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Guo LX, Zhang DX, Zhang M. Destruction mechanism of anterior cervical discectomy and fusion in frontal impact. Med Biol Eng Comput 2024:10.1007/s11517-024-03167-z. [PMID: 39048839 DOI: 10.1007/s11517-024-03167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/22/2024] [Indexed: 07/27/2024]
Abstract
The aim of this study was to quantitatively study the effect of anterior cervical discectomy and fusion (ACDF) on the risk of spinal injury under frontal impact. A head-neck finite element model incorporating active neck muscles and soft tissues was developed and validated. Based on the intact head-neck model, three ACDF models (single-level, two-level and three-level) were used to analyze the frontal impact responses of the head-neck. The results revealed that various surgical approaches led to distinct patterns of vertebral damage under frontal impact. For single-level and three-level ACDFs, vertebral destruction was mainly concentrated at the lower end of the fused segment, while the other vertebrae were not significantly damaged. For two-level ACDF, the lowest vertebra was the first to suffer destruction, followed by severe damage to both the upper and lower vertebrae, while the middle vertebra of the cervical spine exhibited only partial damage around the screws. Fusion surgery for cervical spine injuries predominantly influences the vertebral integrity of the directly fused segments when subjected to frontal impact, while exerting a comparatively lesser impact on the cross-sectional properties of adjacent, non-fused segments.
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Affiliation(s)
- Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, 110819, China.
| | - Dong-Xiang Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, 110819, China
| | - Ming Zhang
- Res Inst Sports Sci & Technol, Hong Kong Polytechnic University, Hong Kong, 999077, China
- Dept Biomed Engn, Hong Kong Polytechnic University, Hong Kong, 999077, China
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Li Z, Zhang B, Fang B, Gong H, Han Y, Pei S, Zhang S, Song G. Finite element analysis of a three-dimensional cervical spine model with muscles based on CT scan data. Comput Methods Biomech Biomed Engin 2024:1-11. [PMID: 38963151 DOI: 10.1080/10255842.2024.2373928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The incidence of cervical spondylosis is increasing, gradually affecting people's normal lives. Establishing a finite element model of the cervical spine is one of the methods for studying cervical spondylosis. MRI (Magnetic Resonance Imaging) still has certain difficulties in transitioning from human imaging to establishing muscle models suitable for finite element analysis. Medical software provides specific morphologies and can generate muscle finite element models. Additionally, there is little research on the static analysis of cervical spine finite element models with solid muscle. PURPOSE A new method is proposed for establishing a finite element model of the cervical spine based on CT (Computed Tomography) data and medical software, and the model's effectiveness is validated. Human movement characteristics based on the force distribution in various parts are analyzed and predicted. METHODS The muscle model is reconstructed in medical software and a three-dimensional finite element model of the entire cervical spine (C0-C7) is established by combining muscle models with CT vertebral data models. 1.5 Nm of load is applied to the finite element model to simulate the cervical spine movement. RESULTS The finite element model was successfully established, and effectiveness was verified. Stress variations in various parts under six movements were obtained. The effectiveness of the model was basically verified. CONCLUSION The finite element model of the cervical spine for mechanical analysis can be successfully established by using medical software and CT data. In daily life, the C2-3, C3-4, C4-C5 intervertebral discs, rectus capitis posterior major, longus colli, and obliquus capitis inferior are more prone to injury.
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Affiliation(s)
- Zhi Li
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Bing Zhang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Bin Fang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Huiping Gong
- Department of Emergency, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Han
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Shize Pei
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Shuqi Zhang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Guangfei Song
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
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Meng B, Zhao X, Wang XL, Wang J, Xu C, Lei W. Does the novel artificial cervical joint complex resolve the conflict between stability and mobility after anterior cervical surgery? a finite element study. Front Bioeng Biotechnol 2024; 12:1400614. [PMID: 38887613 PMCID: PMC11180832 DOI: 10.3389/fbioe.2024.1400614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
Background and objective Our group has developed a novel artificial cervical joint complex (ACJC) as a motion preservation instrument for cervical corpectomy procedures. Through finite element analysis (FEA), this study aims to assess this prosthesis's mobility and stability in the context of physiological reconstruction of the cervical spine. Materials and methods A finite element (FE)model of the subaxial cervical spine (C3-C7) was established and validated. ACJC arthroplasty, anterior cervical corpectomy and fusion (ACCF), and two-level cervical disc arthroplasty (CDA) were performed at C4-C6. Range of motion (ROM), intervertebral disc pressure (IDP), facet joint stress (FJS), and maximum von Mises stress on the prosthesis and vertebrae during loading were compared. Results Compared to the intact model, the ROM in all three surgical groups demonstrated a decline, with the ACCF group exhibiting the most significant mobility loss, and the highest compensatory motion in adjacent segments. ACJC and artificial cervical disc prosthesis (ACDP) well-preserved cervical mobility. In the ACCF model, IDP and FJS in adjacent segments increased notably, whereas the index segments experienced the most significant FJS elevation in the CDA model. The ROM, IDP, and FJS in both index and adjacent segments of the ACJC model were intermediate between the other two. Stress distribution of ACCF instruments and ACJC prosthesis during the loading process was more dispersed, resulting in less impact on the adjacent vertebrae than in the CDA model. Conclusion The biomechanical properties of the novel ACJC were comparable to the ACCF in constructing postoperative stability and equally preserved physiological mobility of the cervical spine as CDA without much impact on adjacent segments and facet joints. Thus, the novel ACJC effectively balanced postoperative stability with cervical motion preservation.
