Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Murphy, Timothy P.; Colantonio, Donald F.; Le, Anthony H.; Fredericks, Donald R.; Schlaff, Cody D.; Holm, Erik B.; Sebastian, Arjun S.; Pisano, Alfred J.; Helgeson, Melvin D.; Wagner, Scott C.

doi:10.1097/bsd.0000000000001429

Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Journal Article · 31 December 2022 · Clinical Spine Surgery

DOI:https://doi.org/10.1097/bsd.0000000000001429· OSTI ID:2425845

Murphy, Timothy P. ^[1]; Colantonio, Donald F. ^[1]; Le, Anthony H. ^[2]; Fredericks, Donald R. ^[1]; Schlaff, Cody D. ^[1]; Holm, Erik B. ^[3]; Sebastian, Arjun S. ^[4]; Pisano, Alfred J. ^[1]; Helgeson, Melvin D. ^[1]; Wagner, Scott C. ^[1]

Department of Orthopaedics; Department of Surgery
DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
Uniformed Services University of the Health Sciences, Bethesda, MD
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN

Study Design:

Controlled Laboratory Study

Objective:

To compare multilevel posterior cervical fusion (PCF) constructs stopping at C7, T1, and T2 under cyclic load to determine the range of motion (ROM) between the lowest instrumented level and lowest instrumented-adjacent level (LIV-1).

Summary of Background Data:

PCF is a mainstay of treatment for various cervical spine conditions. The transition between the flexible cervical spine and rigid thoracic spine can lead to construct failure at the cervicothoracic junction. There is little evidence to determine the most appropriate level at which to stop a multilevel PCF.

Methods:

Fifteen human cadaveric cervicothoracic spines were randomly assigned to 1 of 3 treatment groups: PCF stopping at C7, T1, or T2. Specimens were tested in their native state, following a simulated PCF, and after cyclic loading. Specimens were loaded in flexion-extension), lateral bending, and axial rotation. Three-dimensional kinematics were recorded to evaluate ROM.

Results:

The C7 group had greater flexion-extension motion than the T1 and T2 groups following instrumentation (10.17±0.83 degree vs. 2.77±1.66 degree and 1.06±0.55 degree,P<0.001), and after cyclic loading (10.42±2.30 degree vs. 2.47±0.64 degree and 1.99±1.23 degree,P<0.001). There was no significant difference between the T1 and T2 groups. The C7 group had greater lateral bending ROM than both thoracic groups after instrumentation (8.81±3.44 degree vs. 3.51±2.52 degree,P=0.013 and 1.99±1.99 degree,P=0.003) and after cyclic loading. The C7 group had greater axial rotation motion than the thoracic groups (4.46±2.27 degree vs. 1.26±0.69 degree,P=0.010; and 0.73±0.74 degree,P=0.003) following cyclic loading.

Conclusion:

Motion at the cervicothoracic junction is significantly greater when a multilevel PCF stops at C7 rather than T1 or T2. This is likely attributable to the transition from a flexible cervical spine to a rigid thoracic spine. Although this does not account for in vivo fusion, surgeons should consider extending multilevel PCF constructs to T1 when feasible.

Level of Evidence:

Not applicable.

Research Organization:: Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States)

Sponsoring Organization:: USDOE Office of Science (SC)

DOE Contract Number:: SC0014664

OSTI ID:: 2425845

Journal Information:: Clinical Spine Surgery, Journal Name: Clinical Spine Surgery Journal Issue: 5 Vol. 36; ISSN 2380-0186

Publisher:: Wolters Kluwer Health

Country of Publication:: United States

Language:: English

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