title: The biomechanical stability of a novel spacer with integrated plate in contiguous two-level and three-level ACDF models: an in vitro cadaveric study.
abstract: BACKGROUND
  Anterior cervical plating increases stability and hence improves fusion rates to treat cervical spine pathologies, which are often symptomatic at multiple levels. However, plating is not without complications, such as dysphagia, injury to neural elements, and plate breakage. The biomechanics of a spacer with integrated plate system combined with posterior instrumentation (PI), in two-level and three-level surgical models, has not yet been investigated.
  
  
  OBJECTIVE
  The purpose of the study was to biomechanically evaluate the multidirectional rigidity of spacer with integrated plate (SIP) at multiple levels as comparable to traditional spacers and plating.
  
  
  METHODS
  An in vitro cervical cadaveric model.
  
  
  METHODS
  Eight fresh human cervical (C2-C7) cadaver spines were tested under pure moments of ±1.5 Nm on spine simulator test frame. Each spine was tested in intact condition, with only anterior fixation and with both anterior and PI. Range of motion (ROM) was measured using Optotrak Certus (NDI, Inc., Waterloo, Ontario, Canada) motion analysis system in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) at the instrumented levels (C3-C6). Repeated-measures analysis of variance was used for statistical analysis.
  
  
  RESULTS
  All the surgical constructs showed significant reduction in motion compared with intact condition. In two-level fusion, SIP (C4-C6) construct significantly reduced ROM by 66.5%, 65.4%, and 60.3% when compared with intact in FE, LB, and AR, respectively. In three-level fusion, SIP (C3-C6) construct significantly reduced ROM by 65.8%, 66%, and 49.6% when compared with intact in FE, LB, and AR, respectively. Posterior instrumentation showed significant stability only in three-level fusion when compared with their respective anterior constructs. In both two-level and three-level fusion, SIP showed comparable stability to traditional spacer and plate constructs in all loading modes.
  
  
  CONCLUSIONS
  The anatomically profiled spacer with integrated plate allows treatment of cervical disorders with fewer steps and less impact to cervical structures. In this biomechanical study, spacer with integrated plate construct showed comparable stability to traditional spacer and plate for two-level and three-level fusion. Posterior instrumentation showed significant effect only in three-level fusion. Clinical data are required for further validation of using spacer with integrated plate at multiple levels.
authors.affiliation: W.B. Carrell Clinic, 9301 North Central Expressway, Suite 400, Dallas, TX 75231, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clavenna
authors.forename: William J
authors.initials: WJ
authors.lastname: Beutler
authors.forename: Manasa
authors.initials: M
authors.lastname: Gudipally
authors.forename: Mark
authors.initials: M
authors.lastname: Moldavsky
authors.forename: Saif
authors.initials: S
authors.lastname: Khalil
mesh_terms: D001696:Biomechanical Phenomena / Q000502:physiology*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000502:physiology / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008953:Models, Anatomic; D016059:Range of Motion, Articular / Q000502:physiology*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods