Posterior Facet Load Changes in Adjacent Segments due to Moderate and Severe Degeneration in C5-C6 Disc

Hussain, Mozammil; Natarajan, Raghu N.; Chaudhary, Gulafsha; An, Howard S.; Andersson, Gunnar

doi:10.1097/bsd.0b013e3182159776

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…As indicated in the present finite element study, ACDF impairs normal cervical biomechanics, alters mechanics at adjacent segments, resulting in higher stress and hypermobility in adjacent segments. Our results are in line with the reported data of the biomechanical studies on the behavior of the adjacent segments in the setting of different operation procedures [49][50][51][52][53]. Both the present and all of the reported results suggested that ASD might be related to iatrogenic biomechanics.…”

Section: Discussionsupporting

confidence: 92%

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Jin

Liang³

et al. 2020

BMC Surg

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Background: The development of adjacent segment degeneration (ASD) following ACDF is well established. There is no analytical study related to effects of plate profile on the biomechanics of the adjacent-level after ACDF. This study aimed to test the effects of plate profile on the adjacent-level biomechanics after single-level anterior cervical discectomy and fusion (ACDF). Methods: A three-dimensional finite element model (FEM) of an intact C2-T1 segment was built and validated. From this intact model, two instrumentation models were constructed with the anchored zero-profile spacer or the standard plate-interbody spacer after a C5-C6 corpectomy and fusion. Motion patterns, the stresses in the disc, the endplate, and the facet joint at the levels cephalad and caudal to the fusion were assessed. Results: Compared with the normal condition, the biomechanical responses in the adjacent levels were increased after fusion. Relative to the intact model, the average increase of range of motion (ROM) and stresses in the endplate, the disc, and the facet of the zero-profile spacer fusion model were slightly lower than that of the standard plate-interbody spacer fusion model. The kinematics ROM and stress variations above fusion segment were larger than that below. The biomechanical features of the adjacent segment after fusion were most affected during extension. Conclusions: The FE analysis indicated that plate profile may have an impact on the biomechanics of the adjacentlevel after a single-level ACDF. The impact may be long-term and cumulative. The current findings may help explain the decreasing incidence of ASD complications in the patients using zero-profile spacer compared with the patients using cage and plate construct.

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Section: Discussionsupporting

confidence: 92%

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Jin

Liang³

et al. 2020

BMC Surg

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“…Similar to simulation methods reported by Hussain et al [ 25 ], the FE model of the degenerative cervical spine was generated based on the developed FE model of the normal cervical spine. The cervical disc herniation (herniated on the left side) was simulated in C5-6 spinal motion segment.…”

Section: Methodsmentioning

confidence: 99%

“…The cervical disc herniation (herniated on the left side) was simulated in C5-6 spinal motion segment. The changes in geometry and material properties ( Table 2 ) used to simulate the degeneration were adapted from the clinical classification of degeneration of the cervical spine and the results of the previously published literature [ 18 , 25 , 26 ]. For the herniated disc of C5-6, the left posterolateral annulus was weakened as mid-then-outer annulus fibers tear [ 27 ], allowing herniation of nuclear material into the outer annular structure as a contained protrusion, and part of the disc pass into the vertebral canal space as an extrusion, as shown in Figure 2 .…”

Section: Methodsmentioning

confidence: 99%

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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“…As a consequence, adjacent spinal levels become hypermobile as a compensating measure and may stretch and stress the joint capsules. 38,39 Keeping this mechanism in mind, it is possible that the pain-generating facet joint may not be at the level of most severe degeneration, but at the adjacent segments. [40][41][42] This principle is suggested in a prospective outcome study pertaining to lower back pain, which found that 38% to 50% of patients reported having positive outcomes after a facet joint block.…”

Section: Introductionmentioning

confidence: 99%

Cervical Facet Joint Imaging-Guided Injections: A Comparison of Outcomes in Patients Referred Based on Imaging Findings Vs Palpation for Pain

Clec’h¹,

Peterson

Brunner

et al. 2016

Journal of Manipulative and Physiological Therapeutics

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Posterior Facet Load Changes in Adjacent Segments due to Moderate and Severe Degeneration in C5-C6 Disc

Cited by 9 publications

References 37 publications

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

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

Cervical Facet Joint Imaging-Guided Injections: A Comparison of Outcomes in Patients Referred Based on Imaging Findings Vs Palpation for Pain

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