Abstract
Cervical degenerative disease is one of the most common spinal disorders worldwide, especially in older people. Anterior cervical corpectomy and fusion (ACCF) is a useful method for the surgical treatment of multi-level cervical degenerative disease. Anterior cervical disc replacement (ACDR) is considered as an alternative surgical method. However, both methods have drawbacks, particularly the neck motion decrease observed after arthrodesis, and arthroplasty should only be performed on patients presenting with cervical disc disease but without any vertebral body disease. Therefore, we designed a non-fusion cervical joint system, namely an artificial cervical vertebra and intervertebral complex (ACVC), to provide a novel treatment for multi-level cervical degenerative disease. To enhance the long-term stability of ACVC, we applied a hydroxyapatite (HA) biocoating on the surface of the artificial joint. Thirty-two goats were randomly divided into four groups: a sham control group, an ACVC group, an ACVC-HA group, and an ACCF group (titanium and plate fixation group). We performed the prosthesis implantation in our previously established goat model. We compared the clinical, radiological, biomechanical, and histological outcomes among these four different groups for 24 weeks post surgery. The goats successfully tolerated the entire experimental procedure. The kinematics data for the ACVC and ACVC-HA groups were similar. The range of motion (ROM) in adjacent level increased after ACCF but was not altered after ACVC or ACVC-HA implantation. Compared with the control group, no significant difference was found in ROM and neutral zone (NZ) in flexion-extension or lateral bending for the ACVC and ACVC-HA groups, whereas the ROM and NZ in rotation were significantly greater. Compared with the ACCF group, the ROM and NZ significantly increased in all directions. Overall, stiffness was significantly decreased in the ACVC and ACVC-HA groups compared with the control group and the ACCF group. Similar results were found after a fatigue test of 5,000 repetitions of axial rotation. The histological results showed more new bone formation and better bone implant contact in the ACVC-HA group than the ACVC group. Goat is an excellent animal model for cervical spine biomechanical study. Compared with the intact state and the ACCF group, ACVC could provide immediate stability and preserve segmental movement after discectomy and corpectomy. Besides, HA biocoating provide a better bone ingrowth, which is essential for long-term stability. In conclusion, ACVC-HA brings new insight to treat cervical degenerative disease.
Highlights
Cervical degenerative disease is a prevalent problem in our aging population
Does ACVC result in less kinematic changes compared with ACCF, which is the traditional surgery for cervical degeneration disease? how is the long-term stability of ACVC compared with ACCF? To solve these issues, we developed a titanium mesh cage and an anterior cervical plate system for the goat to implement the ACCF animal model, and the ACVC-HA(ACVC with an HA biocoating)
The ACVC-HA is an ACVC treated with a 30-μm hydroxyapatite biocoating via microarc oxidation technology
Summary
Cervical degenerative disease is a prevalent problem in our aging population. It can be in the form of herniated discs and spondylosis in the cervical spine associated with axial neck and/or radicular arm pain and neurological symptoms. Matsumotoet al.[6] performed a prospective 10-year follow-up magnetic resonance imaging (MRI) study on 64 patients who underwent anterior cervical discectomy and fusion and 201 asymptomatic healthy control subjects They demonstrated that both groups showed a progression towards disc degeneration during the 10-year period, patients treated with anterior cervical fusion had a significantly higher incidence of progression towards disc degeneration at adjacent segments than controls, even if this was not always related to the development of clinical symptoms. The relationship between adjacent segmental disease and anterior cervical fusion remains unanswered, the motion loss following ACCF results in an increased range of motion and a higher intradiscal pressure in the facet joint adjacent to the fusion level, which is considered to be related to the adjacent segmental disease [7] This concern has led to the development of motion-preserving devices such as artificial cervical discs
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