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Jiang W, Zhao F, Rahman WU, Dong T, Yang G. Comparison of the effects of different artificial discs on hybrid surgery: A finite element analysis. Proc Inst Mech Eng H 2024; 238:78-89. [PMID: 38102922 DOI: 10.1177/09544119231215721] [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: 12/17/2023]
Abstract
In recent years, artificial cervical discs have been used in intervertebral disc replacement surgery and hybrid surgery (HS). The advantages and disadvantages of different artificial cervical discs in artificial cervical disc replacement surgery have been compared. However, few scholars have studied the biomechanical effects of various artificial disc prostheses on the human cervical spine in HS which include the Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Arthroplasty (CDA). This study compared the biomechanical behavior of Mobi-C and Prestige LP in the operative and adjacent segments during two-level hybrid surgery. A three-dimensional finite element model of C2-C7 was first established and validated. Subsequently, clinical surgery was then simulated to establish a surgical model of anterior cervical fusion at the C4-C5 level. Mobi-C and Prestige-LP artificial disc prostheses were implanted at the C5-C6 level to create two hybrid models. All finite element models were fixed on the lower endplate of the C7 vertebra and subjected to a load of 73.6 N and different directions of 1 Nm torque on the odontoid process of the C2 vertebra to simulate human flexion, extension, lateral bending, and axial rotation. This paper compares the ROM, intervertebral pressure, and facet joint force after hybrid surgery with the intact model. The results show that compared with Prestige LP, Mobi-C can improve ROM of the replacement segment and compensate for the intervertebral pressure of the adjacent segment more effectively, but the facet joint pressure of the replacement segment may be higher.
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Affiliation(s)
- Wei Jiang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Fulin Zhao
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Waseem Ur Rahman
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Tianxiang Dong
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Guanghui Yang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
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Abudouaini H, Wu T, Meng Y, Ding C, Liu H, Beiyu W. Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study. Front Bioeng Biotechnol 2023; 11:1214877. [PMID: 37711451 PMCID: PMC10497878 DOI: 10.3389/fbioe.2023.1214877] [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: 04/30/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a most frequently used surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration (ASD) rate after ACDF surgery. We creatively designed an elastically deformable cervical implant to reduce the postoperative stress concentration. In this study, we aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical devices. Methods: Biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2-C7) and randomly divided into four groups according to implant types: intact group, Zero-P VA fusion (ACDF) group, the novel cervical implant group and Pretic-I artificial cervical disc (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments and micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments. Results: There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decrease some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups. Conclusion: While the newly developed elastically deformable cervical implant does not completely maintain ROM like the artificial cervical disc, it surpasses the fusion device with regards to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe adjacent segment degeneration after fusion surgery but no indication for artificial cervical disc surgery.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wang Beiyu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Lin D, He Z, Weng R, Zhu Y, Lin Z, Deng Y, Yang Y, Tan J, Wang M, Li Y, Huang G, Yu G, Cai D, Huang X, Huang W. Comparison of biomechanical parameters of two Chinese cervical spine rotation manipulations based on motion capture and finite element analysis. Front Bioeng Biotechnol 2023; 11:1195583. [PMID: 37576989 PMCID: PMC10415076 DOI: 10.3389/fbioe.2023.1195583] [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: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Objective: The purpose of this study was to obtain the stress-strain of the cervical spine structure during the simulated manipulation of the oblique pulling manipulation and the cervical rotation-traction manipulation in order to compare the mechanical mechanism of the two manipulations. Methods: A motion capture system was used to record the key kinematic parameters of operating the two manipulations. At the same time, a three-dimensional finite element model of the C0-T1 full healthy cervical spine was established, and the key kinematic parameters were loaded onto the finite element model in steps to analyze and simulate the detailed process of the operation of the two manipulations. Results: A detailed finite element model of the whole cervical spine including spinal nerve roots was established, and the validity of this 3D finite element model was verified. During the stepwise simulation of the two cervical spine rotation manipulations to the right, the disc (including the annulus fibrosus and nucleus pulposus) and facet joints stresses and displacements were greater in the oblique pulling manipulation group than in the cervical rotation-traction manipulation group, while the spinal cord and nerve root stresses were greater in the cervical rotation-traction manipulation group than in the oblique pulling manipulation group. The spinal cord and nerve root stresses in the cervical rotation-traction manipulation group were mainly concentrated in the C4/5 and C5/6 segments. Conclusion: The oblique pulling manipulation may be more appropriate for the treatment of cervical spondylotic radiculopathy, while cervical rotation-traction manipulation is more appropriate for the treatment of cervical spondylosis of cervical type. Clinicians should select cervical rotation manipulations for different types of cervical spondylosis according to the patient's symptoms and needs.
