Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Ke, Wencan; Chen, Chao; Wang, Bingjin; Hua, Wenbin; Lu, Shuaicheng; Song, Yu; Luo, Rongjin; Liao, Zhiwei; Li, Gaocai; Ma, Liang; Shi, Yunsong; Wang, Kun; Li, Shuai; Wu, Xinghuo; Zhang, Yukun; Yang, Cao

doi:10.3389/fbioe.2021.718996

Cited by 12 publications

(12 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results showed that the ROMs of the surgical segments in all movement directions decreased by 85.9%–91.6% postoperatively, which is consistent with the outcomes of previous literature ( Hua et al, 2020b ; Ke et al, 2021 ). Attributed to the anterior fixation and interbody fusion, sacrificed ROM at the fused segments mainly indicated strong immobilization ( Gao et al, 2012 ; Song and Choi, 2014 ).…”

Section: Discussionsupporting

confidence: 91%

“…The increased mobility of the unfused segment when compared to that of the normal group might be due to the loss of fusion of the fused segments and the compensation of the preserved normal cervical mobility. ACDF was of sacrificed ROM at the fused segments, while increased stress in the adjacent segment may be an important cause for developing adjacent segment degeneration (ASD) ( Eck et al, 2002 ; Hua et al, 2020a ; Ke et al, 2021 ). Considering that the ROM in the assembled uncovertebral joint fusion cage model achieved similar results to those after implantation with the Zero-P device, it is prudent to speculate that the assembled uncovertebral joint fusion cage did not significantly accelerate the degeneration of adjacent segments when compared with Zero-P.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 91%

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.

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown that both the methods can provide beneficial short-term effects [ 26 , 27 ]. On the contrary, spinal fusion is performed for coping with lumbar instability in the PLIF procedure, which can be attributed to some complications such as adjacent segment diseases (ASD) [ 5 , 6 , 28 ], considering that the spinal fusion may change the rotation center over the disc, increasing the stress on the intervertebral disc of the adjacent mobile segments [ 29 ]. We also noted improvements in the VAS score and ODI at the last follow-up.…”

Section: Discussionmentioning

confidence: 99%

The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

Lin

Xiao

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases. Methods This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles. Results As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy. Conclusions As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.

show abstract

“…The STL file was imported into SolidWorks 2017 computer-aided design software (Dassault Systèmes SolidWorks Corporation, Waltham, Massachusetts, USA). The cortical bone, cancellous bone, endplate, annulus fibrosus, nucleus pulposus, articular cartilage, and other elements were created based on previous literature [ 20 ]. An cervical spine model of C2-C7 was created with all the elements mentioned above.…”

Section: Methodsmentioning

confidence: 99%

Comparative analysis of the biomechanics of anterior cervical discectomy and fusion with multiple segmental plates fixation versus single multilevel plate fixation: a finite element study

Huang

Tian

Wang

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background This study aimed to compare the biomechanical differences between anterior cervical discectomy and fusion (ACDF) with multiple-level separate plates and conventional long plates by using finite element analysis. Methods The following four finite element models were created to simulate various fixations: (1) C4–6 ACDF with multiple plates, (2) C4–6 ACDF with a single plate, (3) C3–6 ACDF with multiple plates, and (4) C3–6 ACDF with a single plate. The maximum Von-mises stress of the cage and fixation, compressive force of the adjacent intervertebral discs and range of motion (ROM) of different segments in the four models were calculated and analyzed. Results For C4–6 ACDF, the maximum Von-mises stress of the cage and fixation was lower in the multiple plate fixation model in all motion states. Similarly, for the C3–6 ACDF models, the peak stress of the C3–4 and C5–6 cages was lower with multiple plates fixation in all motions but the stress of the C4–5 cage in the multiple plates model was slightly higher in flexion, bending and rotation. Besides, applying multiple plates in C3–6 ACDF models resulted in a decreased maximum stress of the fixation under different motions except for bending. In both the C4–6 ACDF and C3–6 ACDF models, the ROM values of the adjacent motion segments were lower in the multiple plates models in extension, bending and rotation. In the C4–6 ACDF models, the peak stress on the adjacent intervertebral discs in the multiple plates models was slightly smaller. In C3–6 ACDF models, the maximum stress on the adjacent intervertebral discs was larger in the single-plate model under flexion, bending and rotation movements. Conclusion Multiple plates fixation has a positive effect on increasing stiffness and maintaining the ROM of adjacent segments, indicating lower risk of construct failure and adjacent segment degeneration. Further studies are required to confirm its efficacy in clinical practice.

show abstract

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

Cited by 12 publications

References 47 publications

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

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

The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

Comparative analysis of the biomechanics of anterior cervical discectomy and fusion with multiple segmental plates fixation versus single multilevel plate fixation: a finite element study

Contact Info

Product

Resources

About