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Ke H, Guo Y, Zhang X, Yin L, Nie W, Zhao Y, Zhao B, Zhang K, Wen Y, Ji B, Zhang M. Structural modification and biomechanical analysis of lumbar disc prosthesis: A finite element study. Clin Biomech (Bristol, Avon) 2024; 116:106266. [PMID: 38821035 DOI: 10.1016/j.clinbiomech.2024.106266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Most ball-in-socket artificial lumbar disc implanted in the spine result in increased hypermobility of the operative level and overloading of the facet joint. METHODS A finite element model was established and validated for the lumbar spine (L1-L5). The structure of the Mobidisc prosthesis was modified, resulting in the development of two new intervertebral disc prostheses, Movcore and Mcopro. The prostheses were implanted into the L3/L4 level to simulate total disc replacement, and the biomechanical properties of the lumbar spine model were analyzed after the operation. FINDINGS Following the implantation of the prostheses, the mobility of operative level, peak stress of lumbar spine models, and peak stress of facet joint increased. The performance of mobility was found to be more similar between Movcore and Mobidisc. The mobility and facet joint peak stress of the Mcopro model decreased progressively with an increase in the Young's modulus of the artificial annulus during flexion, extension, and lateral bending. Among all the models, the Mcopro50 model had the mobility closest to the intact model. It showed a 3% decrease in flexion, equal range of motion in extension, a 9% increase in left lateral bending, a 7% increase in right lateral bending, and a 3% decrease in axial rotation. INTERPRETATION The feasibility of the new intervertebral disc prostheses, Movcore and Mcopro, has been established. The Mcopro prosthesis, which features an artificial annular structure, offers significant advantages in terms of reduced mobility of the operative level and peak stress of facet joint.
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Affiliation(s)
- Haibo Ke
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Yuan Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Xushu Zhang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China.
| | - Long Yin
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Wenbin Nie
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Yibo Zhao
- Shanxi Medicine University Second Hospital, Taiyuan 030001, Shanxi, China
| | - Bin Zhao
- Shanxi Medicine University Second Hospital, Taiyuan 030001, Shanxi, China.
| | - Kai Zhang
- Shanxi Hua Jin Orthopaedic Hospital, Taiyuan 030400, Shanxi, China
| | - Yunpeng Wen
- Shanxi Hua Jin Orthopaedic Hospital, Taiyuan 030400, Shanxi, China
| | - Binping Ji
- Shanxi Hua Jin Orthopaedic Hospital, Taiyuan 030400, Shanxi, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
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Li H, Tang Y, Liu Z, Chen K, Zhang K, Hu S, Pan C, Yang H, Li B, Chen H. Lumbar instability remodels cartilage endplate to induce intervertebral disc degeneration by recruiting osteoclasts via Hippo-CCL3 signaling. Bone Res 2024; 12:34. [PMID: 38816384 PMCID: PMC11139958 DOI: 10.1038/s41413-024-00331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 06/01/2024] Open
Abstract
Degenerated endplate appears with cheese-like morphology and sensory innervation, contributing to low back pain and subsequently inducing intervertebral disc degeneration in the aged population.1 However, the origin and development mechanism of the cheese-like morphology remain unclear. Here in this study, we report lumbar instability induced cartilage endplate remodeling is responsible for this pathological change. Transcriptome sequencing of the endplate chondrocytes under abnormal stress revealed that the Hippo signaling was key for this process. Activation of Hippo signaling or knockout of the key gene Yap1 in the cartilage endplate severed the cheese-like morphological change and disc degeneration after lumbar spine instability (LSI) surgery, while blocking the Hippo signaling reversed this process. Meanwhile, transcriptome sequencing data also showed osteoclast differentiation related gene set expression was up regulated in the endplate chondrocytes under abnormal mechanical stress, which was activated after the Hippo signaling. Among the discovered osteoclast differentiation gene set, CCL3 was found to be largely released from the chondrocytes under abnormal stress, which functioned to recruit and promote osteoclasts formation for cartilage endplate remodeling. Over-expression of Yap1 inhibited CCL3 transcription by blocking its promoter, which then reversed the endplate from remodeling to the cheese-like morphology. Finally, LSI-induced cartilage endplate remodeling was successfully rescued by local injection of an AAV5 wrapped Yap1 over-expression plasmid at the site. These findings suggest that the Hippo signaling induced osteoclast gene set activation in the cartilage endplate is a potential new target for the management of instability induced low back pain and lumbar degeneration.
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Affiliation(s)
- Hanwen Li
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Yingchuang Tang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Zixiang Liu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Kangwu Chen
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Kai Zhang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Sihan Hu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China
| | - Chun Pan
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, P.R. China
| | - Huilin Yang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, P.R. China.
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China.
| | - Bin Li
- Orthopedic Institute, Suzhou Medical College, Soochow University, Suzhou, P.R. China.
| | - Hao Chen
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, P.R. China.
- Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, P.R. China.
