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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 161-166. doi: 10.19723/j.issn.1671-167X.2024.01.025

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Clinical outcomes of 3D-printing stand-alone artificial vertebral body in anterior cervical surgeries

Panpan HU,Yan LI,Xiao LIU,Yanchao TANG,Zihe LI,Zhongjun LIU*()   

  1. Department of Orthopaedics, Peking University Third Hospital; Engineering Research Center of Bone and Joint Precision Medicine; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
  • Received:2023-02-07 Online:2024-02-18 Published:2024-02-06
  • Contact: Zhongjun LIU E-mail:zjliu@bjmu.edu.cn
  • Supported by:
    Institutional Clinical Research Incubating Projects of Peking University Third Hospital(BYSYZD2022023)

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Abstract:

Objective: To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body (AVB) in the surgical procedure of anterior cervical corpectomy and fusion (ACCF). Methods: Following the proposal of IDEAL (idea, development, exploration, assessment, and long-term follow-up) framework, we designed and conducted this single-armed, retrospective cohort study. The patients with cervical spondylotic myelopathy were recruited, and these patients exclusively received the surgical procedure of single-level ACCF in our single center. After the process of corpectomy, the size was tailored using different trials and the most suitable stand-alone AVB was then implanted. This AVB was manufactured by the fashion of 3D-printing. Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies, to stabilize the AVB. The participants were regularly followed-up after the operation. Their clinical data were thoroughly reviewed. We assessed the neurological status according to Japanese Orthopedic Association (JOA) scale. We determined the fusion based on imaging examination six months after the operation. The recorded clinical data were analyzed using specific software and they presented in suitable styles. Paired t test was employed in comparison analysis. Results: In total, there were eleven patients being recruited eventually. The patients were all followed up over six months after the operation. The mean age of the cohort was (57.2±10.2) years. The mean operation time was (76.1±23.1) min and the median bleeding volume was 150 (100, 200) mL. The postoperative course was uneventful for all the cases. Dysphagia, emergent hematoma, and deterioration of neurological function did not occur. Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up, which were significantly different (P < 0.001). The mean recovery rate of neurological function was 85.9%. By comparing the imaging examinations postoperatively and six months after the operation, we found that the average subsidence length was (1.2±1.1) mm, and that there was only one cases (9.1%) of the severe subsidence (>3 mm). We observed significant improvement of cervical lordosis after the operation (P=0.013). All the cases obtained solid fusion. Conclusion: 3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study. The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.

Key words: Artificial vertebral body, Stand-alone, Zero-profile, 3D-printing, Cervical spondylotic myelopathy

CLC Number: 

  • R687.3

Figure 1

Stand-alone artificial vertebral body for the cervical spine"

Figure 2

Fluoroscopy images during operation show the effect of compressing A, little space presented between implant and endplates after nailing one screw; B, implant-endplate disappeared, and good attachment was achieved."

Table 1

Clinical features of the recruited patients"

Items Values
Age/years，$\bar x \pm s$ 57.2±10.7
Gender，male/female 7/4
BMI/(kg/m2)，$\bar x \pm s$ 24.6±2.7
Operative segment, n(%)
    C3 1(9.1)
    C4 1 (9.1)
    C5 7 (63.6)
    C6 2 (18.2)
Operative time/min，$\bar x \pm s$ 76.1±23.1
Blood loss/mL, M(min, max) 150 (100, 200)
Height loss of adjacent vertebra/mm，$\bar x \pm s$ 1.17±1.18
Severe subsidence, n(%) 1 (9.1)
Solid fusion, n(%) 11 (100)
Neurological recovery rate/%，$\bar x \pm s$ 85.9±13.2

Table 2

Changes of clinical symptoms and cervical lordosis after the operation"

Items Preoperatively Final follow-up P value
Neck pain 3.3±2.5 0.64±1.12 0.001
JOA scores 13.2±2.2 16.3±0.8 < 0.001
NDI scores 14.2±5.2 3.4±2.1 < 0.001
Global lordosis angle/(°) 10.6±9.6 17.0±15.4 0.013

Figure 3

Illustrative case presents firm bony fusion at the final follow-up A, decreased lordosis curve on lateral X-ray; B, multi-level disc herniation on magnetic resonance imaging; C, lateral X-ray before discharge; D, lateral X-ray at the final follow-up; E, sagittal reconstruction film of CT scan at the final follow-up."

Figure 4

Wide application of stand-alone artificial vertebral body in adjacent vertebral disease, multilevel surgery and spinal tumor surgery A, surgery of adjacent vertebral disease; B, combination with a Zero-P cage; C, application in spinal metastatic cases."