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Affiliation(s)
- Dongxin Lin
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zaopeng He
- Center for Orthopaedic Surgery, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Hand and Foot Surgery and Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Rui Weng
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Yuhua Zhu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiwei Lin
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Yuping Deng
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
| | - Yang Yang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jinchuan Tan
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Mian Wang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanbin Li
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Gang Huang
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Guanghao Yu
- Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Daozhang Cai
- Center for Orthopaedic Surgery, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, Guangzhou, China
| | - Xuecheng Huang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Wenhua Huang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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Chen XM, Wen Y, Chen S, Jin X, Liu C, Wang W, Kong N, Ling DY, Huang Q, Chai JE, Zhao XL, Li J, Xu MS, Jiang Z, Du HG. Traditional Chinese Manual Therapy (Tuina) reshape the function of default mode network in patients with lumbar disc herniation. Front Neurosci 2023; 17:1125677. [PMID: 37008205 PMCID: PMC10050335 DOI: 10.3389/fnins.2023.1125677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023] Open
Abstract
PurposeInvestigating the changes of regional homogeneity (ReHo) values and both static and dynamic functional connectivity (FC) before and after Traditional Chinese Manual Therapy (Tuina) in patients with lumbar disk herniation (LDH) through resting-state functional magnetic resonance imaging (RS-fMRI). Based on this, we observe the effect of Tuina on the above abnormal changes.MethodsPatients with LDH (n = 27) and healthy controls (HCs) (n = 28) were recruited. The functional magnetic resonance imaging (fMRI) scanning was performed two times in LDH patients, before Tuina (time point 1, LDH-pre) and after the sixth Tuina (time point 2, LDH-pos). And for one time in HCs which received no intervention. The ReHo values were compared between LDH-pre and HCs. The significant clusters detected by ReHo analysis were selected as seeds to calculate static functional connectivity (sFC). We also applied the sliding-window to perform dynamic functional connectivity (dFC). To evaluate the Tuina effect, the mean ReHo and FC values (both static and dynamic) were extracted from significant clusters and compared between LDH and HCs.ResultsIn comparison to HCs, LDH patients displayed decreased ReHo in the left orbital part middle frontal gyrus (LO-MFG). For sFC analysis, no significant difference was found. However, we found decreased dFC variance between LO-MFG and the left Fusiform, and increased dFC variance in the left orbital inferior frontal gyrus and left precuneus. Both ReHo and dFC values revealed after Tuina, the brain activities in LDH patients were similar to HCs.ConclusionThe present study characterized the altered patterns of regional homogeneity in spontaneous brain activity and those of functional connectivity in patients with LDH. Tuina can reshape the function of the default mode network (DMN) in LDH patients, which may contribute to the analgesic effect of Tuina in LDH patients.
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Affiliation(s)
- Xiao-Min Chen
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Ya Wen
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shao Chen
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xin Jin
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Chen Liu
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Wei Wang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Ning Kong
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Dong-Ya Ling
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qin Huang
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jin-Er Chai
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiao-Lei Zhao
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jie Li
- Department of Radiology, Changshu No.2 People’s Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Mao-Sheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Zhong Jiang
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
- Zhong Jiang,
| | - Hong-Gen Du
- Department of Tuina, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
- *Correspondence: Hong-Gen Du,
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Zhang X, Yang Y, Shen YW, Zhang KR, Ma LT, Ding C, Wang BY, Meng Y, Liu H. Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis. Front Bioeng Biotechnol 2023; 11:931202. [PMID: 36970630 PMCID: PMC10031026 DOI: 10.3389/fbioe.2023.931202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.
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Sun X, Zhang Q, Cao L, Wang J, Huang J, Liu Y, Zhang Y, Song Z, Tang W, Chen Y, Sun S, Lu S. Biomechanical effects of hybrid constructions in the treatment of noncontinuous cervical spondylopathy: a finite element analysis. J Orthop Surg Res 2023; 18:57. [PMID: 36658557 PMCID: PMC9854215 DOI: 10.1186/s13018-023-03537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery. METHODS Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05). RESULTS In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2. CONCLUSIONS Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration. TRIAL REGISTRATION This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).
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Affiliation(s)
- Xiangyao Sun
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China ,Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Qingming Zhang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Li Cao
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Juyong Wang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Jiang Huang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Yuqi Liu
- grid.413259.80000 0004 0632 3337Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Yang Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, The Seventh Medical Center of PLA General Hospital, Beijing, 100191 China
| | - Zelong Song
- grid.216938.70000 0000 9878 7032Nankai University School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, The PLA General Hospital, Beijing, 100000 China
| | - Wei Tang
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Yunqiang Chen
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Siyuan Sun
- grid.169077.e0000 0004 1937 2197Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN 47907 USA
| | - Shibao Lu
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
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Rahman WU, Jiang W, Zhao F, Li Z, Wang G, Yang G. Biomechanical analysis of single- and double-level cervical disc arthroplasty using finite element modeling. Proc Inst Mech Eng H 2023; 237:91-103. [PMID: 36394294 DOI: 10.1177/09544119221135627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recently, many different types of artificial discs have been introduced to persevere the biomechanical behavior of the cervical spine. This study compares the biomechanical behavior of single- and double-level cervical disc arthroplasty, that is "Prestige LP and Mobi-C" on the index and adjacent segment. A three-dimension finite element model of C2-C7 was developed and validated. In single-level prostheses, the Prestige LP or Mobi-C was implanted in the segment C5-C6, while the double-level arthroplasty was integrated at both segments C4-C5 and C5-C6 in the FE model. The intact FE and prosthesis-modified models were constrained from the inferior endplate of the vertebra C7 and applied a compressive load of 73.6 N with a moment load of 1 Nm on the odontoid process of the vertebra C2 to produce flexion/extension, lateral bending, and axial rotation. The prosthesis-modified model's range of motion and intradiscal pressure were determined and compared to the intact model. Also examined the impact of the prostheses on the stress at the bone-implant interface. The range of motion of the implanted segments in both single- and double-levels arthroplasty was increased while that of the adjacent segment of implanted segments decreased. The intradiscal pressure in both levels of arthroplasty was greater than in the intact model. In conclusion, Mobi-C's cervical prostheses could better preserve the normal range of motion and maintain intradiscal pressure than the Prestige LP.