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Affiliation(s)
- Bing Meng
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Xiong Zhao
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Xin-Li Wang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Jian Wang
- Department of Orthopedics, Affiliated Hospital of NCO School of Army Medical University, Shijiazhuang, Hebei Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, Shaanxi, China
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
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Kumar R, Kumar A, Kumari S. Biomechanical analysis of single and multi-level artificial disc replacement (ADR) in cervical spine using multi-scale loadings: A finite element study. Int J Artif Organs 2024; 47:411-417. [PMID: 38904355 DOI: 10.1177/03913988241259969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Artificial disc replacement (ADR) is a clinical procedure used to diagnose cervical degenerative disc disease, preserving range of motion (ROM) at the fixation level and preventing adjacent segment degeneration (ASD). This study analyzed the biomechanics of ADR by examining range of motion (ROM), stress levels in bone and implants, and strain in the bone-implant interface using multi-scale loadings. The study focused on single- and double-level patients across various loading scales during physiological motions within the cervical spine. Results showed increased ROM in single-level and double-level fixations during physiological loadings, while ROM decreased at the adjacent level of fixation with the intact cervical spine model. The Prodisc-Implant metal endplate experienced a maximum von Mises stress of 432 MPa during axial rotation, confirming the long durability and biomechanical performance of the bone-implant interface.
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Affiliation(s)
- Ram Kumar
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Amit Kumar
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Shabanam Kumari
- Department of Mathematics, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Lin Z, Lin D, Xu L, Chen Q, Vashisth MK, Huang X, Deng Y, Zhang F, Huang W. Biomechanical evaluation on a new type of vertebral titanium porous mini-plate and mechanical comparison between cervical open-door laminoplasty and laminectomy: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1353797. [PMID: 38375455 PMCID: PMC10875091 DOI: 10.3389/fbioe.2024.1353797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Objective: Compare the spine's stability after laminectomy (LN) and laminoplasty (LP) for two posterior surgeries. Simultaneously, design a new vertebral titanium porous mini plate (TPMP) to achieve firm fixation of the open-door vertebral LP fully. The objective is to enhance the fixation stability, effectively prevent the possibility of "re-closure," and may facilitate bone healing. Methods: TPMP was designed by incorporating a fusion body and porous structures, and a three-dimensional finite element cervical model of C2-T1 was constructed and validated. Load LN and LP finite element models, respectively, and analyze and simulate the detailed processes of the two surgeries. It was simultaneously implanting the TPMP into LP to evaluate its biomechanical properties. Results: We find that the range of motion (ROM) of C4-C5 after LN surgery was greater than that of LP implanted with different plates alone. Furthermore, flexion-extension, lateral bending, and axial rotation reflect this change. More noteworthy is that LN has a much larger ROM on C2-C3 in axial rotation. The ROM of LP implanted with two different plates is similar. There is almost no difference in facet joint stress in lateral bending. The facet joint stress of LN is smaller on C2-C3 and C4-C5, and larger more prominent on C5-C6 in the flexion-extension. Regarding intervertebral disc pressure (IDP), there is little difference between different surgeries except for the LN on C2-C3 in axial rotation. The plate displacement specificity does not significantly differ from LP with vertebral titanium mini-plate (TMP) and LP with TPMP after surgery. The stress of LP with TPMP is larger in C4-C5, C5-C6. Moreover, LP with TMP shows greater stress in the C3-C4 during flexion-extension and lateral bending. Conclusion: LP may have better postoperative stability when posterior approach surgery is used to treat CSM; at the same time, the new type of vertebral titanium mini-plate can achieve almost the same effect as the traditional titanium mini-plate after surgery for LP. In addition, it has specific potential due to the porous structure promoting bone fusion.
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Affiliation(s)
- Zhiwei Lin
- School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Dongxin Lin
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Lin Xu
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopaedic, The First Hospital of Qiqihar, Heilongjiang, China
| | - Qiwei Chen
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Manoj Kumar Vashisth
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xuecheng Huang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yuping Deng
- Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Feihu Zhang
- School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Wenhua Huang
- School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopaedic, The First Hospital of Qiqihar, Heilongjiang, China
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Kong W, Du Y, Li J, Shao J, Xi Y. The retropharyngeal reduction plate for atlantoaxial dislocation: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1346850. [PMID: 38318194 PMCID: PMC10841548 DOI: 10.3389/fbioe.2024.1346850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Objective: To investigate the biomechanical properties of the retropharyngeal reduction plate by comparing the traditional posterior pedicle screw-rod fixation by finite element analysis. Methods: Two three-dimensional finite element digital models of the retropharyngeal reduction plate and posterior pedicle screw-rod fixation were constructed and validated based on the DICOM (Digital Imaging and Communications in Medicine) data from C1 to C4. The biomechanical finite element analysis values of two internal fixations were measured and calculated under different conditions, including flexion, extension, bending, and rotation. Results: In addition to the backward extension, there was no significant difference in the maximum von Mises stress between the retropharyngeal reduction plate and posterior pedicle screw fixation under other movement conditions. The retropharyngeal reduction plate has a more uniform distribution under different conditions, such as flexion, extension, bending, and rotation. The stress tolerance of the two internal fixations was basically consistent in flexion, extension, left bending, and right bending. Conclusion: The retropharyngeal reduction plate has a relatively good biomechanical stability without obvious stress concentration under different movement conditions. It shows potential as a fixation option for the treatment of atlantoaxial dislocation.
