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Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw)

 Ji-Won Kwon  ;  Sun Hee Bang  ;  Tae Hyun Park  ;  Sung-Jae Lee  ;  Hwan-Mo Lee  ;  Soo-Bin Lee  ;  Byung Ho Lee  ;  Seong-Hwan Moon 
 CLINICAL BIOMECHANICS, Vol.73 : 226-233, 2020-03 
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Issue Date
ACDF ; Allospacer ; Finite element model ; Lateral mass screw ; Pedicle screw
Background: The purpose of this study is to investigate effects of different fixation methods on the physical stress on allospacers, endplate-vertebral body, and implants using finite element model analyses. Methods: Stress distribution and subsidence risk according to the fixation methods under the condition of hybrid motion control were analyzed. The detailed finite element model of a previously validated, three-dimensional, intact cervical spinal segment model, with C5-C6 segmental fusion using allospacer, was used to evaluate the biomechanical characteristics of different fixation combinations, such as anterior plate/screws, lateral mass screw, and posterior pedicle screw. Findings: The load sharing on allospacers increased in extension in order of posterior pedicle screws (21.4%), lateral mass screws (31.5%), and anterior plate/screws (56.6%). lateral mass screw demonstrated the highest load sharing (68.1%) on the allospacer in flexion. The Peak von Mises stress of the allospacer was the lowest in flexion and axial rotation but the highest in extension with anterior plate/screws. Allospacer subsidence risk was the lowest in extension, lateral bending, and axial rotation with posterior pedicle screws but the lowest in flexion with anterior plate/screws. The bone-screw loosening risk was the lowest in all modes with posterior pedicle screws but the highest with anterior plate/screws. Interpretation: Posterior pedicle screws demonstrated the best mechanical stability of allospacer failure-subsidence and the lowest risk of screw loosening. Different motion restrictions depending on the fixation method should be considered for implant and allospacer safety.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Moon, Seong Hwan(문성환)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
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