Real-Time Monitoring of Stresses and Displacements in Cervical Nuclei Pulposi During Cervical Spine Manipulation: A Finite Element Model Analysis

Wu, Liping; Yuan-qiao, Huang; Das, Manas; Chen, Yong-yuan; Fan, Jian‐Sheng; Mo, Hua-gui

doi:10.1016/j.jmpt.2014.05.007

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…The maximum forward displacements were 0.23, 0.36, and 0.45 mm in left lateral bending position, neutral position, and right lateral bending position, respectively. It reconfirmed that a small forward displacement was generated on the left side (herniated side) of cervical disk during CSM with rotation to the right side (healthy side) [ 12 ]. And it suggested that the release of the compressed nerve root from small to large was left lateral bending position, neutral position, and right lateral bending position, respectively.…”

Section: Discussionmentioning

confidence: 92%

“…In this research, we used the material properties of moderately degenerated disc to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. The mechanical loading steps in sequence to simulate CSM were as follows [ 12 ]: The inferior endplate of C6 was fixed. The C5 vertebra, along with the entire model, was rotated 2°, 0, -2° around y-axis to simulate the left lateral bending, neutral, and right lateral bending positions, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…The manipulation commonly included two key procedures of rotation to the healthy side and lateral bending to the affected (herniated) side [ 6 – 10 ]. Wu et al suggested that compression of the nerve root is relieved by a small displacement between it and the herniated disk during CSM with rotation to the healthy side [ 11 , 12 ]. However, the rationality of lateral bending to the herniated side on performing CSM for CDH is still unclear [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three‐Dimensional Finite Element Analysis

Huang

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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Background Most studies report that the common position of cervical spinal manipulation (CSM) for treating symptomatic cervical disc herniation (CDH) is lateral bending to the herniated side. However, the rationality of lateral bending position on performing CSM for CDH is still unclear. Objective The purpose of this study is to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. Methods A finite element (FE) model of CDH (herniated on the left side) was generated in C5-6 segment based on the normal FE model. The FE model performed CSM in left lateral bending position, neutral position, and right lateral bending position, respectively. Cervical disc displacement, annulus fiber stress, and facet joint stress were observed during the simulation of CSM. Results The cervical disc displacement on herniated side moved forward during CSM, and the maximum forward displacements were 0.23, 0.36, and 0.45 mm in left lateral bending position, neutral position, and right lateral bending position, respectively. As the same trend of cervical disc displacement, the annulus fiber stresses on herniated side from small to large were 7.40, 16.39, and 22.75 MPa in left lateral bending position, neutral position, and right lateral bending position, respectively. However, the maximum facet stresses at left superior cartilage of C6 in left lateral bending position, neutral position, and right lateral bending position were 6.88, 3.60, and 0.12 MPa, respectively. Conclusion Compared with neutral position and right lateral bending position, though the forward displacement of cervical disc on herniated side was smaller in left lateral bending position, the annulus fiber stress on herniated side was declined by sharing load on the left facet joint. The results suggested that lateral bending to the herniated side on performing CSM tends to protect the cervical disc on herniated side. Future clinical studies are needed to verify that.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three‐Dimensional Finite Element Analysis

Huang

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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“…The cervical biomechanical behavior follows the non-linear distribution of each component; hence, previous studies ( 17 , 18 ) focused on computer modeling and analysis of discs. This study focused on the vertebral body, intervertebral discs, ligaments, and spinal cord during cervical spine non-linear stress conditions and the overall analysis of the cervical spine and changes in soft tissue morphology of the neck in patients with CSM and control.…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy

Yang

Yuan

et al. 2022

Front. Surg.