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Affiliation(s)
- Waseemur Ur Rahman
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Wei Jiang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Fulin Zhao
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Zhijun Li
- Department of Orthopedics, Dalian No. 2 People's Hospital, Dalian, China
| | - Guohua Wang
- Department of Orthopedics, Dalian No. 2 People's Hospital, Dalian, China
| | - Guanghui Yang
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
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Weng R, Huang XC, Ye LQ, Yang CK, Cai ZY, Xu YR, Cui JC, Yi SH, Liang D, Yao ZS. Investigating the mechanical effect of the sagittal angle of the cervical facet joint on the cervical intervertebral disc. Digit Health 2022; 8:20552076221134456. [PMID: 36312849 PMCID: PMC9608055 DOI: 10.1177/20552076221134456] [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: 01/03/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Facet tropism is defined as the asymmetry between the left and right facet joints relative to the sagittal plane. Published clinical studies have found that facet tropism is associated with cervical disc herniation. However, the relationship between the facet orientation and the side of cervical disc herniation remains controversial. Therefore, this study used the finite-element technique to investigate the biomechanical effects of the sagittal angle of the cervical facet joints on the cervical intervertebral disc. OBJECTIVE The biomechanical effects of the sagittal angle of the cervical facet joint on the cervical disc and facet joint were investigated using the finite-element technique. METHODS The finite-element model was constructed using computed tomography scans of a 26-year-old female volunteer. First, a cervical model was constructed from C3 to C7. The model was verified using data from previously published studies. Second, the facet orientation at the C5-C6 level was altered to simulate different sagittal angles of cervical facet joints. Five models, F70, F80, F90, F100, and F110, were simulated with different facet joint orientations (70°, 80°, 90°, 100°, and 110° facet joint angles at the left side, respectively, and 90° facet joint angles at the right side) at the C5-C6 facet joints. In each model, annular fibres stress and facet cartilage pressure were studied under six pure moments and two combined moments. RESULTS Comparing the stress of the annulus fibres in flexion combined with right axial rotation and in flexion combined with left axial rotation in the same model, no difference in the maximum stress of the annulus fibres was noted between these two different moments in the F90 model, whereas differences of 12.80%, 8.84%, 14.95% and 33.32% were noted in the F70, F80, F100 and F110 models, respectively. The same trend was observed when comparing the maximum stress of the annulus fibres in each model during left and right axial rotation. No differences in annular fibres stress and facet cartilage pressure were noted among the five models in flexion, extension, lateral bending, left axial rotation, and flexion combined with left axial rotation in this study. However, compared with the F70 model in flexion combined with right axial rotation, the annulus fibres stress of the F80, F90, F100, and F110 models increased by 5.53%, 13.03%, 35.04%, and 72.94%, respectively, and the pressure of the left facet joint of these models decreased by 5.65%, 12.10%, 18.41%, and 25.74%, respectively. The same trend was observed in the right axial moment. CONCLUSION Facet tropism leads to unbalanced stress distribution on the annulus fibres at the cervical intervertebral disc. The greater the sagittal angle of the facet joint, the greater the annular fibres stress on this side. We hypothesised that the side with the larger sagittal angle of the facet joint exhibits a greater risk of disc herniation.
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Affiliation(s)
- Rui Weng
- Department of Spinal Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, China,Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, China
| | - Xue-Cheng Huang
- Department of Spinal Surgery, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), China
| | - Lin-Qiang Ye
- Department of Spinal Surgery, Dongguan Hospital of Traditional Chinese Medicine, China,Lin-Qiang Ye, Dongguan Hospital of Traditional Chinese Medicine, 22 Songshan Lake Avenue, Dongcheng District, Dongguan, 523000, China.
| | - Ce-Kai Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China
| | - Zhuo-Yan Cai
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China
| | - Yue-Rong Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China
| | - Jian-Chao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China
| | - Sheng-Hui Yi
- Department of Spinal Surgery, Yueyang Hospital of Traditional Chinese Medicine, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, China,Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China,Zhen-Song Yao, Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Helong 7 Road, Baiyun District, Guangzhou, 510000, China.
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Akar E, Toprak F, Öğrenci A. The relationship between bone canal diameter and facet tropism in cases of lumbar spinal stenosis. J Neurosci Rural Pract 2022; 13:641-646. [PMID: 36743774 PMCID: PMC9894327 DOI: 10.25259/jnrp-2022-7-26] [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: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Lumbar spinal stenosis (LSS) is a condition that increases in frequency with the aging of the spine and has adverse effects on the quality of life of individuals. Facet tropism (FT) refers to the difference in the orientation of the facet joints relative to each other in the sagittal plane. This situation may be due to a developmental defect or different stimuli. In many biomechanical studies in the literature, the relationship between FT and lumbar degenerative disorders has been investigated. In this study, we aimed to investigate whether there is a relationship between anteroposterior bone canal diameter and FT in LSS cases. Materials and Methods We retrospectively evaluated the CT and T2-weighted axial and sagittal magnetic resonance imaging of the lumbar region of 100 LSS patients who were operated on in our clinic between 2015 and 2017. For each patient, the facet joint angles, the degree of FT, and the AP diameter of the spinal canal were determined. Results The cases were grouped according to FT types and no correlation was found between midsagittal bone spinal canal measurement and FT types. According to the results, no significant difference was found. Conclusion As a result, because of there is no relationship between midsagittal bone canal diameter and FT, we thought that FT may be both a part of the degenerative process and a congenital origin.
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Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fatih Toprak
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Medicana Ataşehir Hospital, Istanbul, Turkey
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Liu Z, Rong X, Liu H, Ding C, Hong Y, Wang B. Effect of Facet Tropism on Postoperative Cervical Range of Motion After Single-Level Cervical Disc Arthroplasty. Global Spine J 2022; 12:1696-1707. [PMID: 33511887 PMCID: PMC9609535 DOI: 10.1177/2192568220986144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES Cervical disc arthroplasty (CDA) was designed to replace the degenerated disc with the prosthesis to preserve cervical motion. The commonly used artificial discs are designed symmetric, whereas the facet joints were reported to be asymmetric in many people. This study aimed to evaluate the effect of facet tropism on the cervical range of motion (ROM) after single-level CDA using Prestige LP. METHODS A total of 90 patients who underwent single-level CDA using Prestige LP from 2012 to 2017 were retrospectively reviewed. Radiographs were taken at each time point to measure the C2-C7 ROM and the ROM at the surgical segment. The pre-operation CT scans were utilized to reconstruct and calculate the angular direction of facet joints with respect to transverse, coronal, and sagittal reference planes. Facet tropism above 7° was defined as facet joint asymmetry. RESULTS No significant difference was found in flexion-extension C2-C7 ROM or ROM at the surgical segment between patients with symmetric and asymmetric fact joints regarding the sagittal plane. Patients with coronal asymmetric facet joints had lower flexion-extension ROM at the surgical level. Patients with transverse asymmetric facet joints had both lower flexion-extension C2-C7 ROM and ROM at the surgical level. After CDA surgery, patients obtained good clinical outcomes including increased Japanese Orthopedic Association (JOA) and decreased Neck Disability Index (NDI) as well as Visual Analogue Scale (VAS). CONCLUSION The coronal and transverse tropism seemed to be correlated with decreased flexion-extension ROM after CDA using Prestige LP.
