The anterior cervical discectomy with fusion procedure is among of the most often performed spinal surgeries across the United States with an average of 137,000 procedures carried out each year.
The Anterior Cervical Diskectomy and Fusion (ACDF) can be described as a popular kind of neck surgery which involves removing an injured disc to relieve pressure on the nerve root, and thus relieve the numbness, pain, and the sensation of tingling. The disc that is damaged is removed between two vertebral bones with fusion surgery that is simultaneous. Fusion involves the placement of an graft of bone or “cage” or implants in the place where the disc was previously to strengthen and stabilize the region.
Use of cages in ACDF are crucial postoperatively to ensure the alignment that the cervical spine as well as to ensure the disc’s intervertebral height. There are a few studies that have looked at the effects on the underlying cancellous, (or “spongy” osteophytes contact on the ability to handle massive loads that are imposed by the cage. In addition, it’s unclear which cage without screws is the most suitable option for long-term fusion , as the micromotion and the subsidence or entry into the cage happen frequently.
Researchers from the Florida Atlantic University’s College of Engineering and Computer Science , in collaboration with Frank Vrionis, M.D. who is the lead researcher of the study and Director of Marcus Neuroscience Institute, part of Baptist Health; and professor of surgery at FAU’s Schmidt College of Medicine, is the first study to examine the effects on an array of movement, the cage mobility and subsidence with adjustable angle screws. Marcus Neuroscience Institute has its center on the Boca Raton Regional’s hospital campus, as well as satellite sites located at Bethesda Hospital in Boynton Beach and Deerfield Beach.
In the course of their research, scientists came up with Five finite element designs based on the cervical spine model. The initial model was an unmodified model of the spine, while the other model had an alteration one with cage insertion as well as two levels of static plate. The three other models were modified models that had similar cage placement, and the 2-level dynamic plate. They were able to compare ACDF cages without and with screws to determine the biomechanical properties that characterize the spine of a human, implants and the associated hardware, through comparing the micro-motion and subsidence.
The results of the study released in The Spine Journal,the journal of the World Neurosurgery and Asian Spine Journal showed that the cage screw and anterior plating model is promising to minimize the possibility of micro movement and subsidence of cages implanted with two or more levels ACDFs. This approach could enhance the rigidity of the construction and lower the chance of fusion and clinical failure after ACDF which, can, in turn, reduce the requirement for revision surgeries or additional posterior realignment.
“Anterior cervical discectomy as well as fusion is extensively utilized to treat patients suffering from spinal problems, and cages are a crucial element in achieving satisfying results in fusion. The factors that increase the risk of cage movement are multifactorial, and comprise radiological aspects, patient factors as well as postoperative variables,” explained Dr. Vrionis. “Our results demonstrated that the plate utilized in our study offered the stability in the direction of travel and also produced an excellent fusion. This indicates positive outcomes for patients suffering from cervical spine diseases that are degenerative.”
Vrionis also explains that due to the biomechanical stability of the present structure, there is no requirement for cervical collars that are rigid, that is commonly utilized for other surgeons.
“In the meantime, with more than 100 cases of clinical there is the absence of evidence for pseudarthrosis, or absence of fusion, which is a medically treated complication following cervical disc surgery for anterior cervical,” stated Vrionis.
A less angular screw has resulted in better biomechanical performance and less incidence of subsidence and migration in comparison to a greater angle of rotation in multiple-level systems, regardless of the load. Researchers believe that the root mechanism could be due to the cage screw that is bonded to bone, and also the constrained bottom of the C5 vertebra , making it more solid.
“Our research is aimed at developing an advanced platform for specific spine surgery for patients through the use of intelligent image processing, AI technology/machine learning, finite element simulation, and 3D printing to assist surgeons create a customized surgery program for each patient ” Chi-Tay Tsai Ph.D. Study co-author and professor at the FAU Department of Ocean and Mechanical Engineering as well as director of the FAU Spine Biomechanical Laboratory.
Researchers found that the cage-screw was able to stop subsidence in all loading situations better than cages with no screws.
“Our biomechanical and clinical data have proven that the results for the rigid static plates are excellent. This could be due to the larger contact between the cancellous and cortical bone within the cage screw than in cages that are not anchored,” said Tsai.
ACDF is among the most frequently performed spinal surgeries within the United States with an average of 137,000 procedures carried out each year.
“The innovative method that our researchers have developed working with Drs. Vrionis and O’Connor from Marcus Neuroscience Institute Marcus Neuroscience Institute holds great promise for enhancing the anterior cervical discectomy as well as fusion, and ultimately ease the discomfort and pain that patients suffer from various conditions of the neck and the spine,” said Stella Batalama, Ph.D., dean, FAU College of Engineering and Computer Science.
Other study co-authors include Erik Engeberg, Ph.D. Professor, FAU Department of Ocean and Mechanical Engineering; Maohua Lin, Ph.D., researcher, FAU Department of Ocean and Mechanical Engineering; Stephen Z. Shapiro, M.D. is a neurosurgery specialist from Louisiana State University; and James Doulgeris, Ph.D. both of them in the Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital which is which is part of Baptist Health; Rudy Paul, Ph.D., FAU Department of Ocean and Mechanical Engineering and Timothy E. O’Connor, Ph.D., Department of Neurosurgery, Marcus Neuroscience Institute.
The research was sponsored through the Boca Raton Regional Hospital Foundation that was granted to Tsai the principal researcher.