Biomechanical evaluation of adjacent segment degeneration after one- or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: A finite element analysis

Hua, Wenbin; Zhi, Jinggang; Wang, Bingjin; Ke, Wencan; Wen-gang, Sun; Yang, Shuai; Li, Li; Yang, Cao

doi:10.1016/j.cmpb.2020.105352

Cited by 38 publications

(27 citation statements)

References 32 publications

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“…3 [1]. The nucleus pulposus, annulus fibrosus, and all other com-ponents in this model were considered as elastic material [18,19]. The cage screws were assumed as titanium material.…”

Section: Materials Propertymentioning

confidence: 99%

Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion

et al. 2022

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To characterize the effect of biomechanical strength and increased contact area on the maximum von Mises stress, migration, and subsidence between the cancellous bone, endplate, and implanted cage. Overview of Literature: Anterior cervical discectomy and fusion (ACDF) has been widely used for treating patients with degenerative spondylosis. However, no direct correlations have been drawn that incorporate the impact of the contact area between the cage and the vertebra/endplate. Methods: Model 1 (M1) was an intact C2C6 model with a 0.5 mm endplate. In model 2 (M2), a cage was implanted after removal of the C4-C5 and C5-C6 discs with preservation of the osseous endplate. In model 3 (M3), 1 mm of the osseous endplate was removed at the upper endplate. Model 4 (M4) resembles M3, except that 3 mm of the osseous endplate was removed. Results: The range of motion (ROM) at C2C6 in the M2-M4 models was reduced by at least 9º compared to the M1 model. The von Mises stress results in the C2C3 and C3C4 interbody discs were significantly smaller in the M1 model and slightly increased in the M2-M3 and M3-M4 models. Migration and subsidence decreased from the M2-M3 model, whereas further endplate removal increased the migration and subsidence as shown in the transition from M3 to M4. Conclusions: The M3 model had the least subsidence and migration. The ROM was higher in the M3 model than the M2 and M4 models. Endplate preparation created small stress differences in the healthy intervertebral discs above the ACDF site. A 1 mm embedding depth created the best balance of mechanical strength and contact area, resulting in the most favorable stability of the construct.

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“…3 [1]. The nucleus pulposus, annulus fibrosus, and all other com-ponents in this model were considered as elastic material [18,19]. The cage screws were assumed as titanium material.…”

Section: Materials Propertymentioning

confidence: 99%

Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion

et al. 2022

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“…Seven ligaments, including the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, intertransverse ligament, and supraspinal ligament, were modeled as hypoelastic, tension-only, truss elements. The material properties for bone, intervertebral discs, and ligaments were derived from the ligament stiffness data of previous studies and are shown in Table 1 ( Fagan et al, 2002 ; Jones and Wilcox, 2008 ; Wang B. et al, 2019 ; Hua et al, 2020 ). The finite element model of the T7−T11 thoracic spine segments is shown in Figure 2A .…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the range of motion (ROM), intradiscal pressure (IDP), facet joint stress, and internal fixation device stress were calculated and analyzed to evaluate the biomechanical effect of different surgical approaches. Several previous studies indicated that FEA enabled the evaluation of the ROM and IDP of the adjacent segments to predict the risk factors of adjacent segment degeneration after cervical or lumbar surgeries ( Ke et al, 2019 ; Wang B. et al, 2019 ; Hua et al, 2020 ; Wong et al, 2020 ). However, the studies only focused on the postoperative effect of internal fixation to evaluate the biomechanical advantages and disadvantages of surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis

Wang

Hua

et al. 2020

Front. Bioeng. Biotechnol.

