Anterior cervical discectomy and fusion (ACDF) is one of the most common cervical spine surgery procedures performed worldwide. ACDF utilizes autologous bone graft (autograft) from the iliac crest to induce fusion between neighboring vertebrae following the procedure. The iliac crest is widely considered the gold-standard autograft for ACDF procedures due to its osteoinductive, osteoconductive, and osteointegrative properties. However, harvesting from a second surgical site, as seen with iliac crest autograft, is commonly associated with short- and long-term complications.
To mitigate iliac crest harvest site complications, a novel autograft location must be identified. The adjacent cervical vertebral body has been identified as a potential alternative donor site to the iliac crest. Previous studies have shown that this novel autograft site does not biomechanically compromise the vertebral body harvest site and has demonstrated clinically successful fusion rates comparable to those of the iliac crest. Despite prior successful fusion, a direct morphological and mechanical comparison between autograft from the adjacent cervical vertebra and iliac crest has not been thoroughly investigated.
The primary goal of this thesis was to morphologically and mechanically compare the cervical spine and iliac crest. It was hypothesized that the cervical spine and iliac crest would not significantly vary in their morphological properties; however, due to daily physiological loading at each graft location, it was hypothesized that the two graft locations would differ mechanically.
A clinical model utilizing iliac crest and cervical vertebral bone from human donors was characterized at the meso- and microscale to quantify morphological properties and collagen organization using micro-computed tomography (microCT) and second-harmonic generation (SHG) imaging modalities, respectively. A pre-clinical large animal model was used to characterize the mechanical and material properties of lumbar spine tissue, under similar physiological loading as the cervical spine, relative to the iliac crest through uniaxial compression testing.
No significant difference was identified in the morphological and collagen organization properties in tissue from a human clinical cohort; however, directionality and anatomical location significantly impacted the mechanical and material properties in a bovine comparative anatomy model. Here, trabecular bone from the lumbar vertebra was found to be transversely isotropic whereas iliac crest trabecular bone was nearly isotropic; thus, directionality and anatomical location should be considered and quantified when selecting autograft tissue for future ACDF surgeries.
Further characterization of the mechanical properties of cervical vertebral tissue and determination of correlations between directionality, anatomical location, and morphology through microCT and compression testing should be completed before adopting the cervical vertebra as the gold standard autograft for ACDF procedures. / Master of Science / Anterior cervical discectomy and fusion (ACDF) is a common upper spine surgery that helps to stabilize the spine by fusing two or more vertebrae together. To achieve this fusion, surgeons often use bone grafts taken from the patient's own hip, specifically the iliac crest. While this method is effective, it can lead to complications at the hip bone harvest site.
To avoid these complications, researchers are exploring the possibility of using bone from a nearby vertebra in the upper spine as an alternative graft source. Early studies suggest that using bone from the upper spine does not weaken the spine and achieves similar success rates in fusion as the hip bone. However, a detailed comparison between both graft sites has not been thoroughly investigated until now.
The main goal of this thesis was to compare the bone from the upper spine and the hip in terms of structure and strength. It was expected that the two types of bone would be similar in structure but different in strength due to difference forces they experience in the body.
The research involved examining human bone samples from both the upper spine and hip using advanced imaging techniques to analyze their structure and collagen organization. Additionally, a large animal comparative model was used to test the strength and material properties of bone from the lower spine and hip, which experience similar forces as the human upper spine and hip.
The findings showed no significant difference in the structure and collagen organization of the human bone samples. However, in the animal model, the strength and material properties of the bone significantly varied depending on the direction and location. Bone from the lower spine was found to be significantly stronger in one direction in comparison to two other directions in the lower spine and all three directions in the hip.
These results suggest that when choosing bone for fusion in ACDF surgeries, it is important to consider the direction and location of the graft. Further research is needed to fully understand the mechanical properties of upper spine bone and to confirm its suitability as a standard graft for ACDF procedures.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/120813 |
| Date | 31 July 2024 |
| Creators | Comer, Jackson Simon |
| Contributors | Department of Biomedical Engineering and Mechanics, Collins, Caitlyn Jayne, Kemper, Andrew R., Gray, David Todd |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | ETD, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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