The appropriate hybrid surgical strategy in three-level cervical degenerative disc disease: a finite element analysis

Xie, Yingmin; Zheng, Yong-qiang; Qiu, Sujun; Gong, Kunxiang; Duan, Yang

doi:10.1186/s13018-019-1502-5

Cited by 10 publications

(15 citation statements)

References 32 publications

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“…They found that the CDA-CDA-ACDF construct may lead to more compensation in terms of motion and facet stress. The biomechanical differences of three-level HS concerning one-level CDA and two-level ACDF was employed in Xie et al [ 12 ] study. The results showed that the ACDF-CDA-ACDF construct resulted in a better theoretical outcome, especially in preserving the maximum total ROM.…”

Section: Discussionmentioning

confidence: 99%

Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients

et al. 2022

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Introduction According to the different numbers and locations of cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of the present study was to introduce a classification system for three-level HS and compare the two types with each other and with ACDF. Methods A retrospective study was conducted involving patients with three-level cervical degenerative disc disease (CDDD) who underwent ACDF or HS in our hospital between June 2012 and May 2019. According to the different numbers and locations of ACDFs and CDAs, we classified the three-level HS into two types (type I: one-level CDA and two-level ACDF, and type II: two-level CDA and one-level ACDF). The differences of clinical and radiological outcomes were compared with each other and with three-level ACDF. Results A total of 108 patients were analyzed. The Neck Disability Index (NDI) of the ACDF group at 3 months postoperatively was significantly higher than that in the type I and type II groups (p < 0.05). The cervical lordosis was significantly lower in the ACDF group than that in the type I and II groups at 3 days, 6, 12 months postoperatively and the final follow-up (p < 0.05). The range of motion (ROM) of the total cervical spine decreased significantly in all three groups at 3, 6, and 12 months postoperatively and at the final follow-up (p < 0.05). The ACDF group was observed with the most severe loss of ROM of the total cervical spine, followed by the type I group. The type II group could preserve the most ROM of the total cervical spine. The ROM of adjacent segments increased most in the ACDF group, followed by the type I group. Conclusions Compared with ACDF, three-level HS may yield a faster recovery rate and superior radiological outcomes, such as a superiority in maintaining the cervical curvature and ROM of the total cervical spine and a smaller increase in the ROM of adjacent segments. The advantages were most remarkable in the type II group.

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Section: Discussionmentioning

confidence: 99%

Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients

et al. 2022

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“…The comparison and analysis of the biomechanical changes in the nine surgical models will aid in the selection of an appropriate surgical plan in clinical practice. Previous biomechanical studies have assessed the interbody fusion cage contact pressure, endplate contact pressure, titanium plate and screw contact pressure, and displacement of the cervical vertebrae [ 13 , 22 – 24 ]. However, the biomechanical characteristics of the cervical spine after various anterior cervical surgeries have not been clarified.…”

Section: Discussionmentioning

confidence: 99%

Effect of ACDF combined with different degrees of partial resection of uncovertebral joints on cervical stability and degeneration: a three-dimensional finite element analysis

2022

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Background To evaluate the influence of the resection of different amounts of the uncovertebral joints on the stability of the cervical spine by comparing and analyzing the stress distribution and peak displacement characteristics of the internal fixation structures and endplates. Methods After obtaining the CT data of a 34-year-old male healthy cervical spine, a three-dimensional finite element model was established and verified. The three-dimensional finite element method was used to establish the models of anterior cervical compression fusion and internal fixation surgical implants and anterior cervical compression fusion and internal fixation combined with the partial resection of different amounts of the unilateral or bilateral uncovertebral joints. The models were tested under six working conditions: flexion, extension, left bending, right bending, left rotation, and right rotation. The surgical models were compared regarding the stress distribution of the titanium mesh, titanium plate and screw, and endplate, and the peak displacement of the vertebral body. Results There were no significant differences in the stress distribution and peak displacement of the vertebral body of ACDF combined with different amounts of uncovertebral joint resection in the states of flexion and extension. However, there were significant increases in the stress distribution and peak displacement of the vertebral body in the states of left and right bending and rotation. In the states of left and right bending and rotation, the stress distribution and peak displacement of the vertebral body were significantly greater in the models with bilateral partial resection of the uncovertebral joints than in the models with unilateral partial resection of the uncovertebral joints. Bilateral resection of the uncovertebral joints by 30–40% and unilateral resection of the uncovertebral joints by 40–50% resulted in the greatest increases in the maximum stress distribution of the titanium plate and screw and the peak displacement of the vertebral body. Conclusion Finite element analysis of the biomechanical changes in the cervical spine showed that anterior cervical compression fusion and internal fixation combined with bilateral resection of less than 30% of the uncovertebral joints or unilateral resection of less than 40% of the uncovertebral joints had little effect on the stability of the cervical spine.

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“…The element types and material properties used in the FE model were defined according to previous reports 22 – 25 and are shown in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…A total of seven ligaments were modeled, including the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, supraspinous ligament, and intertransverse ligament. The element types and material properties used in the FE model were defined according to previous reports [22][23][24][25] and are shown in Table 1.…”

Section: Fe Modelingmentioning

confidence: 99%

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Biomechanical properties of a novel nonfusion artificial vertebral body for anterior lumbar vertebra resection and internal fixation

Liu

Niu

et al. 2021

Sci Rep

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The aim of the study was to evaluate the biomechanical properties of a novel nonfused artificial vertebral body in treating lumbar diseases and to compare with those of the fusion artificial vertebral body. An intact finite element model of the L1–L5 lumbar spine was constructed and validated. Then, the finite element models of the fusion group and nonfusion group were constructed by replacing the L3 vertebral body and adjacent intervertebral discs with prostheses. For all finite element models, an axial preload of 500 N and another 10 N m imposed on the superior surface of L1. The range of motion and stress peaks in the adjacent discs, endplates, and facet joints were compared among the three groups. The ranges of motion of the L1–2 and L4–5 discs in flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation were greater in the fusion group than those in the intact group and nonfusion group. The fusion group induced the greatest stress peaks in the adjacent discs and adjacent facet joints compared to the intact group and nonfusion group. The nonfused artificial vertebral body could better retain mobility of the surgical site after implantation (3.6°–8.7°), avoid increased mobility and stress of the adjacent discs and facet joints.

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The appropriate hybrid surgical strategy in three-level cervical degenerative disc disease: a finite element analysis

Cited by 10 publications

References 32 publications

Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients

Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients

Effect of ACDF combined with different degrees of partial resection of uncovertebral joints on cervical stability and degeneration: a three-dimensional finite element analysis

Biomechanical properties of a novel nonfusion artificial vertebral body for anterior lumbar vertebra resection and internal fixation

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