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Article

Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model

1
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Korea
2
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang 410719, Korea
3
Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, Gyeongnam 621749, Korea
*
Author to whom correspondence should be addressed.
Appl. Sci. 2020, 10(18), 6413; https://doi.org/10.3390/app10186413
Received: 9 August 2020 / Accepted: 7 September 2020 / Published: 15 September 2020
The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary. View Full-Text
Keywords: cervical spine surgery; allograft spacer; subsidence; finite element model cervical spine surgery; allograft spacer; subsidence; finite element model
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MDPI and ACS Style

Kwon, J.-W.; Lee, H.-M.; Park, T.-H.; Lee, S.J.; Kwon, Y.-W.; Moon, S.-H.; Lee, B.H. Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model. Appl. Sci. 2020, 10, 6413. https://doi.org/10.3390/app10186413

AMA Style

Kwon J-W, Lee H-M, Park T-H, Lee SJ, Kwon Y-W, Moon S-H, Lee BH. Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model. Applied Sciences. 2020; 10(18):6413. https://doi.org/10.3390/app10186413

Chicago/Turabian Style

Kwon, Ji-Won, Hwan-Mo Lee, Tae-Hyun Park, Sung Jae Lee, Young-Woo Kwon, Seong-Hwan Moon, and Byung Ho Lee. 2020. "Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model" Applied Sciences 10, no. 18: 6413. https://doi.org/10.3390/app10186413

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