The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study
Introduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evalua...
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| Format: | Article |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1217274/full |
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| author | Chih-Hsiu Cheng Chih-Hsiu Cheng Ping-Yeh Chiu Ping-Yeh Chiu Hung-Bin Chen Chi-Chien Niu Chi-Chien Niu Mohammad Nikkhoo Mohammad Nikkhoo Mohammad Nikkhoo |
| author_facet | Chih-Hsiu Cheng Chih-Hsiu Cheng Ping-Yeh Chiu Ping-Yeh Chiu Hung-Bin Chen Chi-Chien Niu Chi-Chien Niu Mohammad Nikkhoo Mohammad Nikkhoo Mohammad Nikkhoo |
| author_sort | Chih-Hsiu Cheng |
| collection | DOAJ |
| description | Introduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evaluated the effect of larger-sized interbody cages on the cervical spine with ACDF under both static and cyclic loading.Method: Twenty pre-operative personalized poro-hyperelastic finite element (FE) models were developed. ACDF post-operative models were then constructed and four clinical scenarios (i.e., 1) No-distraction; 2) 1 mm distraction; 3) 2 mm distraction; and 4) 3 mm distraction) were predicted for each patient. The biomechanical responses at adjacent spinal levels were studied subject to static and cyclic loading. Non-parametric Friedman statistical comparative tests were performed and the p values less than 0.05 were reflected as significant.Results: The calculated intersegmental range of motion (ROM) and intradiscal pressure (IDP) from 20 pre-operative FE models were within the overall ranges compared to the available data from literature. Under static loading, greater ROM, IDP, facet joint force (FJF) values were detected post ACDF, as compared with pre-op. Over-distraction induced significantly higher IDP and FJF in both upper and lower adjacent levels in extension. Higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were observed in ACDF group which significantly increased for over-distraction groups.Discussion: it was concluded that using larger-sized interbody cages (the height of ≥2 mm of the index disc height) can result in remarkable variations in biomechanical responses of adjacent levels, which may indicate as risk factor for adjacent segment disease. The results of this comprehensive FE investigation using personalized modeling technique highlight the importance of selecting the appropriate height of interbody cage in ACDF surgery. |
| first_indexed | 2024-03-12T14:39:59Z |
| format | Article |
| id | doaj.art-4f5b5c5935764d33b4cb4436fa083795 |
| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-03-12T14:39:59Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-4f5b5c5935764d33b4cb4436fa0837952023-08-16T11:54:53ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852023-08-011110.3389/fbioe.2023.12172741217274The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element studyChih-Hsiu Cheng0Chih-Hsiu Cheng1Ping-Yeh Chiu2Ping-Yeh Chiu3Hung-Bin Chen4Chi-Chien Niu5Chi-Chien Niu6Mohammad Nikkhoo7Mohammad Nikkhoo8Mohammad Nikkhoo9School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, TaiwanBone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, TaiwanBone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, TaiwanDepartment of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, TaiwanSchool of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, TaiwanBone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, TaiwanDepartment of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, TaiwanSchool of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, TaiwanBone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, TaiwanDepartment of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IranIntroduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evaluated the effect of larger-sized interbody cages on the cervical spine with ACDF under both static and cyclic loading.Method: Twenty pre-operative personalized poro-hyperelastic finite element (FE) models were developed. ACDF post-operative models were then constructed and four clinical scenarios (i.e., 1) No-distraction; 2) 1 mm distraction; 3) 2 mm distraction; and 4) 3 mm distraction) were predicted for each patient. The biomechanical responses at adjacent spinal levels were studied subject to static and cyclic loading. Non-parametric Friedman statistical comparative tests were performed and the p values less than 0.05 were reflected as significant.Results: The calculated intersegmental range of motion (ROM) and intradiscal pressure (IDP) from 20 pre-operative FE models were within the overall ranges compared to the available data from literature. Under static loading, greater ROM, IDP, facet joint force (FJF) values were detected post ACDF, as compared with pre-op. Over-distraction induced significantly higher IDP and FJF in both upper and lower adjacent levels in extension. Higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were observed in ACDF group which significantly increased for over-distraction groups.Discussion: it was concluded that using larger-sized interbody cages (the height of ≥2 mm of the index disc height) can result in remarkable variations in biomechanical responses of adjacent levels, which may indicate as risk factor for adjacent segment disease. The results of this comprehensive FE investigation using personalized modeling technique highlight the importance of selecting the appropriate height of interbody cage in ACDF surgery.https://www.frontiersin.org/articles/10.3389/fbioe.2023.1217274/fullcervical spine biomechanicsporoelastic finite element modelingpersonalized modelingcervical anterior fusioninterbody cageover-distraction |
| spellingShingle | Chih-Hsiu Cheng Chih-Hsiu Cheng Ping-Yeh Chiu Ping-Yeh Chiu Hung-Bin Chen Chi-Chien Niu Chi-Chien Niu Mohammad Nikkhoo Mohammad Nikkhoo Mohammad Nikkhoo The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study Frontiers in Bioengineering and Biotechnology cervical spine biomechanics poroelastic finite element modeling personalized modeling cervical anterior fusion interbody cage over-distraction |
| title | The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study |
| title_full | The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study |
| title_fullStr | The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study |
| title_full_unstemmed | The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study |
| title_short | The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study |
| title_sort | influence of over distraction on biomechanical response of cervical spine post anterior interbody fusion a comprehensive finite element study |
| topic | cervical spine biomechanics poroelastic finite element modeling personalized modeling cervical anterior fusion interbody cage over-distraction |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1217274/full |
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