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Affiliation(s)
- Ziyang Liu
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China,Department of Orthopedics, Tianjin
Hospital, Tianjin Province, China
| | - Xin Rong
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China,Hao Liu, Department of Orthopedic Surgery,
West China Hospital, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province,
China.
| | - Chen Ding
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ying Hong
- Department of Operating Room, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Beiyu Wang
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
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11
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Zeng HZ, Zheng LD, Xu ML, Zhu SJ, Zhou L, Candito A, Wu T, Zhu R, Chen Y. Biomechanical effect of age-related structural changes on cervical intervertebral disc: A finite element study. Proc Inst Mech Eng H 2022; 236:1541-1551. [DOI: 10.1177/09544119221122007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous literature has investigated the biomechanical response of healthy and degenerative discs, but the biomechanical response of suboptimal healthy intervertebral discs received less attention. The purpose was to compare the biomechanical responses and risk of herniation of young healthy, suboptimal healthy, and degenerative intervertebral discs. A cervical spine model was established and validated using the finite element method. Suboptimal healthy, mildly, moderately, and severely degenerative disc models were developed. Disc height deformation, range of motion, intradiscal pressure, and von Mises stress in annulus fibrosus were analyzed by applying a moment of 4 Nm in flexion, extension, lateral bending, and axial rotation with 100 N compressive loads. Disc height deformation in young healthy, suboptimal healthy, mildly, moderately, and severely degenerative discs was 40%, 37%, 21%, 12%, and 8%, respectively. The decreasing order of the range of motion was young healthy spine > suboptimal healthy spine > mildly degenerative spine > moderately degenerative spine > severely degenerative spine. The mean stress of annulus ground substance in the suboptimal healthy disc was higher than in the young healthy disc. The mean stress of inter-lamellar matrix and annulus ground substance in moderately and severely degenerative discs was higher than in other discs. Age-related structural changes and degenerative changes increased the stiffness and reduced the elastic deformation of intervertebral discs. Decreased range of motion due to the effects of aging or degeneration on the intervertebral disc, may cause compensation of adjacent segments and lead to progressive degeneration of multiple segments. The effect of aging on the intervertebral disc increased the risk of annulus fibrosus damage from the biomechanical point of view. Moderately and severely degenerative discs may have a higher risk of herniation due to the higher risk of damage and layers separation of annulus fibrosus caused by increased stress in the annulus ground substance and inter-lamellar matrix.
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Affiliation(s)
- Hui-zi Zeng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang-dong Zheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meng-lei Xu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shi-jie Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Zhou
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Antonio Candito
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Clinical Research Center for Ageing and Medicine, Shanghai, China
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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12
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Eroglu A, Eroglu A. Evaluation the association of facet tropism in multi-sports athletes with cervical disc hernia. BMC Musculoskelet Disord 2022; 23:615. [PMID: 35761220 PMCID: PMC9235094 DOI: 10.1186/s12891-022-05552-x] [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: 02/11/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Facet tropism (FT) can be defined as the angular difference between the orientation of the right and left facet joints in axial or sagittal planes. Most studies discuss about the relationship with lumbar disc hernia and facet joint angle. However, little is known about the association of facet tropism with disc herniation in the cervical spine in multisports athletes. In this study, We aimed to investigate the relationship between cervical facet tropism and disc hernia in athletes of different branches between the ages of 20–40 from the cervical MR images of the cases. Methods This is a retrospective study performed on athletes who applied our hospital between January 2014–2019 with neck pain and have MR imaging of the cervical spine. Cervical MR images of the patients were evaluated by an experienced radiologist from the hospital system database and archives. 79 cases (52 men and 27 women) were included in the study. Results No statistically significant difference was found between the facet joint angles of both groups at all levels (p˃0.05). Only left C6-7 disc angles of CDH group were measured as 92.99° ± 10.770 (620–1130) and 88.58° ± 7.65° (67°-110°) for the normal group and this difference was found statistically significant (p = 0.007). Conclusion In this study, we did not predict that cervical facet tropism may be a factor associated with cervical disc hernia in young athletes with CDH.
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13
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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: 13] [Impact Index Per Article: 6.5] [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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Zhou Y, Wang B, Pei Z, Yang J, Jiang C, Tian X, Qu X, Li L. Facet tropism: Association between cervical disc degeneration and cervical spondylotic radiculopathy in middle-aged patients. J Clin Neurosci 2022; 99:89-93. [PMID: 35278934 DOI: 10.1016/j.jocn.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/25/2021] [Accepted: 01/13/2022] [Indexed: 12/19/2022]
Abstract
This study aimed to retrospectively explore the relationship between facet tropism (FT) and cervical disc degeneration in cervical spondylotic radiculopathy (CSR) patients on 3-dimensional views. A total of 180 middle-aged patients with single-level CSR at C4/5 who underwent cervical CT and MRI in our hospital were included. The incidence of FT (or called FT (+), defined as FT ≥ 7 degree) at C3/4, C4/5, C5/6 levels were measured and calculated by reconstructed CT images on 3-dimensional views. The grade of cervical disc degeneration at three levels was assessed by MRI images by the method of Miyazali. Univariate analysis was performed to compare their cervical disc degeneration grade and CSR incidence between two groups stratified by FT (+). Moreover, a logistic regression model was used to investigate the association between FT (+) and grade of cervical disc degeneration and incidence of CSR adjusting for age, gender, and BMI. Grade of cervical disc degeneration and incidence of CSR in axial FT (+) group were both significantly increased compared to axial FT (-) group, while sagittal and coronal FT (+) groups showed no difference. Axial FT (+) was significantly associated with the grade of cervical disc degeneration and incidence of CSR. in middle-aged patients with CSR, axial FT (+) might be the risk factor for cervical disc degeneration but not sagittal and coronal FT (+). Also, axial FT (+) was positively associated with CSR incidence. Therefore, axial FT might play a vital role in the progression of cervical disc degeneration and CSR occurrence.