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Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability for the treatment of thoracic spinal tuberculosis. However, the process of selecting the appropriate spinal fixation method remains controversial, and preoperative biomechanical evaluation has not yet been investigated. In this study, we aimed to analyze the application of the assisted finite element analysis (FEA) and the three-dimensional (3D) printed model for the patient-specific preoperative planning of thoracic spinal tuberculosis. An adult patient with thoracic spinal tuberculosis was included. A finite element model of the T7−T11 thoracic spine segments was reconstructed to analyze the biomechanical effect of four different operative constructs. The von Mises stress values of the implants in the vertical axial load and flexion and extension conditions under a 400-N vertical axial pre-load and a 10-N⋅m moment were calculated and compared. A 3D printed model was used to describe and elucidate the patient’s condition and simulate the optimal surgical design. According to the biomechanical evaluation, the patient-specific preoperative surgical design was prepared for implementation. The anterior column, which was reconstructed with titanium alloy mesh and a bone graft with posterior fixation using seven pedicle screws (M+P) and performed at the T7–T11 level, decreased the von Mises stress placed on the right rod, T7 pedicle screw, and T11 pedicle. Moreover, the M+P evaded the left T9 screw without load bearing. The 3D printed model and preoperative surgical simulation enhanced the understanding of the patient’s condition and facilitated patient-specific preoperative planning. Good clinical results, including no complication of implants, negligible loss of the Cobb angle, and good bone fusion, were achieved using the M+P surgical design. In conclusion, M+P was recommended as the optimal method for preoperative planning since it enabled the preservation of the normal vertebra and prevented unnecessary internal fixation. Our study indicated that FEA and the assisted 3D printed model are tools that could be extremely useful and effective in the patient-specific preoperative planning for thoracic spinal tuberculosis, which can facilitate preoperative surgical simulation and biomechanical evaluation, as well as improve the understanding of the patient’s condition.

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“…This nonfusion technique aims at preserving the range of motion (ROM) at the surgical level and delaying degeneration at adjacent levels. [13][14][15][16] To restore the physiological condition of the cervical spine after CDR, it is hypothesized that the cervical sagittal alignment parameters should be corrected to the normal level. However, most previous studies have only focused on describing the CL and FSUA values after CDR, and the other cervical sagittal alignment parameters have been rarely studied.…”

Section: Introductionmentioning

confidence: 99%

Association of cervical sagittal alignment with adjacent segment degeneration and heterotopic ossification following cervical disc replacement with Prestige-LP disc

Wang

Meng

Líu

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Cervical sagittal balance plays important roles in transmitting the load of the head and maintaining global spinal balance. This study aimed to identify the association of cervical sagittal alignment with adjacent segment degeneration (ASD) and heterotopic ossification (HO) after Prestige-LP cervical disc replacement (CDR). Methods: We enrolled 132 patients who underwent one-level Prestige-LP CDR with 2–10 years of follow-up. Cervical sagittal alignment parameters, including the degree of C2–C7 lordosis (CL), functional spinal unit angle (FSUA), sagittal vertical axis (SVA),, and T1 slope (T1s), were measured. ASD and HO were evaluated at the last follow-up. Unpaired t tests and logistic regression analysis were used to identify the associations of cervical sagittal alignment with ASD and HO. Results: We found that patients who developed ASD showed significantly lower FSUA (2.1° vs. −1.4°, p < 0.001) and T1s values (28.4° vs. 25.5°, p = 0.029) after surgery. Similarly, the postoperative CL was significantly better in patients without ASD or HO (18.0° vs. 14.4°, p = 0.043). The decrease in the T1s at the last follow-up was significantly larger in the patients with ASD (−11.0° vs. −3.2°, p = 0.003), HO (−6.7° vs. −2.7°, p = 0.050), and ASD or HO (−7.0° vs. −0.8°, p < 0.001) than in those without ASD or HO. Multivariate logistic regression analysis showed that both the FSUA and T1s are associated with ASD and that the degree of CL is associated with postoperative complications. Conclusion: The results imply that maintaining cervical sagittal alignment after Prestige-LP CDR is important.

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Biomechanical evaluation of adjacent segment degeneration after one- or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: A finite element analysis

Cited by 38 publications

References 32 publications

Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion

Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion

Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis

Association of cervical sagittal alignment with adjacent segment degeneration and heterotopic ossification following cervical disc replacement with Prestige-LP disc

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