Load sharing and stabilization effects of anterior cervical devices

Biomechanical human cadaveric cervical flexibility testing with direct load-sharing measurement.

To determine if the flexibility and load-sharing characteristics of a functional spinal unit were affected by anterior treatments for cervical pathologies.

With advancements in polymers, anterior cervical plates have used thermoplastics including recent designs from biodegradable polylactide acids. However, the difference in material properties between metal and polymer can be significant.

Thirteen cervical spine specimens were subjected to 5 treatments at C4-C5. Each treatment for each specimen was subjected to multidirectional flexibility testing. The third cycle was used for treatment comparisons.

With the integrated load cell spacer, the mean range of motion for the functional spinal unit measured on average 104% + or - 40% normalized to the intact control. The mean biodegradable and titanium plate were 55% + or - 31% and 40% + or - 36%, respectively. Both plates exhibited statistically lower mean range of motions (P = 0.001 and P < 0.001) compared with spacers. The load transmitted through the interbody space was 54% + or - 20%, 43% + or - 20%, and 33% + or - 15% on average for the spacer, biodegradable, and titanium plate constructs, respectively. No statistically significant difference was detected between the biodegradable plate and spacer (P = 0.214).

From this research, a biodegradable plate offers immediate postoperative stability significantly different than spacer alone treatments but with graft load sharing that is statistically no different. Thus, the intrinsic lower native material modulus of elasticity of biodegradable polymers has biomechanical implications. However, clinical evidence, particularly for long-term outcomes, will be required in understanding the efficacy of biodegradable polymers.