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Affiliation(s)
- Yuanxing Zhou
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Bo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Zhongyu Pei
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Jun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Chang Jiang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Xiliang Tian
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Xiaochen Qu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China
| | - Linan Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; First Clinical Institute of Dalian Medical University, Dalian, People's Republic of China.
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15
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Huang Z, Zhang Y, Rong X, Zhang X, Liu H, Jin Z. Investigation on the biomechanical behavior of the lower cervical spine induced by facet tropism with respect to the sagittal plane. Med Eng Phys 2022; 102:103779. [DOI: 10.1016/j.medengphy.2022.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/24/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
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He W, He D, Wang QL, Tian W, Liu B, Liu YJ, Sun YQ, Xing YG, Yuan N, Yuan Q, Xiao B, Han B, Wang YM, Ma TF, Liu MM. Longitudinal Spinous-Splitting Laminoplasty with Coral Bone for the Treatment of Cervical Adjacent Segment Degenerative Disease: A 5-Year Follow-up Study. Orthop Surg 2021; 14:435-442. [PMID: 34939333 PMCID: PMC8867440 DOI: 10.1111/os.13027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
This study was designed to analyze the causes of cervical adjacent segment degenerative disease (ASDis), evaluate the surgical outcomes of longitudinal spinous‐splitting laminoplasty with coral bone (SLAC) during cervical reoperation, and accumulate data on reoperation with SLAC in a primary hospital. Based on the inclusion and exclusion criteria, we conducted a retrospective study involving 52 patients who underwent cervical reoperation for ASDis using SLAC at the spinal surgery department of the Beijing Jishuitan Hospital from 1998 to 2014. Among them, 39 were treated with anterior cervical fusion and internal fixation during the first operation (anterior cervical corpectomy with fusion [ACCF], n = 24; anterior cervical discectomy and fusion [ACDF], n = 11; and cervical disc arthroplasty [CDA], n = 4). Outcomes were the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, upper limb/neck and shoulder evaluated using a visual analogue scale (VAS), and rates of ASDis. In patients who underwent an anterior cervical approach in the first instance, the incidence of ASDis was significantly higher in the C3/4 gap than in the other gaps. In the ACCF group, the lateral radiograph of the cervical spine revealed that the distance between the anterior cervical plate and the adjacent segment disc was <5 mm in 15 (62.5%) cases and five (12.8%) cases, respectively, the internal fixation screws broke into the annulus of the adjacent segment. After the first SLAC, ASDis developed at C2/3 and C3/4 in four (30.8%) and eight (61.5%) cases, respectively. After reoperation, all cases were followed up for >5 (average, 6.2) years. The pre‐reoperation and last follow‐up values were as follows: mean Japanese Orthopaedic Association score, 10.2 ± 1.5 vs 15.5 ± 0.7 (P = 0.03); neck disability index, 26.2 vs 13.6 points (P = 0.01); upper‐limb visual analog scale (VAS) score, 6.1 vs 2.6 points (P = 0.04); and neck and shoulder VAS score, 6.6 vs 2.1 points (P = 0.03). SLAC is a simple technique in which the local anatomy is clearly visible and satisfactory clinical outcomes are obtained.
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Affiliation(s)
- Wei He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Da He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Qi-Long Wang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ya-Jun Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Qing Sun
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yong-Gang Xing
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Yuan
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Qiang Yuan
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Xiao
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bing Han
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Mei Wang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Teng-Fei Ma
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ming-Ming Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
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Estimating Facet Joint Apposition with Specimen-Specific Computer Models of Subaxial Cervical Spine Kinematics. Ann Biomed Eng 2021; 49:3200-3210. [PMID: 34791608 DOI: 10.1007/s10439-021-02888-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Computational models of experimental data can provide a noninvasive method to estimate spinal facet joint biomechanics. Existing models typically consider each vertebra as one rigid-body and assume uniform facet cartilage thickness. However, facet deflection occurs during motion, and cervical facet cartilage is nonuniform. Multi rigid-body computational models were used to investigate the effect of specimen-specific cartilage profiles on facet contact area estimates. Twelve C6/C7 segments underwent non-destructive intervertebral motions. Kinematics and facet deflections were measured. Three-dimensional models of the vertebra and cartilage thickness estimates were obtained from pre-test CT data. Motion-capture data was applied to two model types (2RB: C6, C7 vertebrae each one rigid body; 3RB: left and right C6 posterior elements, and C7 vertebrae, each one rigid body) and maximum facet mesh penetration was compared. Constant thickness cartilage (CTC) and spatially-varying thickness cartilage (SVTC) profiles were applied to the facet surfaces of the 3RB model. Cartilage apposition area (CAA) was compared. Linear mixed-effects models were used for all quantitative comparisons. The 3RB model significantly reduced penetrating mesh elements by accounting for facet deflections (p = 0.001). The CTC profile resulted in incongruent facet articulation, whereas realistic congruence was observed for the SVTC profile. The SVTC profile demonstrated significantly larger CAA than the CTC model (p < 0.001).
