Biomechanical Influences of Transcorporeal Tunnels on C4 Vertebra Under Physical Compressive Load Under Flexion Movement: A Finite Element Analysis

Wu, Wenkai; Yan, Zheng jian; Zhang, Tengfei; Liao, Cong-Gang; Liang, Kunneng; Liang, Chen; Deng, Zhong‐Liang

doi:10.1016/j.wneu.2018.02.140

Cited by 18 publications

(9 citation statements)

References 36 publications

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“…The FE model of the intact cervical spine used in this study was validated by comparison with previous biomechanical models ( Wang K. et al, 2017 ; Wu et al, 2018 ). The ROM and IDP of each segment were consistent with those of previous studies ( Figure 4 ; Supplementary Figure S1 ).…”

Section: Resultsmentioning

confidence: 99%

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Chen

Wang

et al. 2021

Front. Bioeng. Biotechnol.

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Symptomatic adjacent segment disease (ASD) is a common challenge after anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the biomechanical effects of a second ACDF and laminoplasty for the treatment of ASD after primary ACDF. We developed a finite element (FE) model of the C2-T1 based on computed tomography images. The FE models of revision surgeries of ACDF and laminoplasty were simulated to treat one-level and two-level ASD after primary ACDF. The range of motion (ROM) and intradiscal pressure (IDP) of the adjacent segments, and stress in the cord were analyzed to investigate the biomechanical effects of the second ACDF and laminoplasty. The results indicated that revision surgery of one-level ACDF increased the ROM and IDP at the C2–C3 segment, whereas two-level ACDF significantly increased the ROM and IDP at the C2–C3 and C7-T1 segments. Furthermore, no significant changes in the ROM and IDP of the laminoplasty models were observed. The stress in the cord of the re-laminoplasty model decreased to some extent, which was higher than that of the re-ACDF model. In conclusion, both ACDF and laminoplasty can relieve the high level of stress in the spinal cord caused by ASD after primary ACDF, whereas ACDF can achieve better decompression effect. Revision surgery of the superior ACDF or the superior and inferior ACDF after the primary ACDF increased the ROM and IDP at the adjacent segments, which may be the reason for the high incidence of recurrent ASD after second ACDF.

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Section: Resultsmentioning

confidence: 99%

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Chen

Wang

et al. 2021

Front. Bioeng. Biotechnol.

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“…Anterior cervical discectomy and fusion has turned into a standard procedure for cervical spondylotic radiculopathy because of its safety, effectiveness, and high fusion rate since the 1950s ( Ruetten et al, 2009 ; Yang et al, 2014 ; Ren et al, 2019 ), notwithstanding that it may cause some problems such as degeneration of adjacent segments, loss of intervertebral disc height, and pseudarthrosis formation ( Ruetten et al, 2009 ; Yang et al, 2014 ; Yuchi et al, 2019 ; Chen et al, 2020 ). With the development of full-endoscopic cervical discectomy, the complications of anterior cervical discectomy and fusion were managed appropriately ( Ruetten et al, 2009 ; Wu et al, 2018 ; Ahn, 2020 ). Full-endoscopic cervical discectomy is generally divided into two types, i.e., anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD) and posterior endoscopic cervical foraminotomy (PECF) ( Yang et al, 2014 ; Ren et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…With regard to better disc preservation, a similar technique named anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD) was used subsequently ( Choi et al, 2007 ). ATc-ECD can relieve the compression of the nerve root by drilling a hole in the vertebral body, which avoids the unnecessary destruction of the intervertebral disc and bony stabilizers because it can reach the region of the protruded disc or uncovertebral osteophyte through the bone tunnel ( Choi et al, 2007 ; Kim et al, 2011 ; Umebayashi et al, 2013 ; Deng et al, 2016 ; Wu et al, 2018 ; Chen et al, 2021 ). Ren et al (2020) reported that the rate of excellent or good results reached up to 91.4%, and intervertebral space decrease was reported after ATc-ECD.…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis

Zhang

et al. 2021

Front. Bioeng. Biotechnol.