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Ma Y, Yu X, Li C, Xiong Y, Zhao H, Yang Y, Zhao D, Wang F, Qu Y, Yang J, Bi L, Yue X. Changes in the centre of rotation and the anterior bone loss of the vertebral body in Mobi-C artificial disc replacement segments after cervical hybrid surgery: a retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1265-1274. [PMID: 38015272 DOI: 10.1007/s00586-023-08047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To examine the short-term efficacy and imaging results of using the Mobi-C in cervical hybrid surgery on 2-level cervical spondylolisthesis. To observe post-operative changes in the flexion-extension centre of rotation (FE-COR) and anterior bone loss (ABL) of the anterior cervical disc replacement (ACDR) segment. METHODS Forty-two patients (20 males and 22 females, aged 42‒67 years) who underwent cervical hybrid surgery were retrospectively analysed. Their ACDR segment used Mobi-C, and the fusion segment used ROI-C, with a follow-up of 25‒42 months (31.1 ± 4.8 months). The modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and visual analogue scale (VAS) were used to assess clinical outcomes. Pre-operative, 6-month post-operative, and final follow-up radiographs were collected to compare total cervical spine curvature (C2-C7), curvature of the operated segments, range of motion (ROM) in the total cervical spine, operated segmental ROM, ACDR segmental ROM, and operated adjacent segmental ROM. The height of the superior articular process (HSAP), the orientation of zygapophyseal joint spaces (OZJS), and the length of the superior articular surface (LSAS) were measured. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The translation distance of the Mobi-C was measured. The degree of disc degeneration in the adjacent segment, bony fusion of the ACDF segment, and ABL of the upper and lower vertebra of the ACDR segment were observed. RESULTS In our group, all patients have shown improvements in their postoperative mJOA, NDI, and VAS scores. Overall cervical ROM and surgical segmental ROM decreased (P < 0.05). However, there was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with pre-operatively (P > 0.05). For FE-COR-X, only the last follow-up compared with pre-surgery showed statistical significance (46.74 ± 7.71% vs. 50.74 ± 6.92%, P < 0.05). For FE-COR-Y, the change was statistically significant at both 6 months post-operation and the final follow-up compared to pre-operation (45.37% ± 21.11% vs. 33.82% ± 10.87%, 45. 37% ± 21.11% vs. 27.48% ± 13.58%, P < 0.05). No significant difference in the Mobi-C translation distance was observed (P > 0.05). Moreover, the difference in HSAP was not statistically significant at each node (P > 0.05). The OZJS and LSAS were significantly different at the final follow-up compared to the pre-operative period (P < 0.05). All the ACDF segments were observed in a stable condition at the final follow-up. Furthermore, 9 of the adjacent segments showed imaging ASD (9/82, 10.98%), and all were present at the last follow-up, of which 6 were mild, and 3 were moderate. Twenty of the 42 Mobi-C segments had no significant ABL (grade 0) 6 months post-operatively (47.62%). Sixteen cases (38.10%) showed mild ABL (grade 1), and 6 cases (14.28%) showed moderate ABL (grade 2). No severe ABL occurred. CONCLUSION The cervical hybrid surgery using Mobi-C artificial cervical discs can achieve satisfactory results. The Mobi-C segmental FE-COR-X shows a slow forward shift trend, and FE-COR-Y drops noticeably within 6 months post-surgery before stabilizing. It's common to see mild to moderate ABL after cervical hybrid surgery using Mobi-C, and significant progression is unlikely in the short term. Furthermore, changes in the FE-COR after hybrid surgery in the Mobi-C segment might not affect clinical outcomes.
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Affiliation(s)
- Yukun Ma
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Chuanhong Li
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Yang Xiong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - He Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yongdong Yang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Dingyan Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Fengxian Wang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yi Qu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jizhou Yang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Lianyong Bi
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xinliang Yue
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
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Xu Z, Li Y, Huang W, Wang Z, Xu X, Tian S. Preliminary exploration of the biomechanical properties of three novel cervical porous fusion cages using a finite element study. BMC Musculoskelet Disord 2023; 24:876. [PMID: 37950220 PMCID: PMC10636970 DOI: 10.1186/s12891-023-06999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Porous cages are considered a promising alternative to high-density cages because their interconnectivity favours bony ingrowth and appropriate stiffness tuning reduces stress shielding and the risk of cage subsidence. METHODS This study proposes three approaches that combine macroscopic topology optimization and micropore design to establish three new types of porous cages by integrating lattices (gyroid, Schwarz, body-centred cubic) with the optimized cage frame. Using these three porous cages along with traditional high-density cages, four ACDF surgical models were developed to compare the mechanical properties of facet articular cartilage, discs, cortical bone, and cages under specific loads. RESULTS The facet joints in the porous cage groups had lower contact forces than those in the high-density cage group. The intervertebral discs in all models experienced maximum stress at the C5/6 segment. The stress distribution on the cortical bone surface was more uniform in the porous cage groups, leading to increased average stress values. The gyroid, Schwarz, and BCC cage groups showed higher average stress on the C5 cortical bone. The average stress on the surface of porous cages was higher than that on the surface of high-density cages, with the greatest difference observed under the lateral bending condition. The BCC cage demonstrated favourable mechanical stability. CONCLUSION The new porous cervical cages satifies requirements of low rigidity and serve as a favourable biological scaffold for bone ingrowth. This study provides valuable insights for the development of next-generation orthopaedic medical devices.
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Affiliation(s)
- Zhi Xu
- Department of Orthopedic, Zhangjiagang Fifth People's Hospital, Zhangjiagang, 215600, Jiangsu, China.
| | - Yuwan Li
- Department of Orthopedic, Peking University Third Hospital, Beijing, 100191, China
- Department of Orthopedic, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Weijun Huang
- Department of Orthopedic, Shangyu Third Hospital, Shangyu, 312300, Zhejiang, China
| | - Ziru Wang
- Clinical Medical College, Wannan Medical College, Wuhu, 241000, Anhui, China
- Department of Orthopedic, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Xing Xu
- Department of Medicine, Zhijin People's Hospital, Zhijin, 552100, Guizhou, China
| | - Shoujin Tian
- Department of Orthopedic, Zhangjiagang First People's Hospital, Zhangjiagang, 215600, Jiangsu, China.
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Lang A, Lener S, Grassner L, Abramovic A, Thomé C, Päsler D, Lehmberg J, Schär R, Hartmann S. Clinical and radiological outcome 1-year after cervical total disc replacement using the Signus ROTAIO - Prosthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3477-3483. [PMID: 36219329 DOI: 10.1007/s00586-022-07416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The instantaneous center of rotation (iCOR) of a motion segment has been shown to correlate with its total range of motion (ROM). Importantly, a correlation of the correct placement of cervical total disc replacement (cTDR) to preserve a physiological iCOR has been previously identified. However, changes of these parameters and the corresponding clinical relevance have hardly been analyzed. This study assesses the radiological and clinical correlation of iCOR and ROM following cTDR. MATERIALS/METHODS A retrospective multi-center observational study was conducted and radiological as well as clinical parameters were evaluated preoperatively and 1 year after cTDR with an unconstrained device. Radiographic parameters including flexion/extension X-rays (flex/ex), ROM, iCOR and the implant position in anterior-posterior direction (IP ap), as well as corresponding clinical parameters [(Neck Disability Index (NDI) and the visual analogue scale (VAS)] were assessed. RESULTS 57 index segments of 53 patients treated with cTDR were analyzed. Pre- and post-operative ROM showed no significant changes (8.0° vs. 10.9°; p > 0.05). Significant correlations between iCOR and IP (Pearson's R: 0.6; p < 0.01) as well as between ROM and IP ap (Pearson's R: - 0.3; p = 0.04) were identified. NDI and VAS improved significantly (p < 0.01). A significant correlation between NDI and IP ap after 12 months (Pearson's R: - 0.39; p < 0.01) was found. CONCLUSION Implantation of the tested prosthesis maintains the ROM and results in a physiological iCOR. The exact position of the device correlates with the clinical outcome and emphasize the importance of implant design and precise implant positioning.
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Affiliation(s)
- Anna Lang
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Grassner
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dennis Päsler
- Department of Neurosurgery, University of Greifswald, Greifswald, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Academic Hospital Bogenhausen Munich, Munich, Germany
| | - Ralph Schär
- Department of Neurosurgery, University of Bern, Bern, Switzerland
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Pan A, Ding H, Wang J, Zhang Z, Zhang H, Liu Y, Hai Y. The application of finite element analysis to determine the optimal UIV of growing-rod treatment in early-onset scoliosis. Front Bioeng Biotechnol 2022; 10:978554. [PMID: 36118572 PMCID: PMC9478657 DOI: 10.3389/fbioe.2022.978554] [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: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: To analyze the stress distribution in the proximal vertebral body and soft tissue of dual growing-rod (GR) with different upper instrumented vertebra (UIV) to determine the optimal UIV. Methods: A ten-year-old male EOS case treated with GR was selected. Based on spiral computed tomography (CT) scanning performed in 0.6 mm thick slices, a finite element model (FEM) of the preoperative state (M0, the original spine state) of the patient was created. Subsequently, four models with different UIV fixations were numerically analyzed by FEM, including M1 (UIV = T1, i.e., the upper-end vertebrae (UEV) of the upper thoracic curve), M2 (UIV = T2), M3 (UIV = T3) and M4 (UIV = T4, i.e., the lower end vertebrae (LEV) of the upper thoracic curve). Displacement and maximum stress in the proximal vertebral body and soft tissue were measured and compared among the five models. Results: The spine model was fixed with the sacrum, and the gravity conditions were imposed on each vertebral body according to the research of Clin and Pearsall. The results are as follows:M4 model has the largest overall displacement, while M1 has the least displacement among the four models. Except M2, the maximum normalized stress of UIV increases with the downward movement of UIV. M1 has the lowerest annulus fibrosus stress and highest joint capsule stress, which is characterized by the vertebrae backward leaning, while M4 is the opposite. The supraspinous ligament stress of M3 and M4 is significantly higher than that of M1 and M2. This suggests that UIV downshift increases the tendency of the proximal vertebral bodies to bend forward, thereby increasing the tension of the posterior ligaments (PL). Conclusion: The UIV of the GR is recommended to be close to the UEV of the upper thoracic curve, which can reduce the stress of the proximal PL, thereby reducing the occurrence of proximal junctional kyphosis (PJK).
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Affiliation(s)
- Aixing Pan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junjie Wang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Zhuo Zhang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Hongbo Zhang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Yuzeng Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Hai, ; Yuzeng Liu,
| | - Yong Hai
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Hai, ; Yuzeng Liu,
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Liang W, Han B, Hai Y, Yang J, Yin P. Biomechanical Analysis of the Reasonable Cervical Range of Motion to Prevent Non-Fusion Segmental Degeneration After Single-Level ACDF. Front Bioeng Biotechnol 2022; 10:918032. [PMID: 35782514 PMCID: PMC9243332 DOI: 10.3389/fbioe.2022.918032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
The compensatory increase in intervertebral range of motion (ROM) after cervical fusion can increase facet joint force (FJF) and intradiscal pressure (IDP) in non-fusion segments. Guiding the post-ACDF patient cervical exercise within a specific ROM (defined as reasonable ROM) to offset the increase in FJF and IDP may help prevent segmental degeneration. This study aimed to determine the reasonable total C0–C7 ROM without an increase in FJF and IDP in non-fusion segments after anterior cervical discectomy and fusion (ACDF). A three-dimensional intact finite element model of C0–C7 generated healthy cervical conditions. This was modified to the ACDF model by simulating the actual surgery at C5–C6. A 1.0 Nm moment and 73.6 N follower load were applied to the intact model to determine the ROMs. A displacement load was applied to the ACDF model under the same follower load, resulting in a total C0–C7 ROM similar to that of the intact model. The reasonable ROMs in the ACDF model were calculated using the fitting function. The results indicated that the intervertebral ROM of all non-fusion levels was increased in the ACDF model in all motion directions. The compensatory increase in ROM in adjacent segments (C4/5 and C6/7) was more significant than that in non-adjacent segments, except for C3/4 during lateral bending. The intervertebral FJF and IDP of C0–C7 increased with increasing ROM. The reasonable ROMs in the ACDF model were 42.4°, 52.6°, 28.4°, and 42.25° in flexion, extension, lateral bending, and axial rotation, respectively, with a decreased ROM of 4.4–7.2%. The postoperative increase in FJF and IDP in non-fusion segments can be canceled out by reducing the intervertebral ROM within reasonable ROMs. This study provided a new method to estimate the reasonable ROMs after ACDF from a biomechanical perspective, and further in vitro and clinical studies are needed to confirm this.
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Affiliation(s)
| | | | - Yong Hai
- *Correspondence: Yong Hai, ; Peng Yin,
| | | | - Peng Yin
- *Correspondence: Yong Hai, ; Peng Yin,
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Shen YW, Yang Y, Liu H, Qiu Y, Li M, Ma LT, Gan FJ. Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study. Front Bioeng Biotechnol 2022; 10:842382. [PMID: 35372323 PMCID: PMC8969047 DOI: 10.3389/fbioe.2022.842382] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. A solid interbody fusion is of critical significance in achieving satisfactory outcomes after ACDF. However, the current radiographic techniques to determine the degree of fusion are inaccurate and radiative. Several animal experiments suggested that the mechanical load on the spinal instrumentation could reflect the fusion process and evaluated the stability of implant. This study aims to investigate the biomechanical changes during the fusion process and explore the feasibility of reflecting the fusion status after ACDF through the load changes borne by the interbody fusion cage. Methods: The computed tomography (CT) scans preoperatively, immediately after surgery, at 3 months, and 6 months follow-up of patients who underwent ACDF at C5/6 were used to construct the C2–C7 finite element (FE) models representing different courses of fusion stages. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the C7 vertebra fixed. The Von Mises stress at the surfaces of instrumentation and the adjacent intervertebral disc and force at the facet joints were analyzed. Results: The facet contact force at C5/6 suggested a significantly stepwise reduction as the fusion proceeded while the intradiscal pressure and facet contact force of adjacent levels changed slightly. The stress on the surfaces of titanium plate and screws significantly decreased at 3 and 6 months follow-up. A markedly changed stress distribution in extension among three models was noted in different fusion stages. After solid fusion is achieved, the stress was more uniformly distributed interbody fusion in all loading conditions. Conclusions: Through a follow-up study of 6 months, the stress on the surfaces of cervical instrumentation remarkably decreased in all loading conditions. After solid intervertebral fusion formed, the stress distributions on the surfaces of interbody cage and screws were more uniform. The stress distribution in extension altered significantly in different fusion status. Future studies are needed to develop the interbody fusion device with wireless sensors to achieve longitudinal real-time monitoring of the stress distribution during the course of fusion.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hao Liu,
| | - Yue Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Li
- Department of Measurement and Control Technology and Instrument, Sichuan University, Chengdu, China
| | - Li-Tai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Ji Gan
- Department of Measurement and Control Technology and Instrument, Sichuan University, Chengdu, China
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Liu WJP, Parr WCH, Walsh WR, Mobbs RJ. Three-dimensional morphometric analysis of cervical vertebral endplate anatomy: A systematic literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Wo J, Lv Z, Wang J, Shen K, Zhu H, Liu Y, Huang Y, Sun G, Li Z. Biomechanical Analysis of Cervical Artificial Disc Replacement Using Cervical Subtotal Discectomy Prosthesis. Front Bioeng Biotechnol 2021; 9:680769. [PMID: 34336799 PMCID: PMC8317600 DOI: 10.3389/fbioe.2021.680769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) sacrifices segmental mobility, which can lead to the acceleration of adjacent segment degeneration. The challenge has promoted cervical artificial disc replacement (CADR) as a substitute for ACDF. However, CADR has revealed a series of new issues that are not found in ACDF, such as hypermobility, subsidence, and wear phenomenon. This study designed a cervical subtotal discectomy prosthesis (CSDP) consisting of a cervical disc prosthesis structure (CDP structure), cervical vertebra fixation structure (CVF structure), link structure, and locking screw, aiming to facilitate motion control and reduce subsidence. The aim of this study was to assess the biomechanics of the CSDP using finite element (FE) analysis, friction-wear test, and non-human primates implantation study. Study Design: For the FE analysis, based on an intact FE C2-C7 spinal model, a CSDP was implanted at C5-C6 to establish the CSDP FE model and compare it with the Prestige LP prosthesis (Medtronic Sofamor Danek, Minneapolis, MN, United States). The range of motion (ROM), bone-implant interface stress, and facet joint force were calculated under flexion extension, lateral bending, and axial rotation. In addition, CSDP was elevated 1 mm to mimic an improper implantation technique to analyze the biomechanics of CSDP errors in the FE model. Moreover, the friction-wear test was conducted in vitro to research CSDP durability and observe surface wear morphology and total wear volume. Finally, the CSDP was implanted into non-human primates, and its properties were evaluated and verified by radiology. Results: In the FE analysis, the ROM of the CSDP FE model was close to that of the intact FE model in the operative and adjacent segments. In the operative segment, the CSDP error FE model increased ROM in flexion extension, lateral bending, and axial rotation. The maximum stress in the CSDP FE model was similar to that of the intact FE model and was located in the peripheral cortical bone region. The facet joint force changes were minimal in extension, lateral bending, and axial rotation loads in CSDP. In the friction-wear test, after the 150-W movement simulation, both the CVF-link-junction and the CDP-link-junction had slight wear. In the CSDP non-human primate implantation study, no subsidence, dislocation, or loosening was observed. Conclusion: In the FE analysis, the biomechanical parameters of the CSDP FE model were relatively close to those of the intact FE model when compared with the Prestige LP FE model. In terms of CSDP error FE models, we demonstrated that the implantation position influences CSDP performance, such as ROM, bone-implant interface stress, and facet joint force. In addition, we performed a friction-wear test on the CSDP to prove its durability. Finally, CSDP studies with non-human primates have shown that the CSDP is effective.
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Affiliation(s)
- Jin Wo
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhenjing Lv
- Department of Spine Orthopedics, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
| | - Jing Wang
- Department of Neurosurgery, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Kui Shen
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Haoran Zhu
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yang Liu
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yuen Huang
- Department of Rehabilitation, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Guodong Sun
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Orthopedics, Fifth Affiliated Hospital, Heyuan Shenhe People's Hospital, Jinan University, Heyuan, China
| | - Zhizhong Li
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Orthopedics, Fifth Affiliated Hospital, Heyuan Shenhe People's Hospital, Jinan University, Heyuan, China.,Department of Orthopedics, Heyuan People's Hospital, Heyuan Affiliated Hospital of Jinan University, Heyuan, China
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The effect of cervical intervertebral disc degeneration on the motion path of instantaneous center of rotation at degenerated and adjacent segments: A finite element analysis. Comput Biol Med 2021; 134:104426. [PMID: 33979732 DOI: 10.1016/j.compbiomed.2021.104426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The motion path of instantaneous center of rotation (ICR) is a crucial kinematic parameter to dynamically characterize cervical spine intervertebral patterns of motion; however, few studies have evaluated the effect of cervical disc degeneration (CDD) on ICR motion path. The purpose of this study was to investigate the effect of CDD on the ICR motion path of degenerated and adjacent segments. METHOD A validated nonlinear three-dimensional finite element (FE) model of a healthy adult cervical spine was used. Progressive degeneration was simulated with six FE models by modifying intervertebral disc height and material properties, anterior osteophyte size, and degree of endplate sclerosis at the C5-C6 level. All models were subjected to a pure moment of 1 Nm and a compressive follower load of 73.6 N to simulate physical motion. ICR motion paths were compared among different models. RESULTS The normal FE model results were consistent with those of previous studies. In degenerative models, average ICR motion paths shifted significantly anterior at the degenerated segment (β = 0.27 mm; 95% CI: 0.22, 0.32) and posterior at the proximal adjacent segment (β = -0.09 mm; 95% CI: -0.15, -0.02) than those of the normal model. CONCLUSION CDD significantly affected ICR motion paths at the degenerated and proximal adjacent segments. The changes at adjacent segments may be a result of compensatory mechanisms to maintain the balance of the cervical spine. Surgical treatment planning should take into account the restoration of ICR motion path to normal. These findings could provide a basis for prosthesis design and clinical practice.
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Cao F, Fu R, Wang W. Comparison of biomechanical performance of single-level triangular and quadrilateral profile anterior cervical plates. PLoS One 2021; 16:e0250270. [PMID: 33857243 PMCID: PMC8049474 DOI: 10.1371/journal.pone.0250270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/02/2021] [Indexed: 11/18/2022] Open
Abstract
The quadrilateral anterior cervical plate (ACP) is used extensively in anterior cervical discectomy and fusion (ACDF) to reconstruct the stability of the cervical spine and prevent cage subsidence. However, there have been no comparison studies on the biomechanical performance of quadrilateral ACP and triangular ACP. The objective of this study is to investigate the functional outcomes of quadrilateral ACP and triangular ACP usage in ACDF surgery. In this study, a finite element model of intact C1-C7 segments was established and verified. Additionally, two implant systems were built; one using triangle anterior cervical plates (TACP) and another using quadrilateral orion anterior cervical plate (QACP). Both models were then compared in terms of their postoperative biomechanical performance, under normal and excessive motion. Compared to QACP, the peak stress of the TACP screws and plates occurred at 359.2 MPa and 97.2 MPa respectively and were the highest during over extension exercises. Alternately, compared to TACP, the endplate peak stress and the cage displacement of QACP were the largest at over extension, with values of 7.5 MPa and 1.2 mm, respectively. Finally, the average stress ratio of bone grafts in TACP was relatively high at 31.6%. In terms of biomechanical performance, TACP can share the load more flexibly and reduce the risks of cage subsidence and slippage but the screws have high peak stress value, thereby increasing the risk of screw slippage and fracture. This disadvantage must be considered when designing a TACP based implant for a potential patient.
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Affiliation(s)
- Fu Cao
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Rongchang Fu
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Wenyuan Wang
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Anterior bone loss after cervical disc replacement: A systematic review. World J Clin Cases 2020; 8:5284-5295. [PMID: 33269261 PMCID: PMC7674730 DOI: 10.12998/wjcc.v8.i21.5284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anterior bone loss (ABL) is a relatively easily neglected condition after cervical disc replacement (CDR). Whether this phenomenon is a radiological anomaly or a complication remains controversial. Several studies have reported the clinical characteristics of ABL and speculated on the pathogenic mechanism based on a certain type of artificial disc, while the overall understanding of ABL is lacking.
AIM To describe the prevalence, impacts, and risk factors of ABL after CDR.
METHODS We searched the PubMed, Cochrane Library, and Excerpta Medica databases using the terms “bone loss” or “bone remodeling” or “bone absorption” or “osteolysis” or “implant loosening” or “implant migration” or “hypersensitivity” or “hyperreactivity”, “cervical disc replacement” or “cervical disc arthroplasty” or “total disc replacement”. Eligible manuscripts on the prevalence and impacts of ABL were reviewed by the authors. Data extraction was performed using an established extraction form. The results of the included studies were described narratively.
RESULTS Six studies met the inclusion and exclusion criteria. One was a prospective study and the others were retrospective studies. A total of 440 patients with 536 segments were included. The artificial cervical discs included Bryan, Baguera-C, Discocerv, and Mobi-C. The prevalence of ABL ranged from 3.13% to 91.89%, with a combined overall prevalence of 41.84%. ABL occurred within 6 mo and stopped 12 mo after surgery. Several cases were noted to have a self-healing process. Severe ABL resulted in segmental kyphosis, implant subsidence, and persistent neck pain. ABL may be related to heterotopic ossification. Multilevel surgery may be one of the risk factors for ABL.
CONCLUSION ABL is a common condition after CDR. The underlying mechanisms of ABL may include stress concentration and injury to nutrient vessels. ABL should be considered a complication after CDR as it was associated with neck pain, implant subsidence, and heterotopic ossification.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Hua W, Zhi J, Wang B, Ke W, Sun W, Yang S, Li L, Yang C. Biomechanical evaluation of adjacent segment degeneration after one- or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105352. [PMID: 31991316 DOI: 10.1016/j.cmpb.2020.105352] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/29/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE To compare the biomechanical changes of adjacent segment degeneration (ASD) after one- or two-level anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA). METHODS A three-dimensional finite element (FE) model of intact C2-C7 segments was constructed and validated. In the one-level surgery model, the cage with plate implant or Prestige LP cervical disc prosthesis were integrated at C5-C6 segment into the FE model; while in the two-level surgery model, the prostheses were integrated at both C4-C5 and C5-C6 segments into the FE model. A pure moment of 1.0 Nm combined with a follower load of 73.6 N were imposed on C2 to investigate the flexion-extension, lateral bending, and axial rotation of different segments in the FE model. The segmental range of motion (ROM) and intradiscal pressure of the surgery models were investigated and compared with the intact model. RESULTS In the one-level model of ACDF, the ROM at C5-C6 was decreased, the ROM and intradiscal pressure at C4-C5 and C6-C7 segments were increased. In the two-level model of ACDF, the ROM at C4-C5 and C5-C6 were decreased, the ROM and intradiscal pressure at C3-C4 and C6-C7 were increased. However, in both one- and two-level models of CDA, the ROM of surgery segments were preserved, avoiding the increase of the ROM and intradiscal pressure at the adjacent segments. CONCLUSIONS Abnormal ROM and intradiscal pressure at the adjacent segments may contribute to the higher risk of ASD after ACDF compared with CDA.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jinggang Zhi
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wengang Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li Li
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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15
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Cai XY, YuChi CX, Du CF, Mo ZJ. The effect of follower load on the range of motion, facet joint force, and intradiscal pressure of the cervical spine: a finite element study. Med Biol Eng Comput 2020; 58:1695-1705. [DOI: 10.1007/s11517-020-02189-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/10/2020] [Indexed: 12/20/2022]
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16
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Ge CY, Wang J, Zhang BF, Hui H, Shan LQ, Zhao QP, Hao DJ. Spontaneous Fusion After Cervical Disc Arthroplasty: A Case Report and Literature Review. J Pain Res 2020; 13:771-776. [PMID: 32368130 PMCID: PMC7183536 DOI: 10.2147/jpr.s242646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report a rare case of spontaneous fusion (SF) following cervical disc arthroplasty (CDA), to review the related literature, and to propose a new measure to prevent it. Methods The course of a patient with SF is described here. The potential causes, risk factors, and preventive measure of SF after CDA published in previous studies have also been reviewed and discussed. Results A 63-year-old man presented with a 6-month history of progressive neck pain and developed left C-7 radiculopathy 4 years ago. Magnetic resonance imaging revealed disc herniation at the C6–C7 levels resulting in compression of the left C-7 nerve root. The patient underwent CDA at the C6–C7 levels, during which a PRESTIGE cervical disc device was implanted. He failed to follow-up regularly as recommended postoperatively because he was completely free from the pain in his neck and left upper limb. Four years later, he was readmitted with a 2-month history of occasional neck stiffness. Plain radiographs indicated complete radiographic fusion of the C6–C7 levels with trabecular bone bridging surrounding the cervical disc prosthesis, and dynamic imaging showed no motion. He was seen at regular follow-up visits for up to 60 months without special treatment, as his symptoms of neck stiffness were minor and his symptom has not worsened since then. Conclusion SF after CDA is a rare condition that can be attributed to patient- or prosthesis-related causes, and its risk factors are diverse. SF after CDA did not affect the patient’s clinical outcome, and no special treatment was required for it. Practitioners should be aware of this rare complication and advise patients of the risks before performing CDA.