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Shi Z, Shi L, Chen X, Liu J, Wu H, Wang C, Chen Z, Yang F, Yu S, Pang Q. The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine. J Orthop Surg Res 2021; 16:391. [PMID: 34140040 PMCID: PMC8212469 DOI: 10.1186/s13018-021-02540-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV
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Affiliation(s)
- Zewen Shi
- Ningbo University School of Medicine, Ningbo, China
| | - Lin Shi
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Xianjun Chen
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Jiangtao Liu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Haihao Wu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Chenghao Wang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Zeming Chen
- Ningbo University School of Medicine, Ningbo, China
| | - Fang Yang
- Ningbo University School of Medicine, Ningbo, China
| | - Sheng Yu
- Ningbo University School of Medicine, Ningbo, China
| | - Qingjiang Pang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China.
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19
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Zhou JM, Guo X, Kang L, Zhao R, Yang XT, Fu YB, Xue Y. Biomechanical Effect of C 5 /C 6 Intervertebral Reconstructive Height on Adjacent Segments in Anterior Cervical Discectomy and Fusion - A Finite Element Analysis. Orthop Surg 2021; 13:1408-1416. [PMID: 33942538 PMCID: PMC8274176 DOI: 10.1111/os.13010] [Citation(s) in RCA: 3] [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: 11/07/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the biomechanical effect of different intervertebral reconstructive heights on adjacent segments following C5 /C6 anterior cervical discectomy and fusion (ACDF) through finite element analysis. METHODS A finite element model of intact C4 -C7 segments was developed and validated for the present study. Five additional C4 -C7 postoperative models were constructed with 100%, 125%, 150%, 175%, and 200% of the benchmark height of C5 /C6 on the basis of the intact model. The changes in intradiscal pressure (IDP) and range of motion (ROM) of adjacent segments before and after reconstruction of C5 /C6 were analyzed. RESULTS For the upper adjacent segment (C4 /C5 ), the IDPs under the different loading conditions all increased after reconstruction. The maximum IDPs were 0.387, 0.489, 0.491, and 0.472 MPa under flexion, extension, axial rotation, and lateral bending, respectively, observed at the reconstructive height of 200%. The minimum IDPs were observed at 150% reconstructive height under all loading conditions except extension, and were 57, 86 and 81% of the maximum IDPs under flexion, axial rotation, and lateral bending, respectively. The minimum IDP under extension occurred when the reconstructive height is 125% of the benchmark height. For the lower adjacent segment (C6 /C7 ), the IDPs of postoperative models under all loading conditions also increased compared to the preoperative model. The maximum IDPs after reconstruction under flexion, extension, axial rotation, and lateral bending were 0.402, 0.411, 0.461, and 0.497 MPa, respectively, when the height of the reconstruction was 200% of the benchmark. The minimum IDPs were observed after a reconstruction at 150% of the benchmark, and were 59%, 85%, 82%, and 81% of the maximum IDPs under flexion, extension, axial rotation, and lateral bending loading conditions. CONCLUSIONS The reconstructive height is an important factor affecting the IDP and the ROM of adjacent segments after ACDF. To delay the adjacent segment disease, an intervertebral reconstructive height of 150% is an appropriate height in C5 /C6 ACDF.
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Affiliation(s)
- Jia-Ming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Liang Kang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhao
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiao-Tian Yang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi-Bin Fu
- School of Computing and Mathematics, Keele University, Keele, UK
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
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Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis. BMC Musculoskelet Disord 2021; 22:340. [PMID: 33836709 PMCID: PMC8035773 DOI: 10.1186/s12891-021-04218-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF. Methods We constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed. Results The von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.
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21
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The Correlation Between Facet Tropism and Intervertebral Disc Herniation in the Subaxial Cervical Spine. Spine (Phila Pa 1976) 2021; 46:E310-E317. [PMID: 33534441 DOI: 10.1097/brs.0000000000003788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE Investigating the correlation between the facet tropism (FT) and subaxial cervical disc herniation (CDH). SUMMARY OF BACKGROUND DATA Although debatable, it was widely reported that FT was associated with lumbar disc herniation. However, the exact correlation between FT and subaxial CDH is still unclear. METHODS Two-hundred patients with any disc herniation at C3/4, C4/5, C5/6, or C6/7 and 50 normal participants without CDH (normal control group) were included in this study. For patients, the cervical levels with CDH and the levels without herniation were classified into the "herniation group" and "patient control group," respectively. Bilateral facet joint angles at C3/4, C4/5, C5/6, and C6/7 on sagittal, axial, and coronal planes were measured on computed tomography (CT). The disc degeneration at each level was assessed on magnetic resonance imaging (MRI). RESULTS Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6, or C6/7 level and whenever on sagittal, axial, or coronal plane. The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups. The incidence of greater facet angle at the left or right side was not significantly different among the left, central, and right herniation groups. The mean disc degeneration grades in both herniation and patient control groups were significantly higher than those in normal control groups while no difference between herniation and patient control groups. CONCLUSION The FT on the sagittal, axial, and coronal planes are all associated with CDH in the subaxial cervical spine. The greater facet angle at the left or right side does not affect the side of herniation. The severity of cervical disc degeneration is not associated with FT.Level of Evidence: 3.
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22
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Facet Tropism in Lumbar Spine and Cervical Spine: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 147:47-65. [PMID: 33309642 DOI: 10.1016/j.wneu.2020.11.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Facet tropism (FT) refers to the difference in the orientation of facet joints with respect to each other in the sagittal plane. FT leads to unequal biomechanical forces on facet joint and intervertebral disc during rotation and other physiologic movements. Most of the studies have reported the incidence of FT in the lumbar spine to vary between 40% and 70%, with L4-5 level being the most commonly afflicted level. The objective of this study was to find the association between FT and various lumbar and cervical degenerative disorders. METHODS A systematic search of PubMed was performed with the keywords "facet tropism" and "facet asymmetry." Data for meta-analysis were extracted from the studies to obtain pooled impact of FT on lumbar disc herniation (LDH) and lumbar degenerative spondylolisthesis (LDS). RESULTS Eighty-two articles were included in the systematic review and 18 studies had the required data to be included in the meta-analysis. The pooled standard mean difference between FT angles in patients with or without LDH was 0.31 with (P = 0.04). The pooled odds ratio for FT in patients with LDH was 3.27 with (P = 0.02). Subgroup analysis showed that there is no significant difference in the L3/4, L4/5, and L5S1 subgroups. The pooled standard mean difference between FT angles in patients with or without LDS was 0.54 (P = 0.009). CONCLUSIONS FT is significantly associated with LDH and LDS along with various other lumbar and cervical degenerative diseases.
