[Recent Advances of Biomechanical Studies on Cervical Fusion and Non-fusion Surgery]

This article reviews the progress of biomechanical studies on anterior cervical fusion and non-fusion surgery in recent years. The similarities and differences between animal and human cervical spines as well as the major three biomechanical test methods are introduced. Major progresses of biomechanical evaluation in anterior cervical fusion and non-fusion devices, hybrid surgery, coupled motion and biomechanical parameters, such as the instant center of rotation, are classified and summarized. Future development of loading method, multilevel hybrid surgery and coupling character are also discussed.

Biomechanics of Artificial Disc Replacements Adjacent to a 2-Level Fusion in 4-Level Hybrid Constructs: An In Vitro Investigation

Background

The ideal procedure for multilevel cervical degenerative disc diseases remains controversial. Recent studies on hybrid surgery combining anterior cervical discectomy and fusion (ACDF) and artificial cervical disc replacement (ACDR) for 2-level and 3-level constructs have been reported in the literature. The purpose of this study was to estimate the biomechanics of 3 kinds of 4-level hybrid constructs, which are more likely to be used clinically compared to 4-level arthrodesis.

Material/Methods

Eighteen human cadaveric spines (C2–T1) were evaluated in different testing conditions: intact, with 3 kinds of 4-level hybrid constructs (hybrid C3–4 ACDR+C4–6 ACDF+C6–7ACDR; hybrid C3–5ACDF+C5–6ACDR+C6–7ACDR; hybrid C3–4ACDR+C4–5ACDR+C5–7ACDF); and 4-level fusion.

Results

Four-level fusion resulted in significant decrease in the C3–C7 ROM compared with the intact spine. The 3 different 4-level hybrid treatment groups caused only slight change at the instrumented levels compared to intact except for flexion. At the adjacent levels, 4-level fusion resulted in significant increase of contribution of both upper and lower adjacent levels. However, for the 3 hybrid constructs, significant changes of motion increase far lower than 4P at adjacent levels were only noted in partial loading conditions. No destabilizing effect or hypermobility were observed in any 4-level hybrid construct.

Conclusions

Four-level fusion significantly eliminated motion within the construct and increased motion at the adjacent segments. For all 3 different 4-level hybrid constructs, ACDR normalized motion of the index segment and adjacent segments with no significant hypermobility. Compared with the 4-level ACDF condition, the artificial discs in 4-level hybrid constructs had biomechanical advantages compared to fusion in normalizing adjacent level motion.

Biomechanics of Hybrid Anterior Cervical Fusion and Artificial Disc Replacement in 3-Level Constructs: An In Vitro Investigation

Background

The ideal surgical approach for cervical disk disease remains controversial, especially for multilevel cervical disease. The purpose of this study was to investigate the biomechanics of the cervical spine after 3-level hybrid surgery compared with 3-level anterior cervical discectomy and fusion (ACDF).

Material/Methods

Eighteen human cadaveric spines (C2-T1) were evaluated under displacement-input protocol. After intact testing, a simulated hybrid construct or fusion construct was created between C3 to C6 and tested in the following 3 conditions: 3-level disc plate disc (3DPD), 3-level plate disc plate (3PDP), and 3-level plate (3P).

Results

Compared to intact, almost 65~80% of motion was successfully restricted at C3-C6 fusion levels (p<0.05). 3DPD construct resulted in slight increase at the 3 instrumented levels (p>0.05). 3PDP construct resulted in significant decrease of ROM at C3-C6 levels less than 3P (p<0.05). Both 3DPD and 3PDP caused significant reduction of ROM at the arthrodesis level and produced motion increase at the arthroplasty level. For adjacent levels, 3P resulted in markedly increased contribution of both upper and lower adjacent levels (p<0.05). Significant motion increases lower than 3P were only noted at partly adjacent levels in some conditions for 3DPD and 3PDP (p<0.05).

Conclusions

ACDF eliminated motion within the construct and greatly increased adjacent motion. Artificial cervical disc replacement normalized motion of its segment and adjacent segments. While hybrid conditions failed to restore normal motion within the construct, they significantly normalized motion in adjacent segments compared with the 3-level ACDF condition. The artificial disc in 3-level constructs has biomechanical advantages compared to fusion in normalizing motion.

Coupled motion of cervical spine in three level hybrid constructs

To compare the biomechanical characters of three-level anterior cervical fusion and hybrid constructs by measuring coupled motion changes of the cervical spine, Eighteen adult human cadaveric cervical spines were biomechanically investigated under eccentric displacement control in lateral bending and axial rotation by measuring vertebral motion (X, Y, Z -axis).The 3DPD condition displayed similar coupled motion compared to the intact condition both in lateral bending and in axial rotation, while the 3PDP condition was similar only in lateral bending. However, the coupled motion of the cervical spine under 3P conditions markedly changed in both lateral bending and axial rotation. Considering the coupled motion characteristics, the 3DPD hybrid construct is biomechanically advantageous in three types of reconstructions (3DPD, 3PDP, 3P).

Study on improved tribological properties by alloying copper to CP-Ti and Ti-6Al-4V alloy

Copper alloying to titanium and its alloys is believed to show an antibacterial performance. However, the tribological properties of Cu alloyed titanium alloys were seldom studied. Ti-5Cu and Ti-6Al-4V-5Cu alloys were fabricated in the present study in order to further study the friction and wear properties of titanium alloys with Cu additive. The microstructure, composition and hardness were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscope (TEM) and hardness tester. The tribological behaviors were tested with ZrO2 counterface in 25% bovine serum using a ball-on-disc tribo-tester. The results revealed that precipitations of Ti2Cu intermetallic compounds appeared in both Ti-5Cu and Ti-6Al-4V-5Cu alloys. The tribological results showed an improvement in friction and wear resistance for both Ti-5Cu and Ti-6Al-4V-5Cu alloys due to the precipitation of Ti2Cu. The results also indicated that both CP-Ti and Ti-5Cu behaved better wear resistance than Ti-6Al-4V and Ti-6Al-4V-5Cu due to different wear mechanisms when articulated with hard zirconia. Both CP-Ti and Ti-5Cu revealed dominant adhesive wear with secondary abrasive wear mechanism while both Ti-6Al-4V and Ti-6Al-4V-5Cu showed severe abrasive wear and cracks with secondary adhesive wear mechanism due to different surface hardness integrated by their microstructures and material types.