title: Biomechanical evaluation of a low profile, anchored cervical interbody spacer device in the setting of progressive flexion-distraction injury of the cervical spine.
abstract: BACKGROUND
  Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity.
  
  
  METHODS
  Thirteen human cadaveric subaxial cervical spines (C3-C7) were tested at C5-C6 in flexion-extension, lateral bending and axial rotation in the load-control mode under ±1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5-C6.
  
  
  RESULTS
  The anchored spacer device with locked screw configuration significantly reduced C5-C6 flexion-extension (FE) motion from 14.8 ± 4.2 to 3.9 ± 1.8°, lateral bending (LB) from 10.3 ± 2.0 to 1.6 ± 0.8, and axial rotation (AR) from 11.0 ± 2.4 to 2.5 ± 0.8 compared with intact under (p < 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5-C6 FE motion from 10.7 ± 1.7 to 5.5 ± 2.5°, LB from 8.3 ± 1.4 to 2.7 ± 1.0, and AR from 8.8 ± 2.7 to 4.6 ± 1.3 compared with intact (p < 0.01). The ROM of the C5-C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 ± 2.1 in FE, 2.0 ± 1.1 in LB, and 3.3 ± 1.4 in AR. Conversely, the ROM of the C5-C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 ± 4.5 in FE, 5.0 ± 1.6 in LB, and 9.5 ± 4.6 in AR.
  
  
  CONCLUSIONS
  The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion-distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Wojewnik
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Ghanayem
authors.forename: Parmenion P
authors.initials: PP
authors.lastname: Tsitsopoulos
authors.forename: Leonard I
authors.initials: LI
authors.lastname: Voronov
authors.forename: Tejaswy
authors.initials: T
authors.lastname: Potluri
authors.forename: Robert M
authors.initials: RM
authors.lastname: Havey
authors.forename: Julia
authors.initials: J
authors.lastname: Zelenakova
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Gerard
authors.initials: G
authors.lastname: Carandang
authors.forename: Avinash G
authors.initials: AG
authors.lastname: Patwardhan
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002102:Cadaver; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery*; D017586:Diskectomy / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D013123:Spinal Fusion / Q000295:instrumentation*