without screws
.
"Our clinical and biomechanical data suggest that rigid static plates work very well
.
The main reason may be that cage screws have a larger area of contact between the cortex and cancellous bone compared to non-anchored cage structures."
ACDF is one of the most common spine surgeries in the United States, with an average of 137,000 procedures performed annually
.
"The new approach developed by our researchers in collaboration with Dr.Vrionis and O'Connor from the Marcus Neuroscience Institute holds great promise in enhancing anterior cervical discectomy and fusion, and ultimately helping relieve patients Pain and discomfort experienced with various spinal and neck disorders," said Dr.Stella Batalama, Dean of FAU's School of Engineering and Computer Science
.
