Comparative biomechanical analyses of lower cervical spine post anterior fusion versus intervertebral disc arthroplasty: A geometrically patient-specific poroelastic finite element investigation

Khalaf, Kinda; Nikkhoo, Mohammad

doi:10.1016/j.jot.2022.05.008

Cited by 12 publications

(4 citation statements)

References 38 publications

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“…Besides, the vertebral bodies and EPs were assumed based on poroelastic theory ( Table 1 ). The permeability characteristics were calculated based on the void ratio variations during the loading/unloading scenarios ( Argoubi and Shirazi-Adl, 1996 ; Ferguson et al, 2004 ; Hussain et al, 2010 ; Khalaf and Nikkhoo, 2022 ). The swelling phenomenon was mimicked using a constant boundary pore pressure technique ( Galbusera et al, 2011 ; Nikkhoo et al, 2015 ), which was enforced on the external surfaces of IVDs.…”

Section: Methodsmentioning

confidence: 99%

“…While the achieved results from experimental and clinical studies provide valuable observations, nonetheless the detailed kinematics and kinetics of the cervical spine post-surgery are missing ( Huang et al, 2021 ). Various FE models were developed to investigate the cervical spine with ACDF ( Huang et al, 2021 ), based on which the effect of the interbody cage fusion on ASD can be explored ( Zhang et al, 2016 ; Li et al, 2020 ; Khalaf and Nikkhoo, 2022 ). In addition to the comparative FE studies consequent to ACDF and dynamic systems (i.e., arthroplasty implants) ( Choi et al, 2021 ; Khalaf and Nikkhoo, 2022 ), several investigations focused on evaluating the number of fused levels ( Lopez-Espina et al, 2006 ; Hua et al, 2020 ), the materials and design of interbody cages ( Chong et al, 2015 ; Zhang et al, 2016 ; Liu et al, 2017 ; Li et al, 2020 ) on the incidence of ASD.…”

Section: Introductionmentioning

confidence: 99%

“…Various FE models were developed to investigate the cervical spine with ACDF ( Huang et al, 2021 ), based on which the effect of the interbody cage fusion on ASD can be explored ( Zhang et al, 2016 ; Li et al, 2020 ; Khalaf and Nikkhoo, 2022 ). In addition to the comparative FE studies consequent to ACDF and dynamic systems (i.e., arthroplasty implants) ( Choi et al, 2021 ; Khalaf and Nikkhoo, 2022 ), several investigations focused on evaluating the number of fused levels ( Lopez-Espina et al, 2006 ; Hua et al, 2020 ), the materials and design of interbody cages ( Chong et al, 2015 ; Zhang et al, 2016 ; Liu et al, 2017 ; Li et al, 2020 ) on the incidence of ASD. However, most of related FE simulations in literature were performed based on one geometry or very limited number of geometries ( Kim et al, 2018 ; Huang et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study

Cheng

Chiu

Chen

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evaluated the effect of larger-sized interbody cages on the cervical spine with ACDF under both static and cyclic loading.Method: Twenty pre-operative personalized poro-hyperelastic finite element (FE) models were developed. ACDF post-operative models were then constructed and four clinical scenarios (i.e., 1) No-distraction; 2) 1 mm distraction; 3) 2 mm distraction; and 4) 3 mm distraction) were predicted for each patient. The biomechanical responses at adjacent spinal levels were studied subject to static and cyclic loading. Non-parametric Friedman statistical comparative tests were performed and the p values less than 0.05 were reflected as significant.Results: The calculated intersegmental range of motion (ROM) and intradiscal pressure (IDP) from 20 pre-operative FE models were within the overall ranges compared to the available data from literature. Under static loading, greater ROM, IDP, facet joint force (FJF) values were detected post ACDF, as compared with pre-op. Over-distraction induced significantly higher IDP and FJF in both upper and lower adjacent levels in extension. Higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were observed in ACDF group which significantly increased for over-distraction groups.Discussion: it was concluded that using larger-sized interbody cages (the height of ≥2 mm of the index disc height) can result in remarkable variations in biomechanical responses of adjacent levels, which may indicate as risk factor for adjacent segment disease. The results of this comprehensive FE investigation using personalized modeling technique highlight the importance of selecting the appropriate height of interbody cage in ACDF surgery.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study

Cheng

Chiu

Chen

et al. 2023

Front. Bioeng. Biotechnol.