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Affiliation(s)
| | | | | | | | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Xi Z, Xie Y, Chen S, Sun S, Zhang X, Yang J, Li J. The cranial vertebral body suffers a higher risk of adjacent vertebral fracture due to the poor biomechanical environment in patients with percutaneous vertebralplasty. Spine J 2023; 23:1764-1777. [PMID: 37611873 DOI: 10.1016/j.spinee.2023.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/08/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND CONTEXT Adjacent vertebral fracture (AVF), a frequent complication of PVP, is influenced by factors such as osteoporosis progression, increased intervertebral cement leakage (ICL), and biomechanical deterioration. Notably, the risk of AVF is notably elevated in the cranial vertebral body compared with the caudal counterpart. Despite this knowledge, the underlying pathological mechanism remains elusive. PURPOSE This study delves into the role of biomechanical deterioration as a pivotal factor in the heightened risk of AVF in the cranial vertebral body following PVP. By isolating this variable, we aim to unravel its prominence relative to other potential risk factors. STUDY DESIGN A retrospective study and corresponding numerical mechanical simulations. PATIENT SAMPLE Clinical data from 101 patients treated by PVP were reviewed in this study. OUTCOME MEASURES Clinical assessments involved measuring Hounsfield unit (HU) values of adjacent vertebral bodies as a representation of patients' bone mineral density (BMD). Additionally, the rates of ICL were compared among these patients. Numerical simulations were conducted to compute stress values in the cranial and caudal vertebral bodies under various body positions. METHODS In a retrospective analysis of PVP patients spanning July 2016 to August 2019, we scrutinized the HU values of adjacent vertebral bodies to discern disparities in BMD between cranial and caudal regions. Additionally, we compared ICL rates on both cranial and caudal sides. To augment our investigation, well-validated numerical models simulated the PVP procedure, enabling the computation of maximum stress values in cranial and caudal vertebral bodies across varying body positions. RESULTS The incidence rate of cranial AVF was significantly higher than the caudal side. No notable distinctions in HU values or ICL rates were observed between the cranial and caudal sides. The incidence of AVF showed no significant elevation in patients with ICL in either region. However, numerical simulations unveiled heightened stress values in the cranial vertebral body. CONCLUSIONS In patients postPVP, the cranial vertebral body faces a heightened risk of AVF, primarily attributed to biomechanical deterioration rather than lower BMD or an elevated ICL rate.
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Affiliation(s)
- Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, P.R. China
| | - Yimin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, P.R. China
| | - Shuang Chen
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, P.R. China
| | - Shenglu Sun
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, P.R. China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, P.R. China
| | - Jiexiang Yang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, No.182, Chunhui Rd, Longmatan District, Luzhou, Sichuan Province, 646000, P.R. China
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, No.182, Chunhui Rd, Longmatan District, Luzhou, Sichuan Province, 646000, P.R. China.
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Young MW, Abtahi AM. Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement: Current Evidence. Clin Spine Surg 2023; 36:391-397. [PMID: 37798824 DOI: 10.1097/bsd.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES The purpose of this study was to provide a review of the current evidence on the impact of posterior cervical foraminotomy (PCF) performed before or after cervical disk replacement (CDR). SUMMARY OF BACKGROUND DATA The impact of PCF on outcomes in the setting of CDR is an evolving field, given the recent widespread adoption of CDR and the relative rarity of patients who have undergone both procedures. METHODS A literature search was conducted using PubMed to determine current evidence regarding the indications, outcomes, and biomechanical effects of CDR and PCF when performed alone or in combination. RESULTS When radicular symptoms persist following PCF, a CDR can be safely performed to provide further decompression. Conversely, a PCF can be safely performed following CDR for these same indications. The biomechanical effects of these procedures in combination demonstrate maintained stability when the facetectomy is less than 50% of the facet joint. Studies demonstrate that stability is not significantly decreased by the presence, amount, or level of posterior foraminotomies in the setting of CDR. CONCLUSIONS A PCF can be safely performed before or after cervical disk arthroplasty for recurrent radicular symptoms. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Mason W Young
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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He W, Du Q, Wang ZJ, Xin ZJ, Wu FJ, Kong WJ, Su H, Liao WB. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels for adjacent two-segment cervical spondylotic myelopathy: a technical note. BMC Musculoskelet Disord 2023; 24:844. [PMID: 37884962 PMCID: PMC10601313 DOI: 10.1186/s12891-023-06978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The current treatments for adjacent two-segment cervical spondylotic myelopathy (CSM) include two-segment anterior cervical discectomy and fusion (ACDF) and single-segment anterior cervical corpectomy and fusion (ACCF). Long-term follow-up has demonstrated that both procedures have complications such as reduced cervical mobility, accelerated degeneration of adjacent segments and loosening of internal fixation screws. The purpose of this study is to demonstrate the feasibility, safety, and efficacy of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels for the treatment of adjacent two-segment CSM and to present our surgical experience. METHODS Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels was performed for 12 patients with adjacent two-segment CSM with follow-up care for at least 12 months. The Visual analog scale (VAS) and the Japanese Orthopedic Association Score (JOA) were recorded, and modified Macnab criteria were used to evaluate the treatment excellence rate. Radiological examinations, including X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), were used to evaluate spinal cord decompression, intervertebral stability and healing of the bony channel. RESULTS All 12 patients completed the operation successfully. No postoperative complications, such as dysphagia, Horner's syndrome, or laryngeal recurrent nerve palsy, were found. The postoperative VAS and JOA scores were significantly improved compared with those before surgery(P < 0.001). According to the modified Macnab criteria, the clinical outcome was excellent in 8 cases, good in 3 cases and fine in 1 case at the final follow-up and the excellent and good rate was 91.7%. Postoperative and follow-up imaging showed significant spinal cord decompression, well-healed bony channels and no cervical instability. CONCLUSIONS This study is the first report of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels. This procedure has the advantages of less trauma, faster recovery, fewer complications and no need to implant internal fixators. This is a minimally invasive, feasible and safe surgical procedure for patients with adjacent two-segment CSM.
