Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENG Jun ^1,2 ,  CHEN Jian ^1,2 , XIE Lizhong ² , FENG Shilong ² , ZHOU Jibin ² , ZHAN Fangbiao ²

1. Graduate Training Base of Jinzhou Medical University (Chongqing University Three Gorges Hospital), Wanzhou Chongqing, 404100, P. R. China;
2. Orthopedic Center, Chongqing University Three Gorges Hospital, Wanzhou Chongqing, 404100, P. R. China;

Corresponding author：

CHEN Jian, Email: 284262176@qq.com

Keywords：

Cervical ossification of posterior longitudinal ligament; titanium alloy trabecular bone three-dimensional printed artificial vertebral body; titanium cage; anterior cervical corpectomy and decompression; titanium plate internal fixation

DOI：

10.7507/1002-1892.202403003

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Objective To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional (3D) printed artificial vertebral body in treating cervical ossification of the posterior longitudinal ligament (OPLL). Methods A retrospective analysis was conducted on clinical data from 45 patients with cervical OPLL admitted between September 2019 and August 2021 and meeting the selection criteria. All patients underwent anterior cervical corpectomy and decompression, interbody bone graft fusion, and titanium plate internal fixation. During operation, 21 patients in the study group received titanium alloy trabecular bone 3D printed artificial vertebral bodies, while 24 patients in the control group received titanium cages. There was no significant difference in baseline data such as gender, age, disease duration, affected segments, or preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), vertebral height, and C_2-7Cobb angle (P>0.05). Operation time, intraoperative blood loss, and occurrence of complications were recorded for both groups. Preoperatively and at 3 and 12 months postoperatively, the functionality and symptom relief were assessed using JOA scores, VAS scores, and NDI evaluations. The vertebral height and C_2-7 Cobb angle were detected by imaging examinations and the implant subsidence and intervertebral fusion were observed. Results The operation time and incidence of complications were significantly lower in the study group than in the control group (P<0.05), while the difference in intraoperative blood loss between the two groups was not significant (P>0.05). All patients were followed up 12-18 months, with the follow-up time of (14.28±4.34) months in the study group and (15.23±3.54) months in the control group, showing no significant difference (t=0.809, P=0.423). The JOA score, VAS score, and NDI of the two groups improved after operation, and further improved at 12 months compared to 3 months, with significant differences (P<0.05). At each time point, the study group exhibited significantly higher JOA scores and improvement rate compared to the control group (P<0.05); but there was no significantly difference in VAS score and NDI between the two groups (P>0.05). Imaging re-examination showed that the vertebral height and C_2-7Cobb angle of the two groups significantly increased at 3 and 12 months after operation (P<0.05), and there was no significant difference between 3 and 12 months after operation (P>0.05). At each time point, the vertebral height and C_2-7Cobb angle of the study group were significantly higher than those of the control group (P<0.05), and the implant subsidence rate was significantly lower than that of the control group (P<0.05). However, there was no significant difference in intervertebral fusion rate between the two groups (P>0.05). Conclusion Compared to traditional titanium cages, the use of titanium alloy trabecular bone 3D-printed artificial vertebral bodies for treating cervical OPLL results in shorter operative time, fewer postoperative complications, and lower implant subsidence rates, making it superior in vertebral reconstruction.

Citation： CHENG Jun, CHEN Jian, XIE Lizhong, FENG Shilong, ZHOU Jibin, ZHAN Fangbiao. Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 535-541. doi: 10.7507/1002-1892.202403003 Copy

1.	Gao A, Yu M, Wei F, et al. One-stage posterior surgery with intraoperative ultrasound assistance for thoracic myelopathy with simultaneous ossification of the posterior longitudinal ligament and ligamentum flavum at the same segment: a minimum 5-year follow-up study. Spine J, 2020, 20(9): 1430-1437.
2.	Lee DH, Lee SK, Cho JH, et al. Efficacy and safety of oblique posterior endplate resection for wider decompression (trumpet-shaped decompression) during anterior cervical discectomy and fusion. J Neurosurg Spine, 2022, 38(2): 157-164.
3.	李玉伟, 李修智, 谷世锋, 等. 自稳定零切迹3D打印人工椎体在颈椎后纵韧带骨化症治疗中的应用观察. 中华医学杂志, 2024, 104(7): 526-532.
4.	王志强, 冯皓宇, 马迅, 等. 3D 打印人工椎体及椎间融合器在颈椎前路手术中应用的临床效果. 中国修复重建外科杂志, 2021, 35(9): 1147-1154.
5.	Oni P, Schultheiß R, Scheufler KM, et al. Radiological and clinical outcome after multilevel anterior cervical discectomy and/or corpectomy and fixation. J Clin Med, 2018, 7(12): 469. doi: 10.3390/jcm7120469.
6.	Ji H, Xie X, Zhuang S, et al. Comparative analysis of three types of titanium mesh cages for anterior cervical single-level corpectomy and fusion in term of postoperative subsidence. Am J Transl Res, 2020, 12(10): 6569-6577.
7.	Wei F, Li Z, Liu Z, et al. Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C₂. Ann Transl Med, 2020, 8(6): 332. doi: 10.21037/atm.2020.03.32.
8.	李玉伟, 王海蛟, 崔巍, 等. 超声刮匙在颈椎前路椎间盘切除融合术中应用的安全性和有效性评价. 中华医学杂志, 2020, 100(9): 669-673.
9.	Glinski AV, Takayanagi A, Elia C, et al. Surgical treatment of ossifications of the cervical anterior longitudinal ligament: a retrospective cohort study. Global Spine J, 2021, 11(5): 709-715.
10.	Kandziora F, Pflugmacher R, Scholz M, et al. Treatment of traumatic cervical spine instability with interbody fusion cages: a prospective controlled study with a 2-year follow-up. Injury, 2005, 36 Suppl 2: B27-B35.
11.	Li S, Peng J, Xu R, et al. Comparison of the surgeries for the ossification of the posterior longitudinal ligament-related cervical spondylosis: A PRISMA-compliant network meta-analysis and literature review. Medicine (Baltimore), 2021, 100(9): e24900. doi: 10.1097/MD.0000000000024900.
12.	Wang H, Yang R, Liu H, et al. Comparison of interventions for cervical ossification of posterior longitudinal ligament: a systematic review and network meta-analysis. World Neurosurg, 2021, 155: 1-12.
13.	姬林松, 王艳萍, 陆廷盛, 等. 3D打印多孔钛合金骨小梁融合器与自体髂骨治疗脊髓型颈椎病. 中国组织工程研究, 2022, 26(18): 2817-2822.
14.	McGilvray KC, Easley J, Seim HB, et al. Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model. Spine J, 2018, 18(7): 1250-1260.
15.	Lohberger B, Eck N, Glaenzer D, et al. Surface modifications of titanium aluminium vanadium improve biocompatibility and osteogenic differentiation potential. Materials (Basel), 2021, 14(6): 1574. doi: 10.3390/ma14061574.
16.	吴敏飞, 王洋, 矫健航, 等. 3D 打印椎间融合器在脊髓型颈椎病椎间盘摘除减压融合内固定术的应用效果. 中华骨与关节外科杂志, 2019, 12(2): 98-101.
17.	Girolami M, Sartori M, Monopoli-Forleo D, et al. Histological examination of a retrieved custom-made 3D-printed titanium vertebra: Do the fine details obtained by additive manufacturing really promote osteointegration? Eur Spine J, 2021, 30(10): 2775-2781.
18.	Yang JC, Ma XY, Xia H, et al. Clinical application of computer-aided design-rapid prototyping in C₁-C₂ operation techniques for complex atlantoaxial instability. J Spinal Disord Tech, 2014, 27(4): E143-E150.
19.	Fang T, Zhang M, Yan J, et al. Comparative analysis of 3D-printed artificial vertebral body versus titanium mesh cage in repairing bone defects following single-level anterior cervical corpectomy and fusion. Med Sci Monit, 2021, 27: e928022. doi: 10.12659/ MSM.928022. doi: 10.12659/MSM.928022.
20.	Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
21.	Burnard JL, Parr WCH, Choy WJ, et al. 3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J, 2020, 29(6): 1248-1260.

