Effects of a new anatomical adaptive titanium mesh cage on supportive load at the cervical endplate: a morphological and biomechanical study

Abstract

To assess the geometrical matching of a new anatomical adaptive titanium mesh cage (AA-TMC) with the endplate and its effect on cervical segmental alignment reconstruction in single- and two-level anterior cervical corpectomy and fusion (ACCF) and compare the compressive load at the endplate between the AA-TMC and the conventional titanium mesh cage (TMC). Twelve cervical cadaveric specimens were used to perform single- and two-level ACCF. The interbody angle (IBA), interbody height (IBH) and the interval between the AA-TMC and the endplate were evaluated by comparison of the pre- and postoperative X-ray images. The maximum load at the endplate was compared between the AA-TMC and TMC based on American Society for Testing and Materials (ASTM) F2267 standard. No significant differences were found between the preoperative and postoperative IBA and IBH in either single-level ACCF (11.62°±2.67° vs 12.13°±0.69° and 23.90±2.18 mm vs 24.23±1.13 mm, respectively; P > 0.05) or two-level ACCF (15.63°±5.06° vs 16.16°±1.05°and 42.93±3.51 mm vs 43.04±1.70 mm, respectively; P > 0.05). The mean interval between the AA-TMC and the endplate was 0.37 ± 0.3 mm. Compared to the conventional TMC, the use of AA-TMC significantly increased the maximum load at the endplate in both single-level ACCF (719.7±5.5 N vs 875.8±5.2 N, P < 0.05) and two-level ACCF (634.3±5.9 N vs 873±6.1 N, P < 0.05). The use of AA-TMC in single-level and two-level ACCF can significantly increase the maximum load at the endplate to lower the possibility of implant subsidence and allows effective reconstruction of the cervical alignment.