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Affiliation(s)
- Wen He
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zheng-Ji Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Fu-Jun Wu
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Heng Su
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Xu C, Xi Z, Fang Z, Zhang X, Wang N, Li J, Liu Y. Annulus Calibration Increases the Computational Accuracy of the Lumbar Finite Element Model. Global Spine J 2023; 13:2310-2318. [PMID: 35293827 PMCID: PMC10538312 DOI: 10.1177/21925682221081224] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Mechanical simulations. OBJECTIVE Inadequate calibration of annuli negatively affects the computational accuracy of finite element (FE) models. Specifically, the definition of annulus average radius (AR) does not have uniformity standards. Differences between the elastic moduli in the different layers and parts of the annulus were not fully calibrated when a linear elastic material is used to define its material properties. This study aims to optimize the computational accuracy of the FE model by calibrating the annulus. METHODS We calibrated the annulus AR and elastic modulus in our anterior-constructed lumbar model by eliminating the difference between the computed range of motion and that measured by in vitro studies under a flexion-extension loading condition. Multi-indicator validation was performed by comparing the computed indicators with those measured in in vitro studies. The computation time required for the different models has also been recorded to evaluate the computational efficiency. RESULTS The difference between computed and measured ROMs was less than 1% when the annulus AR and elastic modulus were calibrated. In the model validation process, all the indicators computed by the calibrated FE model were within ±1 standard deviation of the average values obtained from in vitro studies. The maximum difference between the computed and measured values was less than 10% under nearly all loading conditions. There is no apparent variation tendency for the computational time associated with different models. CONCLUSION The FE model with calibrated annulus AR and regional elastic modulus has higher computational accuracy and can be used in subsequent mechanical studies.
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Affiliation(s)
- Chen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhipeng Xi
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, China
| | - Xiaoyu Zhang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Nan Wang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Jingchi Li
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
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Mu G, Yue L, Sun H. Long-Term Radiographic and Clinical Outcomes in Patients Undergoing Transforaminal Endoscopic Lumbar Discectomy: A Propensity Score Matching Study. J Pain Res 2023; 16:3019-3027. [PMID: 37674818 PMCID: PMC10478952 DOI: 10.2147/jpr.s406071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 09/08/2023] Open
Abstract
Background Our study aims to investigate the long-term clinical and radiographic effects of transforaminal endoscopic lumbar discectomy (TELD) on lumbar disc herniation. Patients and Methods Radiographic and clinical data of patients undergoing TELD in our institution from January 2015 to January 2019 were retrospectively collected. LDH outpatients who had not received surgical treatment during the same period were 1:1 matched by propensity score matching as the conservative group. The radiographic parameters of the two groups at baseline and at the last follow-up (≥24 months) were analyzed. Results The study included 47 patients in the TELD group, matched with 47 patients in the conservative group. The disc height of the TELD group at the last follow-up was lower than that at the baseline (P < 0.001), and lower than that of the conservative group at the last follow-up (P < 0.05). The disc degeneration grade of the TELD group at the last follow-up was greater than that at the baseline, and greater than that of the conservative group at the last follow-up. There was no significant difference in the facet joint degeneration in the TELD group between the baseline and the last follow-up, and between the TELD group and the conservative group at the last follow-up (P > 0.05). The pain intensity and disability score in the TELD group at 3-month follow-up and at the last follow-up were significantly lower than those at the baseline (P < 0.001). Six patients in the TELD group required additional surgery during the follow-up period. Conclusion Our long-term follow-up data shows that the disc height of the operated level was significantly reduced and the disc degeneration was significantly aggravated in TELD-treated patients; in contrast, the facet joint degeneration did not show significant aggravation.
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Affiliation(s)
- Guanzhang Mu
- Orthopaedic Department, Peking University First Hospital, Beijing, People’s Republic of China
| | - Lei Yue
- Orthopaedic Department, Peking University First Hospital, Beijing, People’s Republic of China
| | - Haolin Sun
- Orthopaedic Department, Peking University First Hospital, Beijing, People’s Republic of China
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12
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Cheng CH, Chiu PY, Chen HB, Niu CC, Nikkhoo M. The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study. Front Bioeng Biotechnol 2023; 11:1217274. [PMID: 37650042 PMCID: PMC10464836 DOI: 10.3389/fbioe.2023.1217274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
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.