1. Gao A, Yu M, Wei F, et al. One-stage posterior surgery with intraoperative ultrasound assistance for thoracic myelopathy with simultaneous ossification of the posterior longitudinal ligament and ligamentum flavum at the same segment: a minimum 5-year follow-up study. Spine J, 2020, 20(9): 1430-1437.
2. Lee DH, Lee SK, Cho JH, et al. Efficacy and safety of oblique posterior endplate resection for wider decompression (trumpet-shaped decompression) during anterior cervical discectomy and fusion. J Neurosurg Spine, 2022, 38(2): 157-164.
3. 李玉伟, 李修智, 谷世锋, 等. 自稳定零切迹3D打印人工椎体在颈椎后纵韧带骨化症治疗中的应用观察. 中华医学杂志, 2024, 104(7): 526-532.
4. 王志强, 冯皓宇, 马迅, 等. 3D 打印人工椎体及椎间融合器在颈椎前路手术中应用的临床效果. 中国修复重建外科杂志, 2021, 35(9): 1147-1154.
5. Oni P, Schultheiß R, Scheufler KM, et al. Radiological and clinical outcome after multilevel anterior cervical discectomy and/or corpectomy and fixation. J Clin Med, 2018, 7(12): 469. doi: 10.3390/jcm7120469.
6. Ji H, Xie X, Zhuang S, et al. Comparative analysis of three types of titanium mesh cages for anterior cervical single-level corpectomy and fusion in term of postoperative subsidence. Am J Transl Res, 2020, 12(10): 6569-6577.
7. Wei F, Li Z, Liu Z, et al. Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C₂. Ann Transl Med, 2020, 8(6): 332. doi: 10.21037/atm.2020.03.32.
8. 李玉伟, 王海蛟, 崔巍, 等. 超声刮匙在颈椎前路椎间盘切除融合术中应用的安全性和有效性评价. 中华医学杂志, 2020, 100(9): 669-673.
9. Glinski AV, Takayanagi A, Elia C, et al. Surgical treatment of ossifications of the cervical anterior longitudinal ligament: a retrospective cohort study. Global Spine J, 2021, 11(5): 709-715.
10. Kandziora F, Pflugmacher R, Scholz M, et al. Treatment of traumatic cervical spine instability with interbody fusion cages: a prospective controlled study with a 2-year follow-up. Injury, 2005, 36 Suppl 2: B27-B35.
11. Li S, Peng J, Xu R, et al. Comparison of the surgeries for the ossification of the posterior longitudinal ligament-related cervical spondylosis: A PRISMA-compliant network meta-analysis and literature review. Medicine (Baltimore), 2021, 100(9): e24900. doi: 10.1097/MD.0000000000024900.
12. Wang H, Yang R, Liu H, et al. Comparison of interventions for cervical ossification of posterior longitudinal ligament: a systematic review and network meta-analysis. World Neurosurg, 2021, 155: 1-12.
13. 姬林松, 王艳萍, 陆廷盛, 等. 3D打印多孔钛合金骨小梁融合器与自体髂骨治疗脊髓型颈椎病. 中国组织工程研究, 2022, 26(18): 2817-2822.
14. McGilvray KC, Easley J, Seim HB, et al. Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model. Spine J, 2018, 18(7): 1250-1260.
15. Lohberger B, Eck N, Glaenzer D, et al. Surface modifications of titanium aluminium vanadium improve biocompatibility and osteogenic differentiation potential. Materials (Basel), 2021, 14(6): 1574. doi: 10.3390/ma14061574.
16. 吴敏飞, 王洋, 矫健航, 等. 3D 打印椎间融合器在脊髓型颈椎病椎间盘摘除减压融合内固定术的应用效果. 中华骨与关节外科杂志, 2019, 12(2): 98-101.
17. Girolami M, Sartori M, Monopoli-Forleo D, et al. Histological examination of a retrieved custom-made 3D-printed titanium vertebra: Do the fine details obtained by additive manufacturing really promote osteointegration? Eur Spine J, 2021, 30(10): 2775-2781.
18. Yang JC, Ma XY, Xia H, et al. Clinical application of computer-aided design-rapid prototyping in C₁-C₂ operation techniques for complex atlantoaxial instability. J Spinal Disord Tech, 2014, 27(4): E143-E150.
19. Fang T, Zhang M, Yan J, et al. Comparative analysis of 3D-printed artificial vertebral body versus titanium mesh cage in repairing bone defects following single-level anterior cervical corpectomy and fusion. Med Sci Monit, 2021, 27: e928022. doi: 10.12659/ MSM.928022. doi: 10.12659/MSM.928022.
20. Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
21. Burnard JL, Parr WCH, Choy WJ, et al. 3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J, 2020, 29(6): 1248-1260.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body

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