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Minimally invasive surgeries, including posterior endoscopic cervical foraminotomy (PECF), microsurgical anterior cervical foraminotomy (MACF), anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD), and anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD), have obtained positive results for cervical spondylotic radiculopathy. Nonetheless, there is a lack of comparison among them regarding their biomechanical performance. The purpose of this study is to investigate the biomechanical changes of operated and adjacent segments after minimally invasive surgeries compared to a normal cervical spine. A three-dimensional model of normal cervical vertebrae C3–C7 was established using finite element analysis. Afterwards, four surgical models (PECF, MACF, ATd-ECD, and ATc-ECD) were constructed on the basis of the normal model. Identical load conditions were applied to simulate flexion, extension, lateral bending, and axial rotation of the cervical spine. We calculated the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus pressure (AFP), uncovertebral joints contact pressure (CPRESS), and facet joints CPRESS under different motions. For all circumstances, ATc-ECD was close to the normal cervical spine model, whereas ATd-ECD significantly increased ROM and joints CPRESS and decreased IDP in the operated segment. PECF increased more the operated segment ROM than did the MACF, but the MACF obtained maximum IDP and AFP. Except for ATc-ECD, the other models increased joints CPRESS of the operated segment. For adjacent segments, ROM, IDP, and joints CPRESS showed a downward trend in all models. All models showed good biomechanical stability. With their combination biomechanics, safety, and conditions of application, PECF and ATc-ECD could be appropriate choices for cervical spondylotic radiculopathy.

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“…In the other 33 patients, while there was more decrease in the height of the vertebral body, the collapse of the superior endplate did not occur when we controlled the center diameter of drilling hole to approximately 6 mm. is diameter was chosen as our previous finite element analysis, which proved that there was no significant difference in stress distribution when the tunnel diameter was limited to 6 mm [18]. Additionally, the bone wax mixed with methylene blue can mark the ideal puncture trajectory, and thus, the bony tunnel could be accurately and safely created with controlled injury to the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Discectomy by Using Full-Endoscopic Visualization Technique via the Transcorporeal and Transdiscal Approaches in the Treatment of Cervical Intervertebral Disc Herniation: A Comparative Study

Ren

Yang

Chen

et al. 2020

BioMed Research International

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Objective. To compare the difference in clinical and radiographic outcomes between anterior transcorporeal and transdiscal percutaneous endoscopic cervical discectomy (ATc-PECD/ATd-PECD) approaches for treating patients with cervical intervertebral disc herniation (CIVDH). Method. We selected 77 patients with single-segment CIVDH and received ATc-PECD or ATd-PECD in the Second Affiliated Hospital of Chongqing Medical University between March 1, 2010, and July 1, 2015. 35 patients suffered from ATc-PECD, and there were 42 patients in the ATd-PECD group. Obtaining the data of 1, 3, 6, 12, and 24 months postoperatively, the VAS for neck and arm pain and the modified MacNab criteria were used to evaluate the clinical outcomes, comparing radiographic outcomes and complications of these two groups. Results. We found that the mean operative time was significantly longer in the ATc-PECD group (P<0.05). At the 2-year follow-up, the mean VAS score for neck and arm pain was significantly decreased in both two groups. There was no significant difference in the VAS score for arm pain and neck pain between the two groups at the 2-year follow-up (P=0.783 and P=0.785, respectively). For the ATc-PECD group, the difference in the height of IVS or vertebral body was significant between the preoperative and postoperative groups (P<0.05, respectively). For the ATd-PECD group, there was only a significant decrease in the height of the IVS (P<0.05); the decrease in the surgical vertebral body was not significant between the preoperative and postoperative groups (P>0.05). Conclusion. In the 2-year follow-up, there is no significant difference in the clinical outcomes between the 2 approaches. While the longer time was consumed in the ATc-PECD group, the lower rate of disc collapse and recurrence is notable. Additionally, when the center diameter of tunnel was limited to 6 mm, the bony defect can be healed without the occurrence of the collapse of the superior endplate, and ATc-PECD may be preferable in the endoscopic treatment of CIVDH.

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Biomechanical Influences of Transcorporeal Tunnels on C4 Vertebra Under Physical Compressive Load Under Flexion Movement: A Finite Element Analysis

Cited by 18 publications

References 36 publications

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis

Outcomes of Discectomy by Using Full-Endoscopic Visualization Technique via the Transcorporeal and Transdiscal Approaches in the Treatment of Cervical Intervertebral Disc Herniation: A Comparative Study

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