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A biomechanical analysis of decompression and reconstruction methods in the cervical spine. Emphasis on a carbon-fiber-composite cage

The Journal of Bone & Joint Surgery.  1993; 75:1674-1684 
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Abstract

Biomechanical analysis of three different patterns of instability--that created by fifth and sixth cervical anterior discectomy, that created by one-level (fifth cervical) anterior corpectomy, and that created by two-level (fourth and fifth cervical) corpectomy--was performed in eighteen calf spines. Three types of anterior reconstruction--anterior iliac strut bone-grafting, use of an anterior carbon-fiber-composite cage packed with cancellous bone graft, as well as use of polymethylmethacrylate anteriorly--were cyclically tested in axial compression, torsion, and flexion-extension. Each of these types of reconstruction was also tested with supplemental posterior wire stabilization (the triple-wire technique of Bohlman). Regardless of the type of anterior instability, the carbon-fiber-reinforced cage packed with cancellous bone graft was more rigid than the iliac bone graft alone. The cage resulted in good stiffness in the axial compression and rotation tests and was the most rigid construct in the flexion-extension tests. The superior aspect of the polymethylmethacrylate constructs loosened at the bone-cement interface in eight of the twelve specimens during flexion-extension testing. The addition of the supplemental posterior wiring to the anterior constructs provided additional rigidity in flexion-extension testing.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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