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Affiliation(s)
- Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Jing Wang
- Department of Ophthalmology, Xi'an Fourth Hospital, Xi'an 710004, Shaanxi Province, People's Republic of China
| | - Bin-Fei Zhang
- Department of Trauma Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Hao Hui
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Le-Qun Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Qin-Peng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
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Cai XY, Sang D, Yuchi CX, Cui W, Zhang C, Du CF, Liu B. Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration. Comput Biol Med 2020; 116:103519. [DOI: 10.1016/j.compbiomed.2019.103519] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023]
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Yuchi CX, Sun G, Chen C, Liu G, Zhao D, Yang H, Xu B, Deng S, Ma X, Du CF, Yang Q. Comparison of the Biomechanical Changes After Percutaneous Full-Endoscopic Anterior Cervical Discectomy versus Posterior Cervical Foraminotomy at C5-C6: A Finite Element-Based Study. World Neurosurg 2019; 128:e905-e911. [DOI: 10.1016/j.wneu.2019.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
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Biomechanical response of a novel intervertebral disc prosthesis using functionally graded polymers: A finite element study. J Mech Behav Biomed Mater 2019; 94:288-297. [DOI: 10.1016/j.jmbbm.2019.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022]
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Yuan W, Zhang H, Zhou X, Wu W, Zhu Y. The Influence of Artificial Cervical Disc Prosthesis Height on the Cervical Biomechanics: A Finite Element Study. World Neurosurg 2018; 113:e490-e498. [DOI: 10.1016/j.wneu.2018.02.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
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Feng H, Fang XY, Huang DG, Yu CC, Li HK, Zhao SC, Ge CY, Bai RH, Hao DJ. A morphometric study of the middle and lower cervical vertebral endplates and their components. Medicine (Baltimore) 2017; 96:e6296. [PMID: 28272256 PMCID: PMC5348204 DOI: 10.1097/md.0000000000006296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cervical disc arthroplasty is a common method of treating cervical degenerative disease. However, the footprints of most prosthesis dimensions are obtained from data of Caucasian individuals. Besides, there is a large discrepancy between footprints of currently available cervical disc prostheses and anatomic dimensions of cervical endplates. We aimed to detail the three-dimensional (3D) anatomic morphology of the subaxial cervical vertebral endplate, utilizing high-precision, high-resolution scanning equipment, and provide a theoretical basis for designing appropriate disc prostheses for Chinese patients.A total of 138 cervical vertebral endplates were studied. Each endplate was digitized using a non-contact optical 3D range scanning system and then reconstructed to quantify diameters and surface area for the whole endplate and its components (central endplate and epiphyseal rim). The whole endplate and mid-plane concavity depth were measured.There is marked morphologic asymmetry, in that the cranial endplate is more concave than the corresponding caudal endplate, with endplate concavity depths of 2.04 and 0.69 mm, respectively. For the caudal endplates, the endplate concavity apex locations were always located in the posterior portion (81.42%), while in cranial endplates relatively even. The central endplate was approximately 60% of the area of the whole endplate and the anterior section of the ring was the widest. From C3/4 down to C6/7 discs, the vertebral endplate gradually became more elliptical. Chinese cervical endplate anatomic sizes are generally smaller than that of Caucasians. Although Korean and Chinese individuals both belong to the Asian population subgroup, the majority of anatomic dimensions differ. Singaporean cervical endplate morphology is very similar to that of Chinese patients.We performed a comprehensive and accurate quantitative description of the cervical endplate, which provide references to shape and profile an artificial cervical disc without sacrificing valuable bone stock. To design a device with footprint as large as possible to distribute the axial load, we suggest that additional attention should be paid to the marginal rim. It is essential to specifically design appropriate disc prosthesis for Chinese patients. To fit the morphologic and biomechanical variations, we also propose that the disc prostheses for different vertebral segments should be separately designed.
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Affiliation(s)
- Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Xiang-Yi Fang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Cheng-Cheng Yu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Hou-Kun Li
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Song-Chuan Zhao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
| | - Ru-Hai Bai
- Department of Public Health, Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center
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Feng H, Fang X, Huang D, Yu C, Zhao S, Hao D. Quantitative morphometric study of the subaxial cervical vertebrae end plate. Spine J 2017; 17:269-276. [PMID: 27713104 DOI: 10.1016/j.spinee.2016.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty has been gradually adopted as an alternative for the treatment of cervical degenerative disease. However, there is a large discrepancy between footprints of currently available cervical disc prostheses and anatomic dimensions of cervical end plates. PURPOSE This study aimed to accurately and comprehensively quantify the three-dimensional (3D) anatomic morphology of the cervical vertebral end plate and provide a theoretical basis for designing appropriate disc prostheses. Moreover, we introduced a novel geometric and mechanical model for 3D reconstruction techniques of the cervical end plate. STUDY DESIGN A descriptive study of the geometry of the middle and lower cervical vertebral end plates in cadaveric spines was carried out. METHODS A total of 138 cervical vertebral end plates were digitized using an optical 3D range scanning system, and then each end plate was reconstructed using the digitized image. For each end plate, the morphologic characteristics of six surface curves and the end plate concavity depth were symmetrically chosen and depicted. RESULTS The cranial end plates (relative to the disc) were concave and the caudal end plates were relatively flat at all disc levels, with mean concavity depths of 2.04 and 0.69 mm, respectively. For the caudal end plates, the end plate concavity apex was most often (81.42%) located in the posterior portion, whereas in the cranial end plates, the distribution was relatively even. For the sagittal curves, the foremost point and the rearmost point on the middle curve had a more forward position than those in the left curve and the right curve. Regarding the frontal plane curves, the length of the middle curve was longer than that of the anterior curve and posterior curve. For the cranial end plate, the maximal mean depth was the middle curve, whereas for the caudal end plate, the maximum depth was the posterior curve. CONCLUSIONS There is marked morphologic asymmetry, in that the cranial end plate is more concave than the corresponding caudal end plate. In the sagittal plane, the caudal end plates are aerofoil-shaped, whereas the cranial end plates are arc-shaped. In the transverse plane, the end plates are kidney-shaped. These morphologic characteristics of cervical vertebral end plates should be taken into consideration when designing cervical devices, such as artificial discs.
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Affiliation(s)
- Hang Feng
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Xiangyi Fang
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Chengcheng Yu
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Songchuan Zhao
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China.
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