Stress Changes in Intervertebral Discs of the Cervical Spine Due to Partial Discectomies and Fusion

2009 ◽  
Vol 131 (5) ◽  
Author(s):  
Abraham Tchako ◽  
Ali M. Sadegh
Keyword(s):  
Cervical Spine ◽  
Bone Graft ◽  
Vertebral Body ◽  
Surgical Procedure ◽  
Donor Site ◽  
Compressive Force ◽  
High Rate ◽  
Flexion Extension ◽  
Stress Changes ◽  
Autologous Bone

Spine discectomy and fusion is a widely used surgical procedure to correct irreversible degenerative diseases and injuries to the intervertebral disk. The surgical procedure involves the removal of the damage disk material, the decortication of the fusion site, and the placement of the bone graft. Fusion is believed to generate additional stresses in the neighboring disks, which can subsequently lead to new disk degeneration and re-operation. The autologous bone has proven to be the best material for the fusion. However, the autologous bone has three major disadvantages: the high rate of donor site morbidity, the limited and sometimes poor quality of the amounts of bone available, and the extra operative time needed for harvest. For these reasons this study is undertaken to estimate the optimum amount of bone graft needed for a discectomy and correlate it to the change in stress in adjacent levels. A detailed and validated 3D finite element model of the complete human cervical spine (C1-T1) was altered to simulate segmental full and partial discectomies. One full fusion (bone graft occupies about 90% of the vertebral body) and seven partial fusions (bone graft occupies about 10%, 20%, 30%, 40%, 50%, 65%, and 75% of the vertebral body) were simulated at each of the four mid- and lower single levels of the cervical spine and the relationship between the change in stresses in the adjacent levels and the bone graft size (area) was studied. The changes in stress were compared with the previously obtained results of the unfused models. The fused and unfused models were preloaded with a 73.6 N compressive force representing the weight of the head and with a 1.5 Nm physiological moment in flexion, extension, lateral bending, and axial rotation. More than 132 cases were analyzed. The results showed that the necessary amount of bone graft needed for discectomy depends on the cervical disk level to be fused and varies between 30% and 75% of the disk area. The results also suggested that there is a threshold size of the bone graft area, before and/or after which, the long-term effects of the change in stresses in adjacent disks are biomechanically consequential.

Effects of Vertebral Body Changes on Cervical Spine Load Sharing

2002 ◽  
Author(s):  
Jiangyue Zhang ◽  
Narayan Yoganandan ◽  
Frank A. Pintar
Keyword(s):  
Cervical Spine ◽  
Young’S Modulus ◽  
Vertebral Body ◽  
Modulus Of Elasticity ◽  
Young's Modulus ◽  
Compressive Force ◽  
Axial Compressive Force ◽  
Inferior Surface ◽  
Biomechanical Behavior ◽  
Young’S Modulus Of Elasticity

The objective of the study was to determine the effects of changes in the Young’s modulus of elasticity of the cancellous bone that occur due to the ageing process on the biomechanical behavior of the cervical spine. An anatomically accurate three-dimensional (3-D) nonlinear finite element model of the C4-C5-C6 cervical spinal unit was used. The inferior surface of the C6 vertebrae was fixed in all degrees of freedom, and external loads were applied to the top surface of the C4 vertebra. The model was exercised under an axial compressive force of 754 N. In addition, flexion and extension bending moments of 3.44 Nm were applied individually to the model. The effects of ageing on bone strength were simulated by decreasing the Young’s modulus of elasticity from 100 MPa in the healthy spine to 40 MPa in the degenerated spine. The degenerated spine was found to be more flexible than the healthy spine. In addition, the degenerated spine responded with increased forces in the outer anterior and posterior regions of the vertebral body. Furthermore, forces in the facet joints increased in the degenerated spine. In contrast, the middle region of the disc showed decreased forces. These increases in the forces leading to stress risers may explain the occurrence of osteophytes in the spine with age.

