Comparison of the therapeutic effects of traditional titanium mesh and 3D printed artificial vertebral bodies in single segment anterior cervical corpectomy and fusion(ACCF)

English Keywords:Anterior cervical corpectomy and fusion  3D printing of artificial vertebral bodies  Traditional titanium mesh  Comparison of therapeutic effects

English Abstract:

  【Abstract】 Objectives: To analyze and compare the clinical efficacy of traditional titanium mesh and three-dimensional(3D) printed artificial vertebral bodies in anterior cervical corpectomy and fusion(ACCF). Methods: A retrospective analysis was conducted on 42 patients with cervical spondylotic myelopathy who underwent single segment ACCF at our hospital from January 2015 to January 2024. The patients were divided into a traditional titanium mesh group(n=22, 9 males and 13 females, aged 60.6±10.0 years) and a 3D printed artificial vertebral body group(n=20, 10 males and 10 females, aged 55.5±8.3 years) based on the type of implant. There was no statistical difference between the two groups in age, gender, body mass index(BMI), as well as affected segments(P>0.05). The operative time, intraoperative blood loss, and length of hospital stay, as well as imaging parameters(C2-7 Cobb angle), neurological function[Japanese Orthopaedic Association(JOA) score and Nurick grading], neck pain visual analogue scale(VAS) score, and neck disability index(NDI) before operation, at postoperative 3d and 1 year were recoreded and compared between the two groups, meanwhile, the postoperative cage deposition and other complications were also analyzed and compared. Results: There was no significant difference in the operative time between the two groups of cases(P>0.05). The intraoperative blood loss and postoperative length of hospital stay of the 3D printed artificial vertebral body group were significantly lower than those in the traditional titanium mesh group(P<0.05). At each postoperative time point, both groups showed significant improvement in JOA scores, Nurick grading, VAS scores, and NDI scores compared to preoperative levels. However, there were no significant differences in JOA scores, Nurick grading, VAS scores, and NDI scores between the two groups of patients at preoperation, postoperative 3d, and postoperative 1 year. According to radiological measurement analysis, both groups of patients showed great improvement in the C2-7 Cobb angle after surgery, and 3D printed artificial vertebral body group was better than traditional titanium mesh group in C2-7 Cobb angle on postoperative 3d(20.2°±10.1° vs 13.8°±9.8°, P<0.05) and at 1 year follow-up(19.7°±10.2° vs 13.0°±9.7°, P<0.05). There was one case of cage settlement in the traditional titanium mesh group, while no cage settlement was found in the 3D printed artificial vertebral body group during follow-up. Conclusions: Both traditional titanium mesh and 3D printed artificial vertebral body in ACCF can effectively treat cervical spondylotic myelopathy and significantly improve patients′ symptoms. However, the application of 3D printed artificial vertebral bodies can significantly reduce intraoperative bleeding and postoperative hospitalization days for patients. Moreover, 3D printed artificial vertebral bodies have more advantages in maintaining the physiological structure of the cervical spine.