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Biomechanical analysis of multilevel cervical corpectomy and plate constructs
Randall W Porter1, Neil R Crawford, Robert H Chamberlain
1Division of Neurological Surgery, Spinal Biomechanics Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA. neuropub@chw.edu
Journal of Neurosurgery
|July 16, 2003
Summary
The two-level corpectomy/discectomy construct offers superior immediate stability compared to the three-level corpectomy construct. An additional screw enhances stability in the three-level construct but not the two-level construct.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Spinal Fusion
Background:
- Multilevel cervical constructs are used after decompressive surgery.
- Anterior cervical plates (ACPs) are common in these procedures.
- The biomechanical stability of different corpectomy/discectomy techniques requires further investigation.
Purpose of the Study:
- To compare the biomechanical stability of two-level corpectomy/discectomy versus three-level corpectomy constructs.
- To evaluate the effect of an additional screw connecting the ACP to the strut graft on construct stability.
Main Methods:
- In vitro flexibility tests were performed on human cadaveric cervical spines.
- Nondestructive pure moments were applied to measure three-dimensional angular motion.
- Two construct types were tested: three-level corpectomy/strut graft and two-level corpectomy/discectomy/strut graft, with and without an additional screw.
Main Results:
- The two-level corpectomy/discectomy construct demonstrated significantly smaller normalized neutral zone during flexion-extension (p=0.04).
- While not significant, the two-level construct showed consistently smaller normalized elastic zone and range of motion.
- An additional screw significantly reduced motion in the three-level construct during flexion and lateral bending, but not in the two-level construct.
Conclusions:
- The two-level corpectomy/discectomy construct provides superior immediate postoperative biomechanical stability.
- An additional screw to the strut graft improves stability for the three-level construct but not the two-level construct.