Vulnerability of the subcostal nerve to injury during bone graft harvesting from the iliac crest

2004 ◽  
Vol 1 (1) ◽  
pp. 87-89 ◽  
Author(s):  
Dean Chou ◽  
Phillip B. Storm ◽  
James N. Campbell
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Donor Site ◽  
Autologous Bone Graft ◽  
Content Type ◽  
Bone Harvesting ◽  
Cutaneous Branch ◽  
Bone Graft Harvesting ◽  
Autologous Bone ◽  
Fine Print

Object. Autologous bone graft harvesting from the iliac crest remains the gold standard for fusion surgery. One disadvantage of autologous bone harvesting is the patient's enduring postoperative pain at the donor site. Nerve injury is one of the postulated mechanisms that may account for this pain. The object of this study was to determine whether the lateral cutaneous branch of the subcostal nerve is vulnerable to injury in the process of obtaining grafts from the anterior iliac crest. Methods. Anatomical dissections were performed on 10 cadaveric specimens to ascertain the size of the T-12 subcostal nerve and its position in relation to the iliac crest. Conclusions. The lateral cutaneous branch of the subcostal nerve may lie as close as 6 cm from the anterior superior iliac spine. This nerve is very vulnerable to injury when harvesting bone from the anterior iliac crest. Knowledge of the anatomy may decrease the risk of injury to this nerve.

scholarly journals Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

2019 ◽  
pp. 1-3
Author(s):  
Ahmed Aljawadi ◽  
Mazin Al-salihy ◽  
Anand Pillai ◽  
Noman Niazi
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Calcium Sulphate ◽  
Autologous Bone Graft ◽  
Donor Site Morbidity ◽  
First Case ◽  
Masquelet Technique ◽  
Autologous Bone ◽  
Segmental Bone ◽  
Bone Void

Introduction: Large traumatic bone voids are challenging to treat. Autografts are associated with donor site morbidity and limited availability. Bone graft substitutes are successful alternative to fill bone voids. Case Presentation: The management of two patients with an open tibial fracture with segmental bone loss and other patient with periarticular calcaneal void associated with chondral loss. Treatment and outcomes: For first case, a contained cavity was made using Septocoll E, an absorbable collagen fleece, to mimic a pseudo-membrane using Masquelet-technique. Bone void was filled with Cerament-G and autologous bone graft. Second case with large peri-articular calcaneal void and chondral loss, Cerament-G and autologous bone graft were used, and articular defect reconstruction was done with synthetic chondral tissue. Both patients had painless mobility and consolidation of bone void. Discussion: We represent two exceptional cases of traumatic bone void which were treated with modified masquelet/modified AMIC with Cerament Bio-Composite with satisfactory outcomes

scholarly journals Systemic Administration of PTH Supports Vascularization in Segmental Bone Defects Filled with Ceramic-Based Bone Graft Substitute

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 2058
Author(s):  
Holger Freischmidt ◽  
Jonas Armbruster ◽  
Emma Bonner ◽  
Thorsten Guehring ◽  
Dennis Nurjadi ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Bone Grafts ◽  
Bone Graft Substitute ◽  
Therapeutic Strategies ◽  
Care Providers ◽  
Sprague Dawley ◽  
Duration Of Treatment ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Non-unions continue to present a challenge to trauma surgeons, as current treatment options are limited, duration of treatment is long, and the outcome often unsatisfactory. Additionally, standard treatment with autologous bone grafts is associated with comorbidity at the donor site. Therefore, alternatives to autologous bone grafts and further therapeutic strategies to improve on the outcome and reduce cost for care providers are desirable. In this study in Sprague–Dawley rats we employed a recently established sequential defect model, which provides a platform to test new potential therapeutic strategies on non-unions while gaining mechanistic insight into their actions. The effects of a combinatorial treatment of a bone graft substitute (HACaS+G) implantation and systemic PTH administration was assessed by µ-CT, histological analysis, and bio-mechanical testing and compared to monotreatment and controls. Although neither PTH alone nor the combination of a bone graft substitute and PTH led to the formation of a stable union, our data demonstrate a clear osteoinductive and osteoconductive effect of the bone graft substitute. Additionally, PTH administration was shown to induce vascularization, both as a single adjuvant treatment and in combination with the bone graft substitute. Thus, systemic PTH administration is a potential synergistic co-treatment to bone graft substitutes.