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“…Early drug treatment can only slightly reduce patients’ suffering, and very few drugs are approved against IDD pathogenesis and for disc protection. Arthroplasty with artificial disc replacement for surgical treatment has been introduced with the notion that it may decrease the risk of adjacent segment disease ( 6 ). Although the degenerated IVD can be removed surgically, some patients after surgical therapy may suffer from long-term post-spine syndromes and lumbar pain due to the destruction of the original biological structure ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Endoplasmic reticulum stress associates with the development of intervertebral disc degeneration

et al. 2023

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Endoplasmic reticulum (ER) is an important player in various intracellular signaling pathways that regulate cellular functions in many diseases. Intervertebral disc degeneration (IDD), an age-related degenerative disease, is one of the main clinical causes of low back pain. Although the pathological development of IDD is far from being fully elucidated, many studies have been shown that ER stress (ERS) is involved in IDD development and regulates various processes, such as inflammation, cellular senescence and apoptosis, excessive mechanical loading, metabolic disturbances, oxidative stress, calcium homeostasis imbalance, and extracellular matrix (ECM) dysregulation. This review summarizes the formation of ERS and the potential link between ERS and IDD development. ERS can be a promising new therapeutic target for the clinical management of IDD.

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Finite element analysis of two‐level discontinuous cervical hybrid revision surgery strategy to reduce biomechanical responses of adjacent segments

Liang,

Sun,

Han

et al. 2024

JOR Spine

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BackgroundHybrid surgery (HS) combined cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) is emerging, but its biomechanical effects as a revision surgery (RS) on adjacent segments were unclear.ObjectivesThis finite element (FE) study aimed to investigate the biomechanical characteristics of HS to treat two‐level discontinuous ASD in ACDF RS.MethodsA C2‐T1 intact FE model was established and modified to a primary C5/6 ACDF model and five RS models. These RS models' segments C4/5 and C6/7 were revised using cage plus plate (C), zero‐profile devices (P), and Bryan disc (D), respectively, generating C‐C‐C, P‐C‐P, D‐C‐P, P‐C‐D, and D‐C‐D models. In the intact and C5/6 ACDF models, a 1.0 Nm moment was used to produce the range of motion (ROM). A displacement load was applied to all RS models, to achieve a total ROM match that of the primary C5/6 ACDF model.ResultsIn the P‐C‐P model, biomechanical responses including ROM, Intradiscal pressure (IDP), Facet joint force (FJF), and Maximum von Mises stresses of discs at segments C3/4 and C7/T1 were slightly lower than the C‐C‐C model. The biomechanical response parameters at segments C3/4 and C7/T1 of P‐C‐D, D‐C‐P, and D‐C‐D were smaller than those in C‐C‐C and P‐C‐P models. D‐C‐D had the most significant effect on reducing all biomechanical responses among all RS models in segments C3/4 and C7/T1. Moreover, the disc stress cloud maps showed that the maximum von Mises stress of the C3/4 disc was higher than that of C7/T1.ConclusionsD‐C‐D, P‐C‐D, and D‐C‐P are good RS choices for reducing the biomechanical responses, and D‐C‐D was the best choice. P‐C‐P can be the best recommendation when it does not meet the CDA indications. This study provided a biomechanical reference for hybrid surgical decision‐making in the ACDF RS for preventing ASD recurrence.

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Comparative biomechanical analyses of lower cervical spine post anterior fusion versus intervertebral disc arthroplasty: A geometrically patient-specific poroelastic finite element investigation

Cited by 12 publications

References 38 publications

The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study

The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study

Endoplasmic reticulum stress associates with the development of intervertebral disc degeneration

Finite element analysis of two‐level discontinuous cervical hybrid revision surgery strategy to reduce biomechanical responses of adjacent segments

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