Biomechanical consideration of prosthesis selection in hybrid surgery for bi-level cervical disc degenerative diseases

Mo, Zhongjun; Li, Qi; Jia, Zhiwei; Yang, Jiemeng; Wong, Duo Wai-Chi; Fan, Yubo

doi:10.1007/s00586-016-4777-9

Cited by 49 publications

(28 citation statements)

References 35 publications

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“…The element sizes for bone and skin were 2.5 and 1.5 mm, respectively, that resulted in a total of 94,522 nodes and 306,289 elements. Convergence within 3% in joint cartilage stress was achieved in bare feet weight-bearing condition, to ensure that the results were irrelevant to the mesh density [19, 20]. …”

Section: Methodsmentioning

confidence: 99%

The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot

Guo

2017

Journal of Healthcare Engineering

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Flat foot is one of the common deformities in the youth population, seriously affecting the weight supporting and daily exercising. However, there is lacking of quantitative data relative to material selection and shape design of the personalized orthopedic insole. This study was to evaluate the biomechanical effects of material hardness and support height of personalized orthopedic insole on foot tissues, by in vivo experiment and finite element modeling. The correction of arch height increased with material hardness and support height. The peak plantar pressure increased with the material hardness, and these values by wearing insoles of 40° were apparently higher than the bare feet condition. Harder insole material results in higher stress in the joint and ligament stress than softer material. In the calcaneocuboid joint, the stress increased with the arch height of insoles. The material hardness did not apparently affect the stress in the ankle joints, but the support heights of insole did. In general, insole material and support design are positively affecting the correction of orthopedic insole, but negatively resulting in unreasonable stress on the stress in the joint and ligaments. There should be an integration of improving correction and reducing stress in foot tissues.

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Section: Methodsmentioning

confidence: 99%

The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot

Guo

2017

Journal of Healthcare Engineering

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“…The finite element models evaluated the ROM in the levels adjacent to HS (Jia et al, 2014). Some studies compared the biomechanics with different hybrid construct in two-level cervical degenerative disc disease using different dynamic implants of various structure and material properties (Cho et al, 2010;Li et al, 2017;Mo et al, 2017). Cervical fusion was shown to change the ROM distribution of the cervical segments and lead to hypermobility as well as increased burden at the adjacent levels (Natarajan et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

“…Cervical fusion was shown to change the ROM distribution of the cervical segments and lead to hypermobility as well as increased burden at the adjacent levels (Natarajan et al, 2000). HS is beneficial to motion preservation of the operated levels and produced a ROM of the entire operated and adjacent levels close to that of the healthy spine, resulting in less adverse effect on adjacent segments (Natarajan et al, 2000;Mo et al, 2017). Immobilization and segmental motion were achieved at the fusion level and arthroplasty level, respectively.…”

Section: Introductionmentioning

confidence: 99%

Optimization of Three-Level Cervical Hybrid Surgery to Prevent Adjacent Segment Disease: A Finite Element Study

Wong

Hsieh

et al. 2020

Front. Bioeng. Biotechnol.

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Hybrid surgery (HS) allows surgeons to tailor fusion and arthroplasty in the treatment of multiple-level cervical disc degeneration. However, the decision making of selecting either ACDF or ADR for each level in three-level HS remains controversial and has not been fully investigated. This study was aimed to optimize three-level cervical hybrid constructs by systematically investigating their biomechanical properties and their effect on adjacent levels. A finite element model of cervical spine (C2-C7) was developed, and eight C3-C6 surgical models including six HS were constructed. The range of motion (ROM) in flexion, extension, lateral bending, and axial rotation under 2.0 Nm moments with 30 N follower load were simulated. The von Mises stress, strain energy at the adjacent intervertebral disc (IVD) and force at the adjacent facet were calculated. The ROM of the hybrid constructs and adjacent levels was close to that of the intact spine. HS with arthroplasty performed at C5-6 had better performance in terms of ROM reduction at the inferior adjacent level (C6-7). Moreover, C-D-D and 3ADR had best performance in reducing the von Mises stress and strain energy at C6-7. All HS reduced the facet burden at both C2-3 and C6-7 levels. However, the major drawback of HS revealed here is that the effect of C6-7 protection is at the cost of increased C2-3 IVD burden. In conclusion, we recommend C-D-D and 3ADR for patient with C3-C6 disc degeneration without predisposing C2-3 condition. C-C-D could be a good alternative with a lower medical cost. This analysis guides the decision making in three-level cervical HS before future cadaver studies or human clinical trials.

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“…Proponent surgeons claim to also use it for biomechanical considerations in certain patients. Mo et al 30 reported on biomechanical considerations of multiple CDA devices selected in hybrid surgery for bilevel cervical degenerative disc disease using finite element analysis. The authors concluded that Prodisc-C, Mobi-C, and Discover performed similarly with respect to spinal motion, adjacent intradiscal pressures, and driving moments, while Bryan and PCM were more comparable biomechanically.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Patient Selection in Cervical Disc Arthroplasty

2020

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Background: Patient selection for cervical disc arthroplasty (CDA) in the United States remains a topic of debate among surgeons. Many surgeons base US patient selection for CDA implantation on the Food and Drug Administration (FDA) indications/contraindications. While off-label use does occur, the frequency and extent of offlabel use in the US remains largely unknown. Outside the United States, patient selection is notably less stringent; however such data also remain largely unpublished or presented/published with a low level of evidence. Here, we will review the current approved US on-label patient selection criteria for CDA and discuss the rationale and supporting evidence to expand these criteria in the United States. Methods: A PubMed literature search was completed using the keywords ''cervical disc arthroplasty'' and ''cervical disc replacement.'' The articles were evaluated by the authors for patient selection criteria. Conclusions: The current published data do not conclusively prove that the patients excluded from CDA by strict adherence to FDA indications would benefit from CDA surgery over anterior cervical discectomy and fusion. As surgeons, it is a difficult decision regarding when to expand indications to include off-label use of CDA. In our practice, generally CDA patient selection agrees with the FDA indications and contraindications, as there is a lack of level 1 evidence to confirm effectiveness of CDA outside of the current FDA indications. We will likely need more wellconstructed studies to include prospective and controlled trials that specifically evaluate the ''off-label'' applications before US surgeons are convinced to expand indications and insurance companies agree to reimburse.

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Biomechanical consideration of prosthesis selection in hybrid surgery for bi-level cervical disc degenerative diseases

Cited by 49 publications

References 35 publications

The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot

The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot

Optimization of Three-Level Cervical Hybrid Surgery to Prevent Adjacent Segment Disease: A Finite Element Study

Patient Selection in Cervical Disc Arthroplasty

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