1 Lv Y , Tian W , Chen D , et al. The prevalence and associated factors of symptomatic cervical spondylosis in Chinese adults: A community-based cross-sectional study[J]. BMC Musculoskelet Disord, 2018, 19 (1): 325.
doi: 10.1186/s12891-018-2234-0
2 Bakhsheshian J , Mehta VA , Liu JC . Current diagnosis and management of cervical spondylotic myelopathy[J]. Global Spine J, 2017, 7 (6): 572- 586.
doi: 10.1177/2192568217699208
3 蔡钦林. 颈椎病的手术治疗(一)[J]. 中国脊柱脊髓杂志, 1996, (2): 42- 45.
4 Böhler J , Gaudernak T . Anterior plate stabilization for fracture-dislocations of the lower cervical spine[J]. J Trauma, 1980, 20 (3): 203- 205.
doi: 10.1097/00005373-198003000-00002
5 Orozco-Declos R , Llovet-Tapies J . Osteosintesis en las fracturas del raquis cervical: Nota técnica[J]. Rev Ortop Traumatol, 1970, 14, 285- 288.
6 袁文, 贾连顺, 倪斌. 前路椎体次全切除减压及带锁钢板固定治疗脊髓型颈椎病[J]. 中华外科杂志, 2000, 38 (3): 182- 184.
7 毛志国, 袁文, 贾连顺, 等. 钛质网笼内植物加前路带锁钢板对颈椎稳定性的生物力学评价[J]. 中国脊柱脊髓杂志, 2001, 11 (6): 355- 357.
doi: 10.3969/j.issn.1004-406X.2001.06.010
8 Qin R , Chen X , Zhou P , et al. Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: A meta-analysis[J]. Eur Spine J, 2018, 27 (6): 1375- 1387.
doi: 10.1007/s00586-017-5451-6
9 Wang T , Tian XM , Liu SK , et al. Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade[J]. Medicine (Baltimore), 2017, 96 (12): e6421.
doi: 10.1097/MD.0000000000006421
10 Lin Q , Zhou X , Wang X , et al. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy[J]. Eur Spine J, 2012, 21 (3): 474- 481.
doi: 10.1007/s00586-011-1961-9
11 Joaquim AF , Murar J , Savage JW , et al. Dysphagia after anterior cervical spine surgery: A systematic review of potential preventative measures[J]. Spine J, 2014, 14 (9): 2246- 2260.
doi: 10.1016/j.spinee.2014.03.030
12 Barbagallo GM , Romano D , Certo F , et al. Zero-P: A new zero-profile cage-plate device for single and multilevel ACDF. A single institution series with four years maximum follow-up and review of the literature on zero-profile devices[J]. Eur Spine J, 2013, 22 (Suppl 6): S868- S878.
13 Njoku I Jr , Alimi M , Leng LZ , et al. Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: A clinical and radiological study[J]. J Neurosurg Spine, 2014, 21 (4): 529- 537.
doi: 10.3171/2014.6.SPINE12951
14 Tohamy MH , Osterhoff G , Abdelgawaad AS , et al. Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe[J]. BMC Musculoskelet Disord, 2022, 23 (1): 20.
doi: 10.1186/s12891-021-04883-5
15 Zhou H , Liu S , Li Z , et al. 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors[J]. J Neurosurg Spine, 2022, 25, 1- 9.
16 Hu P , Du S , Wei F , et al. Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh[J]. Front Oncol, 2022, 12, 1065303.
doi: 10.3389/fonc.2022.1065303
17 Yang J , Cai H , Liu Z , et al. In vivo study of a self-stabilizing artificial vertebral body fabricated by electron beam melting[J]. Spine (Phila Pa 1976), 2014, 39 (8): E486- E492.
doi: 10.1097/BRS.0000000000000211
18 Bazaz R , Lee MJ , Yoo JU . Incidence of dysphagia after anterior cervical spine surgery: A prospective study[J]. Spine (Phila Pa 1976), 2002, 27 (22): 2453- 2458.
doi: 10.1097/00007632-200211150-00007
19 Kanayama M , Hashimoto T , Shigenobu K , et al. Pitfalls of anterior cervical fusion using titanium mesh and local autograft[J]. J Spinal Disord Tech, 2003, 16 (6): 513- 518.
doi: 10.1097/00024720-200312000-00005
20 Wei F , Xu N , Li Z , et al. A prospective randomized cohort study on 3D-printed artificial vertebral body in single-level anterior cervical corpectomy for cervical spondylotic myelopathy[J]. Ann Transl Med, 2020, 8 (17): 1070.
doi: 10.21037/atm-19-4719
21 Liu Y , Qi M , Chen H , et al. Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy[J]. Eur Spine J, 2012, 21 (12): 2428- 2435.
doi: 10.1007/s00586-012-2323-y
22 Ji C , Yu S , Yan N , et al. Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion[J]. BMC Musculoskelet Disord, 2020, 21 (1): 32.
doi: 10.1186/s12891-019-3036-8
23 Mohammad-Shahi MH , Nikolaou VS , Giannitsios D , et al. The effect of angular mismatch between vertebral endplate and vertebral body replacement endplate on implant subsidence[J]. J Spinal Disord Tech, 2013, 26 (5): 268- 273.
doi: 10.1097/BSD.0b013e3182425eab
24 Chen Y , Chen D , Guo Y , et al. Subsidence of titanium mesh cage: A study based on 300 cases[J]. J Spinal Disord Tech, 2008, 21 (7): 489- 492.
doi: 10.1097/BSD.0b013e318158de22
25 Cheng H , Luo G , Xu D , et al. Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis[J]. Front Surg, 2023, 9, 1077551.
doi: 10.3389/fsurg.2022.1077551
26 Jiang SD , Jiang LS , Dai LY . Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: A systematic review[J]. Arch Orthop Trauma Surg, 2012, 132 (2): 155- 161.
doi: 10.1007/s00402-011-1402-6
27 Riley LH 3rd , Skolasky RL , Albert TJ , et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study[J]. Spine (Phila Pa 1976), 2005, 30 (22): 2564- 2569.
doi: 10.1097/01.brs.0000186317.86379.02
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