Biomechanical Analysis of the Reasonable Cervical Range of Motion to Prevent Non-Fusion Segmental Degeneration After Single-Level ACDF

Abstract

The compensatory increase in intervertebral range of motion (ROM) after cervical fusion can increase facet joint force (FJF) and intradiscal pressure (IDP) in non-fusion segments. Guiding the post-ACDF patient cervical exercise within a specific ROM (defined as reasonable ROM) to offset the increase in FJF and IDP may help prevent segmental degeneration. This study aimed to determine the reasonable total C0–C7 ROM without an increase in FJF and IDP in non-fusion segments after anterior cervical discectomy and fusion (ACDF). A three-dimensional intact finite element model of C0–C7 generated healthy cervical conditions. This was modified to the ACDF model by simulating the actual surgery at C5–C6. A 1.0 Nm moment and 73.6 N follower load were applied to the intact model to determine the ROMs. A displacement load was applied to the ACDF model under the same follower load, resulting in a total C0–C7 ROM similar to that of the intact model. The reasonable ROMs in the ACDF model were calculated using the fitting function. The results indicated that the intervertebral ROM of all non-fusion levels was increased in the ACDF model in all motion directions. The compensatory increase in ROM in adjacent segments (C4/5 and C6/7) was more significant than that in non-adjacent segments, except for C3/4 during lateral bending. The intervertebral FJF and IDP of C0–C7 increased with increasing ROM. The reasonable ROMs in the ACDF model were 42.4°, 52.6°, 28.4°, and 42.25° in flexion, extension, lateral bending, and axial rotation, respectively, with a decreased ROM of 4.4–7.2%. The postoperative increase in FJF and IDP in non-fusion segments can be canceled out by reducing the intervertebral ROM within reasonable ROMs. This study provided a new method to estimate the reasonable ROMs after ACDF from a biomechanical perspective, and further in vitro and clinical studies are needed to confirm this.

Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis

“…This study is based on the following hypothesis: With a decrease in total L1-S1 ROM, the ROM of each adjacent segment will decrease correspondingly, which can offset the increase in IDP and FJF after lumbar fusion [ 14 ]. Based on this hypothesis, a relative total L1-S1 ROM without an increase in IDP and FJF was proposed to guide the patients to conduct postoperative waist activities, which may help delay the progression of ASD.…”

Biomechanical study of anterior transpedicular root screw intervertebral fusion system of lower cervical spine: a finite element analysis

“…Based on previous literature, an axial pressure of 75 N was applied to the upper surface of the C3 vertebra to mimic the weight of the head ( Zhang et al, 2022 ). A 1.0 Nm moment was loaded at the coupling point on the upper surface of the C3 vertebra to cause anterior flexion, posterior extension, lateral flexion, and axial rotational activity in the FE models ( Lee et al, 2016 ; Liang et al, 2022 ). The ROM of cervical spine surgical segments, the stress distribution of screws, plates, fusion devices, upper endplate, and intervertebral discs were recorded for each model and analyzed comparatively.…”

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

“…However, the current study aimed to provide a trend instead of natural status. Several recent studies have adopted similar methods in developing the finite element spine model and reported acceptable results (Wu et al, 2019;Liang et al, 2022;Zhang et al, 2022b). Third, the geometry of the human spine varies among individuals, while the model of this present study was developed on the basis of the data from a single patient.…”