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Affiliation(s)
- Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ping-Yeh Chiu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Bin Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Biomechanical Effect of Using Cement Augmentation to Prevent Proximal Junctional Kyphosis in Long-Segment Fusion: A Finite Element Study. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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14
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Chang L, Wang H, Guo Y, Cai Z, Zhan H. Experimental and numerical analysis of biomechanical effects in cervical spine positioning rotation manipulation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3651. [PMID: 36166310 DOI: 10.1002/cnm.3651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/28/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Unlocking the biomechanical effects of cervical spine positioning rotation manipulation in the treatment of patients with neck pain. In this paper, the safety of the cervical positioning rotation manipulation is analyzed by experimentally obtaining head kinematic data, importing them into a finite element model that has been developed and validated, and calculating and analyzing the angular displacements, disc pressures, and articular surface contact forces in the normal and pathological models. The results show that the cervical spine positioning rotation technique is more effective in adjusting the position and applying force to the cervical spine C5-C6 "tendon out of the groove and bone misalignment" pathological model. Also, the cervical positioning rotation manipulation is applied with less variation in disc nucleus pulposus pressure than in the non-positioning situation. Thus, in patients with disc degeneration, cervical positioning rotational manipulation has a more direct mechanical effect and is safer than non-positioning rotational manipulation. The cervical spine positioning rotation manipulation is a safe method that can effectively treat patients with neck pain. It has been well demonstrated in the computational analysis of the pathological model.
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Affiliation(s)
- Lijun Chang
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Huihao Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of TCM, Shanghai, China
| | - Yingfu Guo
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Zhihua Cai
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of TCM, Shanghai, China
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15
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Dong J, Liang B, Sun Y, Li X, Han P, Wang C, Song Y, Wu H, Liu R, Huang S, Yu S, Jin L, Yu Z, Fan L, Song H, Zhang C, He X. Biomechanics of a novel artificial cervical vertebra from an in vivo caprine cervical spine non-fusion model. J Orthop Translat 2022; 37:61-68. [PMID: 36225948 PMCID: PMC9523198 DOI: 10.1016/j.jot.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/12/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Anterior cervical corpectomy and fusion (ACCF) has been widely used in the treatment of cervical spondylotic myelopathy (CSM) but is accompanied by unavoidable motion loss and destruction of vertebra. We aim to evaluate the range of motion (ROM) of caprine cervical spine constructs implanted with cervical artificial disc and vertebra system (ADVS). The purpose of this study was to investigate the biomechanical properties of the ADVS from an in vivo caprine cervical spine non-fusion model. Methods Twelve goats were randomly divided into ADVS or control group, with 6 animals in each group. The animals in the ADVS group were implanted with ADVS at the C4 level. The cervical spine constructs were harvested 6 months after the operation. The ROM of cervical spine specimens in the ADVS group was recorded. Biomechanical testing of the specimens in the control group were conducted to evaluate the ROM of the cervical spine specimens under intact and fixed condition (C3-C5) by an anterior plate, respectively. Results The biomechanical outcomes showed that the ROM of the levels (C3-C5) implanted with ADVS was maintained. The ROM in the adjacent level (C2-3) did not increase significantly comparing with intact group. Conclusions In general, ADVS could preserve the ROM of operative levels and could reconstruct the height of the vertebra. ADVS did not increase the ROM of upper adjacent level. This device provides a non-fusion method for the treatment of patients suffering from CSM. However, improvements on the design of ADVS are still needed. Translational potential statement This study introduced a novel cervical spinal implant, which was designed to have the ability of motion preservation and vertebra construction. Our study provided a non-fusion procedure in the treatment of CSM after ACCF.
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Affiliation(s)
- Jun Dong
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Baobao Liang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, West Five Road, Xi'an, 710004, China
| | - Yuan Sun
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xi Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Pei Han
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chen Wang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Yabing Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Hao Wu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Ruoxi Liu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sihua Huang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sen Yu
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Lei Jin
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Zhentao Yu
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou, 510632, China
| | - Liying Fan
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Huanjin Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chun Zhang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
- Department of Orthopaedics, Xi'an International Medical Center Hospital, No. 777, Xitai Road, Xi'an, 710000, PR China
- Corresponding author. Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xincheng District, Xi'an, Shaanxi Province, 710004, PR China.
