Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Laboratory investigation

View More View Less
  • 1 Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;
  • 2 KeiperSpine, PC, Eugene, Oregon;
  • 3 Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida;
  • 4 Medtronic Spinal and Biologics, Memphis, Tennessee; and
  • 5 Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The clinical success rates of anterior cervical discectomy and fusion (ACDF) procedures are substantially reduced as more cervical levels are included in the fusion procedure. One method that has been proposed as an adjunctive technique for multilevel ACDF is the placement of screws across the facet joints (“transfacet screws”). However, the biomechanical stability imparted by transfacet screw placement (either unilaterally or bilaterally) has not been reported. Therefore, the purpose of this study was to determine the acute stability conferred by implementation of unilateral and bilateral transfacet screws to an ACDF construct.

Methods

Eight C2–T1 fresh-frozen human cadaveric spines (3 female and 5 male; mean age 50 years) were tested. Three different instrumentation variants were performed on cadaveric cervical spines across C4–7: 1) ACDF with an intervertebral spacer and standard plate/screw instrumentation; 2) ACDF with an intervertebral spacer and standard plate/screw instrumentation with unilateral facet screw placement; and 3) ACDF with an intervertebral spacer and standard plate/screw instrumentation with bilateral facet screw placement. Kinetic ranges of motion in flexion-extension, lateral bending, and axial rotation at 1.5 Nm were captured after each of these procedures and were statistically analyzed for significance.

Results

All 3 fixation scenarios produced statistically significant reductions (p < 0.05) in all 3 bending planes compared with the intact condition. The addition of a unilateral facet screw to the ACDF construct produced significant reductions at the C4–5 and C6–7 levels in lateral bending and axial rotation but not in flexion-extension motion. Bilateral facet screw fixation did not produce any statistically significant decreases in flexion-extension motion compared with unilateral facet screw fixation. However, in lateral bending, significant reductions at the C4–5 and C5–6 levels were observed with the addition of a second facet screw. The untreated, adjacent levels (C2–3, C3–4, and C7–1) did not demonstrate significant differences in range of motion.

Conclusions

The data demonstrated that adjunctive unilateral facet screw fixation to an ACDF construct provides significant gains in stability and should be considered a potential option for increasing the likelihood for obtaining a successful arthrodesis for multilevel ACDF procedures.

Abbreviations used in this paper:ACDF = anterior cervical discectomy and fusion; ROM = range of motion.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Christian M. Puttlitz, Ph.D., 1374 Campus Delivery, Colorado State University, Fort Collins, CO 80523. email: puttlitz@engr.colostate.edu.

Please include this information when citing this paper: published online February 21, 2014; DOI: 10.3171/2014.1.SPINE13837.

  • 1

    Agarwala A, , Bucklen B, , Muzumdar A, , Moldavsky M, & Khalil S: Do facet screws provide the required stability in lumbar fixation? A biomechanical comparison of the Boucher technique and pedicular fixation in primary and circumferential fusions. Clin Biomech (Bristol, Avon) 27:6470, 2012

    • Search Google Scholar
    • Export Citation
  • 2

    Ahmad F, , Sherman JD, & Wang MY: Percutaneous trans-facet screws for supplemental posterior cervical fixation. World Neurosurg 78:716.e1716.e4, 2012

    • Search Google Scholar
    • Export Citation
  • 3

    Aydogan M, , Enercan M, , Hamzaoglu A, & Alanay A: Reconstruction of the subaxial cervical spine using lateral mass and facet screw instrumentation. Spine (Phila Pa 1976) 37:E335E341, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Ayturk UM, & Puttlitz CM: Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine. Comput Methods Biomech Biomed Engin 14:695705, 2011

    • Search Google Scholar
    • Export Citation
  • 5

    Clavenna AL, , Beutler WJ, , Gudipally M, , Moldavsky M, & Khalil S: The biomechanical stability of a novel spacer with integrated plate in contiguous two-level and three-level ACDF models: an in vitro cadaveric study. Spine J 12:157163, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Cripton PA, , Bruehlmann SB, , Orr TE, , Oxland TR, & Nolte LP: In vitro axial preload application during spine flexibility testing: towards reduced apparatus-related artefacts. J Biomech 33:15591568, 2000

    • Search Google Scholar
    • Export Citation
  • 7

    Fraser JF, & Härtl R: Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:298303, 2007

    • Search Google Scholar
    • Export Citation
  • 8

    Gorek J, , Acaroglu E, , Berven S, , Yousef A, & Puttlitz C: Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine (Phila Pa 1976) 30:15131518, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Grip H, , Sundelin G, , Gerdle B, & Stefan Karlsson J: Cervical helical axis characteristics and its center of rotation during active head and upper arm movements—comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals. J Biomech 41:27992805, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    Horn EM, , Reyes PM, , Baek S, , Senoglu M, , Theodore N, & Sonntag VKH, : Biomechanics of C-7 transfacet screw fixation. Laboratory investigation. J Neurosurg Spine 11:338343, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Horn EM, , Theodore N, , Crawford NR, , Bambakidis NC, & Sonntag VKH: Transfacet screw placement for posterior fixation of C-7. Technical note. J Neurosurg Spine 9:200206, 2008

    • Search Google Scholar
    • Export Citation
  • 12

    Jiang SD, , Jiang LS, & Dai LY: Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review. Arch Orthop Trauma Surg 132:155161, 2012

    • Search Google Scholar
    • Export Citation
  • 13

    Kaiser MG, , Haid RW Jr, , Subach BR, , Barnes B, & Rodts GE Jr: Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229238, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Klekamp JW, , Ugbo JL, , Heller JG, & Hutton WC: Cervical transfacet versus lateral mass screws: a biomechanical comparison. J Spinal Disord 13:515518, 2000

    • Search Google Scholar
    • Export Citation
  • 15

    Metzger MF, , Faruk Senan NA, , O'Reilly OM, & Lotz JC: Minimizing errors associated with calculating the location of the helical axis for spinal motions. J Biomech 43:28222829, 2010

    • Search Google Scholar
    • Export Citation
  • 16

    Puttlitz CM, , Melcher RP, , Kleinstueck FS, , Harms J, , Bradford DS, & Lotz JC: Stability analysis of craniovertebral junction fixation techniques. J Bone Joint Surg Am 86-A:561568, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Schmidt H, , Heuer F, & Wilke HJ: Interaction between finite helical axes and facet joint forces under combined loading. Spine (Phila Pa 1976) 33:27412748, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Wang JC, , McDonough PW, , Kanim LE, , Endow KK, & Delamarter RB: Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 26:643646, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Womack W, , Leahy PD, , Patel VV, & Puttlitz CM: Finite element modeling of kinematic and load transmission alterations due to cervical intervertebral disc replacement. Spine (Phila Pa 1976) 36:E1126E1133, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Zhao L, , Xu R, , Liu J, , Sochacki KR, , Ma W, & Jiang W, : The study on comparison of 3 techniques for transarticular screw placement in the lower cervical spine. Spine (Phila Pa 1976) 37:E468E472, 2012

    • Search Google Scholar
    • Export Citation
  • 21

    Zheng X, , Chaudhari R, , Wu C, , Mehbod AA, , Erkan S, & Transfeldt EE: Biomechanical evaluation of an expandable meshed bag augmented with pedicle or facet screws for percutaneous lumbar interbody fusion. Spine J 10:987993, 2010

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 207 104 8
Full Text Views 419 8 1
PDF Downloads 265 10 3
EPUB Downloads 0 0 0