Comparative Study On The Application Of 3D Printed Artificial Vertebral Body And Traditional Titanium Cage In Anterior Cervical Corpectomy And Fusion Surgery

Objective:Anterior Cervical Corpectomy and Fusion(ACCF)is a common surgical approach for cervical spondylotic myelopathy with definite clinical efficacy.The surgery can directly remove anterior spinal compression to improve spinal cord function and sagittal balance of cervical spine.Multiple studies have found that sagittal position balance parameters of cervical spine play an important role in evaluating postoperative clinical efficacy and stability of cervical spine.The purpose of this study was to compare the clinical effects and changes of sagittal balance between the 3D printed artificial vertebral body and the traditional titanium cage in ACCF,so as to further explore whether the 3D printed artificial vertebral body has advantages over the traditional titanium cage in clinical application,and provide reference for clinical surgical application.Methods:A retrospective analysis was performed on fifty patients with cervical spondylotic myelopathy who underwent single vertebral body ACCF in the spinal surgery Department of the Affiliated Hospital of Chengde Medical College from June 2017 to June 2020 were retrospectively analyzed.Among them,25 patients received 3D printing artificial vertebral body during ACCF surgery(observation group)and 25 patients received traditional titanium cage during ACCF surgery(control group).Preoperative data of patients:name,gender and age were collected and recorded.Operation time,intraoperative blood loss and C-arm fluoroscopy times were recorded and compared between the two groups.Before surgery,3 days after surgery,3months after surgery and at the last follow-up,the changes of vertebral anterior margin height H1,vertebral posterior margin height H2,C2-7Cobb Angle,C2-7SVA and T1 inclination Angle of the last completely resected segment on lateral cervical radiographs of the patients were recorded,and the correlation between imaging parameters at each follow-up time node of the two groups was observed and analyzed.The Japanese Orthopaedic Association(JOA)score was used to evaluate the improvement of neurological function,and the visual analogue scale(VAS)was used to evaluate the improvement of neck pain.The fusion of 3D printed artificial vertebra and titanium cage was judged by Kandziora criteria during postoperative follow-up.Results:There were no significant differences in operative time,intraoperative blood loss and C-arm fluoroscopy times between the two groups(P > 0.05).JOA score and VAS score in each postoperative period in 2 groups were significantly improved compared with that before surgery,with statistical significance(P<0.05),but there was no significant statistical difference between groups at the same period after surgery(P > 0.05).Intervertebral height and sagittal parameters at each period in the two groups were significantly improved after surgery(P<0.05),but there was no significant difference between the two groups in the above indexes before and 3 days after surgery(P > 0.05),and there was statistical difference in the follow-up data of the two groups at the last follow-up(P<0.05).At the last follow-up,19 patients in the observation group had subsidence of the artificial vertebral body,with the subsidence height ranging from 0.1mm to 0.9mm,without serious subsidence.In the control group,20 cases sank under the titanium cage,with subsidence of 1.3 to 3.5mm,and 4 cases seriously sank.The sinking distance of the 3D printed artificial vertebra body in the observation group was smaller than that in the control group,and the difference was statistically significant(P< 0.05).Conclusions:In patients with cervical spondylotic myelopathy,the application of 3D printed artificial vertebral body and traditional titanium cage in ACCF surgery can restore the height between vertebral bodies,support the cervical spine,rebuild the stability of the cervical spine and restore the physiological curvature of the cervical spine,and improve the cervical sagittal position imbalance.However,compared with titanium cage,the 3D printed artificial vertebral body is not easy to settle,which can slow down the settlement of the postoperative supporting prosthesis,and then maintain the height of the decompression vertebral body and the physiological curvature of the cervical spine in a long and stable way.In terms of maintaining the height and sagittal position balance between the vertebral bodies after surgery,the 3D printed artificial vertebral body is obviously superior to the traditional titanium cage.