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Khalaf K, Nikkhoo M. Comparative biomechanical analyses of lower cervical spine post anterior fusion versus intervertebral disc arthroplasty: A geometrically patient-specific poroelastic finite element investigation. J Orthop Translat 2022; 36:33-43. [PMID: 35891924 PMCID: PMC9293956 DOI: 10.1016/j.jot.2022.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 10/31/2022] Open
Abstract
Background/Objective The optimal surgical technique for the treatment of cervical degenerative disc disease (CDDD) towards decreasing the risk of adjacent segment disease (ASD) remains elusive. This study aimed to comparatively investigate the biomechanics of the lower cervical spine following fusion (ACDF) and artificial disc arthroplasty (Bryan® and Prestige LP®) using a validated geometrically patient-specific poroelastic finite element modeling (FEM) approach. Methods Ten subject-specific pre-operative models were developed and validated based on a FEM approach. Poroelastic models were then constructed using post-operation images for three different treatment scenarios: ACDF; Prestige LP® and Bryan® artificial discs at the C5-C6 level. The biomechanical responses at both surgical and adjacent spinal levels were studied subject to static and cyclic loading. Results Postoperatively, greater range of motion (ROM), higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were detected post ACDF, as compared with pre-op as well as artificial disc arthroplasty. The facet joint forces were larger for the Prestige LP® disc, particularly during extension. The lowest values in disc height and fluid exchange were observed in the Bryan® artificial disc arthroplasty models. Conclusion Biomechanical analyses revealed that ACDF poses the highest potential risk for adjacent disc degeneration. The artificial discs investigated here (Prestige LP® and Bryan®) not only preserved motion at the instrumented level, but also sustained the pre-op ROM and decreased the intradiscal pressure (IDP) and facet joint forces (FJFs) at adjacent levels, particularly during flexion/extension. The Bryan® artificial disc demonstrated the most efficacy in maintaining the natural poroelastic characteristics of adjacent discs. The translational potential of this article This study provided a technique for clinicians to use quantitative data towards subject-specific evaluation to comparatively evaluate the impact of ACDF and disc arthroplasty using two types of artificial discs on the biomechanics of the cervical spine. It confirms differences in the poroelastic characteristics of adjacent discs for different fixation techniques, and reveals the advantage of artificial discs with a flexible core for decreasing the risk of ASD.
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Affiliation(s)
- Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, And Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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17
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Ma W, Peng Y, Zhang S, Wang Y, Gan K, Zhao X, Xu D. Comparison of Percutaneous Endoscopic Cervical Keyhole Foraminotomy versus Microscopic Anterior Cervical Discectomy and Fusion for Single Level Unilateral Cervical Radiculopathy. Int J Gen Med 2022; 15:6897-6907. [PMID: 36061960 PMCID: PMC9439641 DOI: 10.2147/ijgm.s378837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the clinical and radiological outcomes between microscopic anterior cervical discectomy and fusion (ACDF) and percutaneous endoscopic cervical keyhole foraminotomy (PECF) for single level unilateral cervical radiculopathy. Methods A total of 127 patients (59 in PECF VS 68 in ACDF) were enrolled in this study from April 2016 to May 2018 with a minimum follow-up of 2 years. Clinical data including baseline data, Neck Disability Index (NDI), and Visual Analogue Scale for neck and arm (VAS-n, VAS-a) were collected and compared. Radiological evaluation such as disc height, ROM of cervical, Cobb’s angle of cervical and Cobb’s angle of operated segment was measured by two experienced radiologists in twice. Results There was no significant difference between the two groups in the baseline data, and hospital stay was significantly decreased in PECF group than ACDF group (P < 0.001). PECF group did not yield superior better outcomes in NDI, VAS-a and VAS-n than ACDF group except at 1-month follow-up. As for radiological outcomes, PECF group has significantly better cervical motion, cervical angle and segmental angle than ADCF group at 12- and 24-month follow-up visit (P < 0.05); however, ACDF had shown better disc height restoration and maintenance than PECF (P < 0.05). More complications including surface hematoma and swallowing difficulty were occurred in ADCF group. Conclusion Percutaneous endoscopic cervical keyhole foraminotomy could be the alternative method for anterior cervical discectomy and fusion in selective cases. However, the indication should be fulfilled, more studies need to be conducted to further testify the efficacy of PECF.
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Affiliation(s)
- Weihu Ma
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, People’s Republic of China
| | - Yujie Peng
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Song Zhang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Yulong Wang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Kaifeng Gan
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xuchen Zhao
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Dingli Xu
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
- Correspondence: Dingli Xu, Email
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Yu Q, Han F, Yuan Z, Zhu Z, Liu C, Tu Z, Guo Q, Zhao R, Zhang W, Wang H, Mao H, Li B, Zhu C. Fucoidan-loaded nanofibrous scaffolds promote annulus fibrosus repair by ameliorating the inflammatory and oxidative microenvironments in degenerative intervertebral discs. Acta Biomater 2022; 148:73-89. [PMID: 35671874 DOI: 10.1016/j.actbio.2022.05.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/01/2022]
Abstract
Tissue engineering holds potential in the treatment of intervertebral disc degeneration (IDD). However, implantation of tissue engineered constructs may cause foreign body reaction and aggravate the inflammatory and oxidative microenvironment of the degenerative intervertebral disc (IVD). In order to ameliorate the adverse microenvironment of IDD, in this study, we prepared a biocompatible poly (ether carbonate urethane) urea (PECUU) nanofibrous scaffold loaded with fucoidan, a natural marine bioactive polysaccharide which has great anti-inflammatory and antioxidative functions. Compared with pure PECUU scaffold, the fucoidan-loaded PECUU nanofibrous scaffold (F-PECUU) decreased the gene and protein expression related to inflammation and the oxidative stress in the lipopolysaccharide (LPS) induced annulus fibrosus cells (AFCs) significantly (p<0.05). Especially, gene expression of Ill 6 and Ptgs2 was decreased by more than 50% in F-PECUU with 3.0 wt% fucoidan (HF-PECUU). Moreover, the gene and protein expression related to the degradation of extracellular matrix (ECM) were reduced in a fucoidan concentration-dependent manner significantly, with increased almost 3 times gene expression of Col1a2 and Acan in HF-PECUU. Further, in a 'box' defect model, HF-PECUU decreased the expression of COX-2 and deposited more ECM between scaffold layers when compared with pure PECUU. The disc height and nucleus pulposus hydration of repaired IVD reached up to 75% and 85% of those in the sham group. In addition, F-PECUU helped to maintain an integrate tissue structure with a similar compression modulus to that in sham group. Taken together, the F-PECUU nanofibrous scaffolds showed promising potential to promote AF repair in IDD treatment by ameliorating the harsh degenerative microenvironment. STATEMENT OF SIGNIFICANCE: Annulus fibrosus (AF) tissue engineering holds potential in the treatment of intervertebral disc degeneration (IDD), but is restricted by the inflammatory and oxidative microenvironment of degenerative disc. This study developed a biocompatible polyurethane scaffold (F-PECUU) loaded with fucoidan, a marine bioactive polysaccharide, for ameliorating IDD microenvironment and promoting disc regeneration. F-PECUU alleviated the inflammation and oxidative stress caused by lipopolysaccharide and prevented extracellular matrix (ECM) degradation in AF cells. In vivo, it promoted ECM deposition to maintain the height, water content and mechanical property of disc. This work has shown the potential of marine polysaccharides-containing functional scaffolds in IDD treatment by ameliorating the harsh microenvironment accompanied with disc degeneration.
