Finite Element Analysis of the Effect of Dynamic Plating on Two-Level Anterior Cervical Discectomy Fusion Biomechanics

Lin, Maohua; Shapiro, Stephen Z.; Engeberg, Erik D.; Tsai, Chi-Tay; Vrionis, Frank D.

doi:10.1016/j.wneu.2022.02.032

Cited by 6 publications

(5 citation statements)

References 67 publications

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“…Screw loosening generally increased as the plate length increased [52]. Micromotion and subsidence are lessened by rotational dynamic plating, yet too much tolerance for rotational freedom in the screws eventually becomes detrimental [53]. Segmental plating decreased the chance of screw pullout postsurgery [54].…”

Section: Spine Hardwarementioning

confidence: 99%

A Review of Finite Element Modeling for Anterior Cervical Discectomy and Fusion

Lin¹,

Paul²,

Dhar³

et al. 2023

Asian Spine J

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The cervical spine poses many complex challenges that require complex solutions. Anterior cervical discectomy and fusion (ACDF) has been one such technique often employed to address such issues. In order to address the problems with ACDF and assess the modifications that have been made to the technique over time, finite element analyses (FEA) have proven to be an effective tool. The variations of cervical spine FEA models that have been produced over the past couple of decades, particularly more recent representations of more complex geometries, have not yet been identified and characterized in any literature. Our objective was to present material property models and cervical spine models for various simulation purposes. The outlining and refinement of the FEA process will yield more reliable outcomes and provide a stable basis for the modeling protocols of the cervical spine.

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Section: Spine Hardwarementioning

confidence: 99%

A Review of Finite Element Modeling for Anterior Cervical Discectomy and Fusion

Lin¹,

Paul²,

Dhar³

et al. 2023

Asian Spine J

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“…In our previous works, we successfully developed a complex 3D FEA model in the cervical spine (Lin et al, 2021;Lin et al, 2022a;Lin et al, 2022b;Lin et al, 2023), thereby confirming the accurate representation of ligaments, nucleus pulposus, and annulus through solid modeling. In this study, we extended our model to the lumbar spine and focused on a section of the lumbar spine and did a comparative FEA on common treatments for spinal stenosis.…”

Section: Introductionmentioning

confidence: 59%

Effect of graded posterior element and ligament removal on annulus stress and segmental stability in lumbar spine stenosis: a finite element analysis study

Lin,

Doulgeris,

Dhar

et al. 2023

Front. Bioeng. Biotechnol.

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The study aimed to investigate the impact of posterior element and ligament removal on the maximum von Mises stress, and maximum shear stress of the eight-layer annulus for treating stenosis at the L3-L4 and L4-L5 levels in the lumbar spine. Previous studies have indicated that laminectomy alone can result in segmental instability unless fusion is performed. However, no direct correlations have been established regarding the impact of posterior and ligament removal. To address this gap, four models were developed: Model 1 represented the intact L2-L5 model, while model 2 involved a unilateral laminotomy involving the removal of a section of the L4 inferior lamina and 50% of the ligament flavum between L4 and L5. Model 3 consisted of a complete laminectomy, which included the removal of the spinous process and lamina of L4, as well as the relevant connecting ligaments between L3-L4 and L4-L5 (ligament flavum, interspinous ligament, supraspinous ligament). In the fourth model, a complete laminectomy with 50% facetectomy was conducted. This involved the same removals as in model 3, along with a 50% removal of the inferior/superior facets of L4 and a 50% removal of the facet capsular ligaments between L3-L4 and L4-L5. The results indicated a significant change in the range of motion (ROM) at the L3-L4 and L4-L5 levels during flexion and torque situations, but no significant change during extension and bending simulation. The ROM increased by 10% from model 1 and 2 to model 3, and by 20% to model 4 during flexion simulation. The maximum shear stress and maximum von-Mises stress of the annulus and nucleus at the L3-L4 levels exhibited the greatest increase during flexion. In all eight layers of the annulus, there was an observed increase in both the maximum shear stress and maximum von-Mises stress from model 1&2 to model 3 and model 4, with the highest rate of increase noted in layers 7&8. These findings suggest that graded posterior element and ligament removal have a notable impact on stress distribution and range of motion in the lumbar spine, particularly during flexion.

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“…Because the physiological curvature of the cervical spine is anteriorly convex and loads on the anterior spine are eccentric relative to the posterior spine ( Zhang et al, 2022b ), the failure loads were related to many factors, such as the applied high tensile strains ( Fields et al, 2010 ), bone–end plate contact area or cage shape ( Tan et al, 2005 ), and bone mineral density (BMD) or cage placement ( Labrom et al, 2005 ). Lin et al (2021 , 2022) determined subsidence by measuring the distance that penetrated both the cage and screw into the end plate bone. Therefore, it is necessary to adopt a more rational and individual approach in estimating the maximum stress to failure loads, and we aim to perform relevant targeted optimizations in future studies.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Zhang

Yang²,

Shen³

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.

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Finite Element Analysis of the Effect of Dynamic Plating on Two-Level Anterior Cervical Discectomy Fusion Biomechanics

Cited by 6 publications

References 67 publications

A Review of Finite Element Modeling for Anterior Cervical Discectomy and Fusion

A Review of Finite Element Modeling for Anterior Cervical Discectomy and Fusion

Effect of graded posterior element and ligament removal on annulus stress and segmental stability in lumbar spine stenosis: a finite element analysis study

Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

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