title: The role of bone graft force in stabilizing the multilevel anterior cervical spine plate system.
abstract: METHODS
  The role of bone graft force in stabilizing an instrumented cervical spine was evaluated for one-level and three-level corpectomy models using in vitro experiments.
  
  
  OBJECTIVE
  To investigate the role of bone graft force in enhancing stability of anterior cervical plate, and to study effects of fatigue loading.
  
  
  BACKGROUND
  The anterior cervical plate system is used widely in stabilizing the cervical spine after spinal corpectomy and grafting. Many factors such as applied screw torque, screw pullout force, plate strength, plate geometry, and type of bone graft have been studied. However, the role of bone graft in stabilizing the anterior plate system has not been explored.
  
  
  METHODS
  Two models (one-level and three-level) incorporating corpectomy, strut graft, and anterior plate were constructed from eight human spine specimens (C2-T1). The flexibility of an intact specimen and two constructs with graft forces of 0 N and 100 N was determined. A flexibility test, simulating physiologic loads, consisted of pure moments of flexion, extension, lateral bending, and axial torques up to 1 Nm. For each moment, range of motion and neutral zone were determined. The stability potential index was defined as the decrease in motion caused by instrumentation, as compared with intact motion. A larger stability potential index indicates a more stable spinal construct. Repeated measures analysis of variance was used to determine the significant changes.
  
  
  RESULTS
  In both models, bone graft force increased during extension, decreased during flexion, and showed minor changes during axial torsion and lateral bending. Higher bone graft force increased stability potential index-neutral zone and stability potential index-range of motion in the three-level model in all directions, but only in flexion-extension in the one-level model. Fatigue loading decreased bone graft force to a greater extent in the three-level model.
  
  
  CONCLUSIONS
  In the corpectomy-graft-anterior-plate model, graft force decreased in flexion and increased in extension. Higher graft force increased and fatigue decreased stability of the spinal construct in the three-level model.
authors.affiliation: Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Wang
authors.forename: M M
authors.initials: MM
authors.lastname: Panjabi
authors.forename: T
authors.initials: T
authors.lastname: Isomi
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D002102:Cadaver; D002574:Cervical Vertebrae / Q000502:physiology / Q000601:surgery*; D017586:Diskectomy; D006801:Humans; D066298:In Vitro Techniques; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007596:Joints / Q000502:physiology; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion; D019415:Torque; D016474:Weight-Bearing