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Affiliation(s)
- Qifan Yu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Feng Han
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Zhangqin Yuan
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Zhuang Zhu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Changjiang Liu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Zhengdong Tu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Qianping Guo
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Runze Zhao
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Weidong Zhang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Huan Wang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Haijiao Mao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315000, China.
| | - Bin Li
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315000, China; Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu 215000, China.
| | - Caihong Zhu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
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Xu C, Wang R, Li J, Zhong H, Zhang Z, Cui C, Sun B, Tian Y, Chen H, Shen X, Liu Y, Yuan W. Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure. J Orthop Surg Res 2022; 17:91. [PMID: 35168657 PMCID: PMC8845354 DOI: 10.1186/s13018-022-02983-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/02/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the relationship of postoperative cervical axial pain with different vertebral distraction methods used during ACDF procedures in cervical spondylosis patients. Methods Ninety-four single-level cervical spondylotic myelopathy patients with significantly loss of intervertebral disc height who underwent ACDF surgery in our institute between January 2018 and January 2020 were enrolled. Cervical spine lateral radiographs were taken preoperatively, 3 days, 1-month, 2-month and 6-month after the surgery. The intervertebral disc height (IDH), interfacet distance (IFD), JOA (Japanese Orthopaedic Association) score, NDI (Neck Disability Index) score, nVAS (Neck Visual Analogue Scale) score and aVAS (Arm Visual Analogue Scale) score were measured. The correlation of clinical parameters and intervertebral disc height was evaluated. Then the correlation of clinical outcomes and different distraction method was evaluated. The patients were randomly divided into two groups, one uses Casper pin distractor system alone for distraction (Caspar alone group) and the other uses spreader assisted distraction method (Casper + spreader group). In biomechanical study, four cervical spine cadavers were selected for facet pressure measurements under different vertebral distraction methods, and the facet joint pressure was measured using force sensors. Results Satisfactory cervical fusion and neurological recovery were achieved in all patients. No significant correlation of IDH, IFD, JOA, NDI or aVAS with nVAS score was found. No significant difference between the change in disc height and clinical outcomes was found. However, by comparing the clinical parameters of patients in different vertebral distraction groups, we found significant changes in the early nVAS and NDI scores (P = 0.11, P = 0.48) of the Casper + spreader group (3 days postoperation), and was associated with a better nVAS score at 2 months postoperation (P < 0.05). The biomechanical study in cervical cadavers also showed significantly and continuously decreased facet joint pressure in the spreader assisted vertebral distraction group (P < 0.01). Conclusions Spreader-assisted vertebral distraction method effectively alleviates postoperative neck pain in degenerative cervical spondylosis patients treated with ACDF. The mechanism may be related to the transient relief of facet joint pressure during the vertebral distraction procedure in ACDF.
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Affiliation(s)
- Chen Xu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ruizhe Wang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jingchi Li
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China.,Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, 182th Chunhui Road, Luzhou, Sichuan Province, 646000, People's Republic of China
| | - Huajian Zhong
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Zifang Zhang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Cheng Cui
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Baifeng Sun
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ye Tian
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Yang Liu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Wen Yuan
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, 200003, People's Republic of China.