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23
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Biomechanical modelling of the facet joints: a review of methods and validation processes in finite element analysis. Biomech Model Mechanobiol 2020; 20:389-401. [PMID: 33221991 PMCID: PMC7979651 DOI: 10.1007/s10237-020-01403-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
There is an increased interest in studying the biomechanics of the facet joints. For in silico studies, it is therefore important to understand the level of reliability of models for outputs of interest related to the facet joints. In this work, a systematic review of finite element models of multi-level spinal section with facet joints output of interest was performed. The review focused on the methodology used to model the facet joints and its associated validation. From the 110 papers analysed, 18 presented some validation of the facet joints outputs. Validation was done by comparing outputs to literature data, either computational or experimental values; with the major drawback that, when comparing to computational values, the baseline data was rarely validated. Analysis of the modelling methodology showed that there seems to be a compromise made between accuracy of the geometry and nonlinearity of the cartilage behaviour in compression. Most models either used a soft contact representation of the cartilage layer at the joint or included a cartilage layer which was linear elastic. Most concerning, soft contact models usually did not contain much information on the pressure-overclosure law. This review shows that to increase the reliability of in silico model of the spine for facet joints outputs, more needs to be done regarding the description of the methods used to model the facet joints, and the validation for specific outputs of interest needs to be more thorough, with recommendation to systematically share input and output data of validation studies.
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24
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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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25
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Morphometric analysis of the costal facet of the thoracic vertebrae. Anat Sci Int 2020; 95:478-488. [PMID: 32335803 DOI: 10.1007/s12565-020-00544-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
Various studies have examined morphometric features of the vertebrae to understand the functional aspects of the spine. Geometric analysis of vertebral zygapophyseal facets has also been related to functional and clinical aspects of the spine, but no quantitative investigation of the costotransverse joint facet is found in the literature. The costal facet geometry may partly determine the mechanical interaction between the rib cage and spine for trunk stabilization during functional tasks and during breathing. Therefore, the present study proposes a method for estimating the 3D geometric features of the costal facets of the first 10 thoracic vertebrae (Th1-Th10). Series of landmarks (95 ± 43) were placed on 258 costal facets from a sample of 14 asymptomatic individuals to determine their 3D location and orientation. The relative location of the costal facet was used to investigate symmetry and asymmetry components of the overall vertebrae shape variation among thoracic levels using 3D geometric morphometric methods. Results showed significant variation in sagittal orientation (inclination angle) between levels with a gradual cephalic orientation in the lower levels. No significant difference was observed on transverse orientation (declination angle). The shape of the costal facet was flatter at Th1 and from Th5 to Th10 and more concave from Th2 to Th4. An average difference of 7° between right and left facet orientation in both sagittal and transverse plane was demonstrated. Asymmetry of costal facet relative location was also detected and significantly influenced by the thoracic level. Nevertheless, location and orientation of the costal facets seem to be independent features of vertebrae morphology.
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26
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Sun X, Sun S, Zhang T, Kong C, Wang W, Lu S. Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis. J Orthop Surg Res 2020; 15:36. [PMID: 32005193 PMCID: PMC6995191 DOI: 10.1186/s13018-020-1549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Biomechanical characteristics of noncontinuous ACDF and noncontinuous CDA in the treatment of noncontinuous cervical degenerative disc disease were still unclear. The aim of this research is to compare the differences between these two kinds of treatment methods and to verify the effectiveness of Prodisc-C in noncontinuous CDA. Methods Eight FEMs of the cervical spine (C2–C7) were built based on CT images of 8 mild CDDD volunteers. In the arthroplasty group, we inserted Prodisc-C at C3/4 and C5/6. In the fusion group, CoRoent® Contour and NuVasive® Helix ACP were implanted at C3/4 and C5/6. Initial loads of 75 N were used to simulate the head weight and muscle forces. The application of 1.0 N m moment on the top on the C2 vertebra was used to create motion in all directions. Statistical analyses were performed using STATA version 14.0 (Stata Corp LP, College Station, Texas, USA). Statistical significance was set at P < 0.05. Results The IDPs in C2/3 (P < 0.001, P = 0.005, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the intact group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. In addition, the IDPs in C2/3 (P < 0.001, P = 0.001, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the arthroplasty group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. Contact forces of facet joints in C2/3 (P = 0.010) in the arthroplasty group was significantly less than that in the intact group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the arthroplasty group was significantly less than that in the fusion group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the intact group were significantly less than that in the fusion group. Conclusions Noncontinuous CDA could preserve IDP and facet joint forces at the adjacent and intermediate levels to maintain the kinematics of cervical spine near preoperative values. However, noncontinuous ACDF would increase degenerative risks at adjacent and intermediate levels. In addition, the application of Prodisc-C in noncontinuous CAD may have more advantages than that of Prestige LP.