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BackgroundSpinal cord ischemia is largely caused by cervical spondylotic myelopathy (CSM), which has a corresponding biomechanical basis. Finite element analysis of spinal cord stress in diseased segments of CSM was performed to provide a biomechanical basis for the pathogenesis of CSM.MethodsA single segment (C4-5) in a patient with CSM was selected for mechanical simulation of three-dimensional (3D) computed tomography scanning, and a 3D finite element model of the cervical vertebra was constructed. Based on the patient's age, sex, height, weight, and other parameters, a finite element analysis model of an individual with healthy cervical vertebrae in our hospital was selected as the control to compare the stress changes between the patient and control groups in the analysis of the cervical vertebrae under anterior flexion, posterior extension, lateral flexion, and rotating load in the diseased spinal cord segment.ResultsIn the CSM patient, the diseased segment was C4-5. Under loading conditions of forward flexion, posterior extension, left flexion, right flexion, left rotation, and right rotation, the maximum stress on the spinal cord in the control group was 0.0044, 0.0031, 0.00017, 0.00014, 0.0011, and 0.001 MPa, respectively, whereas those in the spinal cord in the CSM group were 0.039, 0.024, 0.02, 0.02, 0.0194, and 0.0196 MPa, respectively.ConclusionThe maximum stress on the diseased segments of the spinal cord in the CSM group was higher than that in the control group, which contributed to verifying the imaging parameters associated with spinal cord compression stress.

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“…The influence of CSM or position on displacement of posterolateral AF has already been employed in some treatment methods of CSR with contained posterolateral disc herniation such as manipulation [ 19 ], distraction [ 20 ] and surgical methods [ 21 – 23 ]. Huang et al [ 19 ] investigated the biomechanical effects of cervical spinal manipulation on cervical disc herniation using three-dimensional FE analysis and found that cervical spinal manipulation with rotation to the healthy side made posterolateral AF of the herniated side move forward, which may help to change the relative position of posterolateral AF and nerve root to release adhesion and relieve compression [ 24 ]. Wong et al [ 20 ] studied the influence of different traction angles on intervertebral separation and found that posterior intervertebral space in flexion position before traction was greater than that in the neutral position, which indicates that flexion position had a pulling effect on the posterolateral AF and may contribute to make bulging posterolateral AF move forward.…”

Section: Discussionmentioning

confidence: 99%

Effect of cervical spine motion on displacement of posterolateral annulus fibrosus in cervical spondylotic radiculopathy with contained posterolateral disc herniation: a three-dimensional finite element analysis

Chen

Liu

et al. 2022

J Orthop Surg Res

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Background Previous studies on dynamic impingement of nerve root in cervical spondylotic radiculopathy (CSR) have focused on effect of cervical spine motion (CSM) on dimensional changes of intervertebral foramen. However, there are few studies to investigate effect of CSM on displacement of posterolateral intervertebral disc until now. The present study aimed to investigate effect of CSM on displacement of posterolateral annulus fibrosus (AF) in CSR with contained posterolateral disc herniation. Methods A C5–C6 CSR finite element model with unilateral contained posterolateral disc herniation was generated based on validated C5–C6 normal finite element model. Forward and backward displacement distributions of posterolateral AFs in CSR model and normal model were compared. Changes in forward and backward displacement magnitudes of posterolateral AFs of the herniated side and the healthy side in CSR model, with respect to those of the ipsilateral posterolateral AFs in normal model, were compared. The comparisons were performed under flexion, extension, lateral bendings and axial rotations. Results There was no difference in deformation trend of posterolateral AF between CSR model and normal model. Bilateral posterolateral AFs mainly moved forward during flexion and backward during extension. Left posterolateral AF mainly moved backward and right posterolateral AF forward during left lateral bending and left axial rotation. Left posterolateral AF mainly moved forward and right posterolateral AF backward during right lateral bending and right axial rotation. However, with respect to forward and backward displacement magnitudes of the ipsilateral posterolateral AFs in normal model, those of the herniated side increased relatively significantly compared with those of the healthy side in CSR model. Conclusions Flexion, lateral bending to the healthy side and axial rotation to the healthy side make posterolateral AF of the herniated side mainly move forward, whereas extension, lateral bending to the herniated side and axial rotation to the herniated side make it mainly move backward. These data may help select CSM or positions to diagnose and treat CSR with contained posterolateral disc herniation. Increase in deformation amplitude of posterolateral AF of the herniated side may also be the reason for dynamic impingement of nerve root in CSR with contained posterolateral disc herniation.

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Real-Time Monitoring of Stresses and Displacements in Cervical Nuclei Pulposi During Cervical Spine Manipulation: A Finite Element Model Analysis

Cited by 5 publications

References 21 publications

Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three‐Dimensional Finite Element Analysis

Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three‐Dimensional Finite Element Analysis

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy

Effect of cervical spine motion on displacement of posterolateral annulus fibrosus in cervical spondylotic radiculopathy with contained posterolateral disc herniation: a three-dimensional finite element analysis

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