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He T, Zhang J, Yu T, Wu J, Yuan T, Liu R, Yun Z, Du H, Qi L, An J, Xue W, Nie X, Liu Q. Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:772853. [PMID: 34976969 PMCID: PMC8716838 DOI: 10.3389/fbioe.2021.772853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Minimally invasive surgeries, including posterior endoscopic cervical foraminotomy (PECF), microsurgical anterior cervical foraminotomy (MACF), anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD), and anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD), have obtained positive results for cervical spondylotic radiculopathy. Nonetheless, there is a lack of comparison among them regarding their biomechanical performance. The purpose of this study is to investigate the biomechanical changes of operated and adjacent segments after minimally invasive surgeries compared to a normal cervical spine. A three-dimensional model of normal cervical vertebrae C3–C7 was established using finite element analysis. Afterwards, four surgical models (PECF, MACF, ATd-ECD, and ATc-ECD) were constructed on the basis of the normal model. Identical load conditions were applied to simulate flexion, extension, lateral bending, and axial rotation of the cervical spine. We calculated the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus pressure (AFP), uncovertebral joints contact pressure (CPRESS), and facet joints CPRESS under different motions. For all circumstances, ATc-ECD was close to the normal cervical spine model, whereas ATd-ECD significantly increased ROM and joints CPRESS and decreased IDP in the operated segment. PECF increased more the operated segment ROM than did the MACF, but the MACF obtained maximum IDP and AFP. Except for ATc-ECD, the other models increased joints CPRESS of the operated segment. For adjacent segments, ROM, IDP, and joints CPRESS showed a downward trend in all models. All models showed good biomechanical stability. With their combination biomechanics, safety, and conditions of application, PECF and ATc-ECD could be appropriate choices for cervical spondylotic radiculopathy.
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Wang Y, Zhao X, Geng B, Sheng X, Zhang K, Cao C, Xia Y, Chen S. Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy. Orthop Surg 2021; 13:2236-2245. [PMID: 34668326 PMCID: PMC8654663 DOI: 10.1111/os.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To describe the rationale and application of triggered EMG (T-EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM). METHODS This study was a retrospective cohort control study. The clinical data of 74 patients with single-segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM-assisted PPECD with triggered EMG (T-EMG group), while 39 were subjected to IOM-assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale. RESULTS Operations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow-up. No significant difference was found in preoperative baseline data between the T-EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T-EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T-EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post-operation (T-EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow-up (T-EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T-EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1-month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow-up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T-EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T-EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow-up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T-EMG group and IOM group, respectively. CONCLUSIONS Triggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.
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Affiliation(s)
- Yao‐bin Wang
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Xiao‐bing Zhao
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Bin Geng
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Xiao‐yun Sheng
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Kai Zhang
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Chen Cao
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Ya‐yi Xia
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Shu‐lian Chen
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
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22
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Li J, Xu C, Zhang X, Xi Z, Sun S, Zhang K, Fang X, Xie L, Liu Y, Song Y. Disc measurement and nucleus calibration in a smoothened lumbar model increases the accuracy and efficiency of in-silico study. J Orthop Surg Res 2021; 16:498. [PMID: 34389025 PMCID: PMC8362282 DOI: 10.1186/s13018-021-02655-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
Backgrounds Finite element analysis (FEA) is an important tool during the spinal biomechanical study. Irregular surfaces in FEA models directly reconstructed based on imaging data may increase the computational burden and decrease the computational credibility. Definitions of the relative nucleus position and its cross-sectional area ratio do not conform to a uniform standard in FEA. Methods To increase the accuracy and efficiency of FEA, nucleus position and cross-sectional area ratio were measured from imaging data. A FEA model with smoothened surfaces was constructed using measured values. Nucleus position was calibrated by estimating the differences in the range of motion (RoM) between the FEA model and that of an in-vitro study. Then, the differences were re-estimated by comparing the RoM, the intradiscal pressure, the facet contact force, and the disc compression to validate the measured and calibrated indicators. The computational time in different models was also recorded to evaluate the efficiency. Results Computational results indicated that 99% of accuracy was attained when measured and calibrated indicators were set in the FEA model, with a model validation of greater than 90% attained under almost all of the loading conditions. Computational time decreased by around 70% in the fitted model with smoothened surfaces compared with that of the reconstructed model. Conclusions The computational accuracy and efficiency of in-silico study can be improved in the lumbar FEA model constructed using smoothened surfaces with measured and calibrated relative nucleus position and its cross-sectional area ratio.
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Affiliation(s)
- Jingchi Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, Chengdu, 610041, China
| | - Chen Xu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Shenglu Sun
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu, China
| | - Ke Zhang
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyang Fang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, 210028, China.
| | - Yang Liu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, Chengdu, 610041, China.
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Finite Element Method for the Evaluation of the Human Spine: A Literature Overview. J Funct Biomater 2021; 12:jfb12030043. [PMID: 34449646 PMCID: PMC8395922 DOI: 10.3390/jfb12030043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
The finite element method (FEM) represents a computer simulation method, originally used in civil engineering, which dates back to the early 1940s. Applications of FEM have also been used in numerous medical areas and in orthopedic surgery. Computing technology has improved over the years and as a result, more complex problems, such as those involving the spine, can be analyzed. The spine is a complex anatomical structure that maintains the erect posture and supports considerable loads. Applications of FEM in the spine have contributed to the understanding of bone biomechanics, both in healthy and abnormal conditions, such as scoliosis, fractures (trauma), degenerative disc disease and osteoporosis. However, since FEM is only a digital simulation of the real condition, it will never exactly simulate in vivo results. In particular, when it concerns biomechanics, there are many features that are difficult to represent in a FEM. More FEM studies and spine research are required in order to examine interpersonal spine stiffness, young spine biomechanics and model accuracy. In the future, patient-specific models will be used for better patient evaluations as well as for better pre- and inter-operative planning.
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Hopkins C, Qin L. Transformation of preclinical study results into clinical applications: Improving protocols and clinical practice in translational orthopaedics. J Orthop Translat 2020; 23:A4. [PMID: 32834998 PMCID: PMC7423332 DOI: 10.1016/j.jot.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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