In vitro evaluation of stiffness and load sharing in a two-level corpectomy: comparison of static and dynamic cervical plates

Abstract 

Background context

Anterior cervical plating has been accepted in corpectomy and fusion of the cervical spine. Constrained plates were criticized for stress shielding that may lead to subsidence and pseudarthrosis. A dynamic plate allows load sharing as the graft subsides. Ideally, the dynamic plate design should maintain adequate stiffness of the construct while providing a reasonable load sharing with the strut graft.

Purpose

The purpose of the study was to compare dynamic and static plate kinematics with graft subsidence.

Study design/setting

The study designed was an in vitro biomechanical study in a porcine cervical spine model.

Methods

Twelve spines were initially tested in intact condition with 20-N axial load in 15 degrees of flexion and extension range of motion (ROM). Then, a two-level corpectomy was created in all specimens with spines randomized to receive either a static or dynamic plate. The spines were retested under identical conditions with optimal length and undersized graft. Range of motion and graft loading were analyzed with a one-way analysis of variance (p<.05).

Results

Both plates significantly limited ROM compared with the intact spine in both graft length conditions. In extension graft, load was significantly higher (p=.001) in the static plate with optimal length, and in flexion, there was a significant loss of graft load (p=.0004). In flexion, the dynamic plate with undersized graft demonstrated significantly more load sustained (p=.0004).

Conclusions

Both plates reasonably limited the ROM of the corpectomy. The static plate had significantly higher graft loads in extension and significant loss of graft load in flexion, whereas the dynamic plate maintained a reasonable graft load in ROM even when graft contact was imperfect.

Keywords: Adult, Biomechanics, Bone plates, Cadaver, Cervical vertebrae, Human