Development and validation of a geometrically personalized finite element model of the lower ligamentous cervical spine for clinical applications

Nikkhoo, Mohammad; Cheng, Chih-Hsiu; Wang, Jaw‐Lin; Khoz, Zahra; El‐Rich, Marwan; Hebela, Nader M.; Khalaf, Kinda

doi:10.1016/j.compbiomed.2019.04.010

Cited by 37 publications

(26 citation statements)

References 46 publications

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“…Therefore, similar approach in interbody cage with implantable microelectromechanical systems (MEMS) sensor may provide promising diagnostic potential to assess intervertebral fusion and reduce clinical reliance on current radiation-emitting imaging methods ( Ledet et al, 2018 ). In addition, due to the variability of the cervical anatomy across patients, several studies established patient-specific FE models for better clinical applications ( Laville et al, 2009 ; Nikkhoo et al, 2019 ; Nikkhoo et al, 2021a ). Nikkhoo et al (2019 ) developed and validated a geometrically personalized FE model of the lower cervical spine based on parameters extracted from radiographs of each subject.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, due to the variability of the cervical anatomy across patients, several studies established patient-specific FE models for better clinical applications ( Laville et al, 2009 ; Nikkhoo et al, 2019 ; Nikkhoo et al, 2021a ). Nikkhoo et al (2019 ) developed and validated a geometrically personalized FE model of the lower cervical spine based on parameters extracted from radiographs of each subject. They further analyzed the biomechanical effect of laminectomy using this parametric personalized FE model ( Nikkhoo et al, 2021a ).…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Shen

Yang

Líu

et al. 2022

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. A solid interbody fusion is of critical significance in achieving satisfactory outcomes after ACDF. However, the current radiographic techniques to determine the degree of fusion are inaccurate and radiative. Several animal experiments suggested that the mechanical load on the spinal instrumentation could reflect the fusion process and evaluated the stability of implant. This study aims to investigate the biomechanical changes during the fusion process and explore the feasibility of reflecting the fusion status after ACDF through the load changes borne by the interbody fusion cage.Methods: The computed tomography (CT) scans preoperatively, immediately after surgery, at 3 months, and 6 months follow-up of patients who underwent ACDF at C5/6 were used to construct the C2–C7 finite element (FE) models representing different courses of fusion stages. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the C7 vertebra fixed. The Von Mises stress at the surfaces of instrumentation and the adjacent intervertebral disc and force at the facet joints were analyzed.Results: The facet contact force at C5/6 suggested a significantly stepwise reduction as the fusion proceeded while the intradiscal pressure and facet contact force of adjacent levels changed slightly. The stress on the surfaces of titanium plate and screws significantly decreased at 3 and 6 months follow-up. A markedly changed stress distribution in extension among three models was noted in different fusion stages. After solid fusion is achieved, the stress was more uniformly distributed interbody fusion in all loading conditions.Conclusions: Through a follow-up study of 6 months, the stress on the surfaces of cervical instrumentation remarkably decreased in all loading conditions. After solid intervertebral fusion formed, the stress distributions on the surfaces of interbody cage and screws were more uniform. The stress distribution in extension altered significantly in different fusion status. Future studies are needed to develop the interbody fusion device with wireless sensors to achieve longitudinal real-time monitoring of the stress distribution during the course of fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Shen

Yang

Líu

et al. 2022

Front. Bioeng. Biotechnol.

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“…Finally, with the current thrust for personized medicine, individualized computational modeling, which may incorporate patient-specific geometry and/or tissue properties based on imaging, has a great potential to improve treatment strategies and patient outcomes for disc degeneration. Subject-specific finite element modeling can provide valuable quantitative biomechanical information to clinicians through non-invasive, time, and cost effective means ( Nikkhoo et al, 2019 ). Since traditional methods of investigating IVD degeneration are difficult to measure directly and often do not represent the human disc, personalized modeling could be the solution for planning surgery or prescribing biotherapies for disc degeneration ( Hu et al, 2019 ; Molinari and Falcinelli, 2021 ).…”

Section: Limitations Of the Models And Future Directionsmentioning

confidence: 99%

Computational Modeling Intervertebral Disc Pathophysiology: A Review

et al. 2022

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Lower back pain is a medical condition of epidemic proportion, and the degeneration of the intervertebral disc has been identified as a major contributor. The etiology of intervertebral disc (IVD) degeneration is multifactorial, depending on age, cell-mediated molecular degradation processes and genetics, which is accelerated by traumatic or gradual mechanical factors. The complexity of such intertwined biochemical and mechanical processes leading to degeneration makes it difficult to quantitatively identify cause–effect relationships through experiments. Computational modeling of the IVD is a powerful investigative tool since it offers the opportunity to vary, observe and isolate the effects of a wide range of phenomena involved in the degenerative process of discs. This review aims at discussing the main findings of finite element models of IVD pathophysiology with a special focus on the different factors contributing to physical changes typical of degenerative phenomena. Models presented are subdivided into those addressing role of nutritional supply, progressive biochemical alterations stemming from an imbalance between anabolic and catabolic processes, aging and those considering mechanical factors as the primary source that induces morphological change within the disc. Limitations of the current models, as well as opportunities for future computational modeling work are also discussed.

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“…The finite element (FE) analysis is an important method to study the spinal biomechanics ( Nikkhoo et al, 2019 ; Cai et al, 2020b ; Mesbah and Barkaoui, 2020 ). The range of motion (ROM), intradiscal pressure (IDP), facet joint stress, and stress in the cord can be calculated and analyzed to evaluate the biomechanical effects of different spine surgeries ( Mesbah et al, 2020 ; Nikkhoo et al, 2020 ; Srinivasan et al, 2021 ).…”

Section: Introductionmentioning

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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Development and validation of a geometrically personalized finite element model of the lower ligamentous cervical spine for clinical applications

Cited by 37 publications

References 46 publications

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Computational Modeling Intervertebral Disc Pathophysiology: A Review

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

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