Kinematics of the Cervical Spine: Path of the Instant Axis of Rotation in Flexion and Extension

2000 ◽  
Author(s):  
Denis J. DiAngelo ◽  
Keith Vossel ◽  
Kevin T. Foley
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Measurement System ◽  
Axis Of Rotation ◽  
Rotational Components ◽  
Flexion Extension ◽  
Vertebral Kinematics ◽  
Set Up ◽  
Flexion And Extension

Abstract Previous Biomechanical Measures of Vertebral Kinematics. White and Panjabi (1990) have suggested that the Instant Axis of Rotation (IAR) be used to describe the 2-D motion of a vertebral body. However, the location of the IAR for the cervical spine varies amongst spine researchers. White and Panjabi (1990) have suggested the IAR of each vertebra is located in the anterior region of the subjacent vertebra; Porterfield and Derosa (1995) suggest it is located in the mid-region of the subjacent vertebra; and Mameren et al. (1992) found it to lay in the central region of the vertebral body being tracked. Goel and Winterbottom (1991) stated that during flexion and extension, the axis of rotation is located somewhere within the vertebral body itself. Unfortunately, no accurate calculations of the IAR paths of the cervical spine exist; typical vertebral measurements only include the rotational components. Estimation of the vertebrae’s IAR location in vitro depends on the experimental set-up (motion and loading mechanics), anatomical structure, mathematical reduction technique, and accuracy of the measurement equipment. Crisco et al. (1994) determined the theoretical error in calculating the location of the IAR as a function of the measurement system specifications and the placement of the markers on the spinal body. Conventional tracking systems having translational resolutions of 0.1mm to 0.05mm were found to calculate the location of the IAR to within 7mm to 10mm, respectively. This error became significantly larger as the resolution of the measurement system dropped off. Most investigators only calculate the rotational components of a body’s motion and seldom calculate the error involved in their mathematical analysis. Furthermore, overall head movement is often reported (i.e., C0 to T1), but smaller flexion-extension movements of individual spinal bodies are either void in the literature or suspect to large theoretical errors. The objective of the study was to determine the IAR of the sub-axial cervical vertebral bodies under physiological flexion and extension conditions in vitro.

scholarly journals Our first experience with cervical expandable cage for vertebral body reconstruction

2016 ◽  
Vol 30 (1) ◽  
pp. 41-46
Author(s):  
A. Chiriac ◽  
Z. Faiyad ◽  
C. Popescu ◽  
B. Costachescu ◽  
I. Poeata
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Surgical Procedure ◽  
Expandable Cage ◽  
Thoracic Level ◽  
Expandable Cages ◽  
Cervical Vertebral Body

Abstract Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM)

Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome

2020 ◽  
pp. 193864002091626
Author(s):  
Farough Khademi ◽  
Amirhossein Erfani ◽  
Mohammad Ali Erfani ◽  
Amir Reza Vosoughi
Keyword(s):  
Bone Graft ◽  
Sural Nerve ◽  
Donor Site ◽  
Case Series ◽  
Pathologic Fracture ◽  
Lateral Wall ◽  
Autologous Bone Graft ◽  
Hematoma Formation ◽  
Bone Graft Harvesting ◽  
Autologous Bone

Background: The aim of this study was to evaluate the complications following calcaneal autologous bone graft harvesting using an osteotome in patients who underwent foot and ankle surgery with follow-up of at least 1 year. Methods: In a cohort study, all consecutive patients underwent forefoot or midfoot surgeries in conjunction with harvesting bone graft from the calcaneus using lateral wall corticotomy technique by an osteotome from 2015 till 2018 were asked to follow. The outcome and morbidity were assessed by visual analogue scale (VAS) pain, numbness in territory of the sural nerve, surgical site numbness or tenderness, infection, hematoma formation, or pathologic fracture. Also any possible restrictions on wearing desired shoes were asked. Results: Totally, 50 patients (11 males, 39 females; 29 right foot, 21 left foot) with the mean age of 48.2 ± 13.8 years (range 8-66 years) were assessed. There were no major complications on donor site such as infection, hematoma formation, or pathologic fracture. The following results were seen; 90% without any pain (VAS 0/10), 96% without numbness at the incision site, 96% without point tenderness on lateral of heel, 98% without paresthesia or numbness in the sural nerve territory, and 84% were able to wear their favorite shoes. Forty-one (82%) cases said if they need another foot surgery, they would permit to harvest bone graft from their heel. Conclusions: Autologous bone graft harvesting from the calcaneus using lateral wall corticotomy technique by an osteotome could be a useful method with very low complications. Levels of Evidence: Therapeutic, level IV: cohort, case series

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