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Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China. .,Charité - Universitätsmedizin Berlin, Berlin, 113353, Germany.
| | - Siyuan Sun
- Department of Interdisciplinary Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Tongtong Zhang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.,Department of Orthopaedics, ChuiYang Liu Hospital affiliated to Tsinghua University, Beijing, 100020, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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27
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Huang X, Ye L, Liu X, Weng R, Tan J, Xie P, Yang Y, Liang L, Huang W, Jiang X. The relationship between facet tropism and cervical disc herniation. J Anat 2020; 236:916-922. [PMID: 31961950 DOI: 10.1111/joa.13151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Many studies have demonstrated the association between facet tropism and disc herniation in the lumbar spine. Some of them found that lumbar disc herniation was on the side of the more sagittal facet joint interface. However, little is understood about the association of facet tropism with disc herniation in the cervical spine. As the relationship between the facet orientation and the side of cervical disc herniation (CDH) is unclear, the purpose of this study is to investigate that relationship. Ninety-six patients with single-level CDH (C4-C5, C5-C6 or C6-C7) were included in the CDH group of this study. Another 50 age-matched and gender-matched healthy participants who accepted physical examinations were enrolled as the control group. The cervical facet angles of two sides were measured using axial computed tomography (CT). The intersection angle of the midsagittal line of the vertebra to the facet line represents the facet angle. Facet tropism was defined as the angular difference of 7º between the left and the right sides. Facet tropism angle was recorded as the absolute value of the difference of facet angles between two sides. There were 20 herniations at C4-C5 level, 50 herniations at C5-C6 level and 26 herniations at C6-C7 level. The present study showed that more cases in the CDH group had facet tropism than did those in the control group at C4-C5, C5-C6 and C6-C7 level (p = .021, p = .001, p = .015, respectively). The facet tropism angles in the CDH group were significantly bigger than those in the control group at C4-C5, C5-C6 and C6-C7 level (p = .001, p = .002, p = .028, respectively). In the CDH group, the facet angles on the herniated side were found to be significantly bigger than those on the healthy side at C4-C5, C5-C6 and C6-C7 level (p = .000, p = .000, p = .037, respectively). The findings of this present study suggest that facet tropism is associated with the disc herniation in the cervical spine. We also found that cervical disc herniates towards the side of the bigger facet angle with respect to the sagittal plane. There is a need for future studies to verify the biomechanical impact of facet tropism on CDH.
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Affiliation(s)
- Xuecheng Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, China
| | - Linqiang Ye
- Department of Spinal Surgery, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China
| | - Xiang Liu
- Department of Spinal Surgery, Chancheng District Central Hospital, Foshan, China
| | - Rui Weng
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Pusheng Xie
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, China
| | - Lichang Liang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Department of Human Anatomy, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Lv B, Fan X, Ding H, Ji P, Zhao Y, Wan B, Jiang Q, Luo Y, Xu T, Zhou Z, Chen J, Yuan J, Wang L, Huang A. Analysis of Correlation Between Age and Cervical Facet Joint Degeneration and Modic Changes in Patients with Cervical Spondylotic Myelopathy. Med Sci Monit 2019; 25:7882-7888. [PMID: 31634342 PMCID: PMC6820335 DOI: 10.12659/msm.915136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Because facet joints move with the disc, changes in vertebral bodies occur simultaneously with progression of degeneration of cervical facet joints. This study investigated age-related differences in cervical facet joint abnormalities and multi-dimensional characteristics of MCs in patients with cervical spondylotic myelopathy. Material/Methods Forty-five patients underwent both magnetic resonance imaging (MRI) and computed tomography (CT) of the cervical spine. Axial and sagittal parameter changes from C3 to C7, including facet orientation (FO) and facet tropism (FT), and Modic changes (MCs), were evaluated and documented preoperatively, and we also measured the heights and diameters of MCs and performed correlation analysis and established linear regression models. Results The axial facet orientation increased slightly from C3 66.5 (11.4) to C7 89.9 (19). The sagittal facet orientation and facet tropism increased between C3–C4 and C6–C7, but it decreased between C4 to C6. The MCs volume decreased from C3 to C4 and increased from C4 to C7. There was a gradual decrease of FO and FT from C3 to C5 and a gradual increase of these 2 angles from C5 to C7 in all age groups. The lowest values of FO and FT were detected at C5, while the highest values of FO and FT were detected at C7. Conclusions Age was negatively correlated with the axial, sagittal, and coronal cervical facet orientation, especially at C4/5 level. The FT with respect to the axial and sagittal plane from C5 to C6 increased with age.
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Affiliation(s)
- Bin Lv
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Xiaochen Fan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Hua Ding
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Peng Ji
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Yilei Zhao
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Bowen Wan
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Qinyi Jiang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Yongjun Luo
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Tao Xu
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhimin Zhou
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jian Chen
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jishan Yuan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Lei Wang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Anquan Huang
- Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
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Sorokin YN. [Back pain and intervertebral disc degeneration in the International Classification of Diseases 11th revision]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:153-159. [PMID: 31626184 DOI: 10.17116/jnevro2019119081153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2018, the World Health Organization introduced a new version of the International Classification of Diseases (ICD-11), which is preliminary and introductory in nature and will come into force on 1 January 2022. One of the most changed sections compared to ICD-10 is the section characterizing the spine pain syndrome and other manifestations of discogenic pathology. The article describes the terms and codes for the degenerative lesion of the intervertebral disk (IVD) in accordance with the requirements of ICD-11, which also agree with the definitions of the 2nd revision of the nomenclature and classification of the pathology of the lumbar IVD from 2014. The basic concepts of IVD degenerative changes are also revealed. The need to create a new revision of the domestic clinical classification of vertebrogenic neurologic pathology adapted to ICD-11 codes is underlined.
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Affiliation(s)
- Yu N Sorokin
- Rostov State Medical University, Rostov-on-Don, Russia
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30
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Wu TK, Meng Y, Liu H, Wang BY, Hong Y, Rong X, Ding C, Chen H. Biomechanical effects on the intermediate segment of noncontiguous hybrid surgery with cervical disc arthroplasty and anterior cervical discectomy and fusion: a finite element analysis. Spine J 2019; 19:1254-1263. [PMID: 30742975 DOI: 10.1016/j.spinee.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND CONTEXT Surgery for cervical degenerative disc disorder (CDDD) at two noncontiguous segments is infrequent. Few studies have explored the biomechanical effects on the intermediate adjacent segment of anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA) in this situation. No study has examined biomechanical differences between ACDF and hybrid surgery (HS) constructs for noncontiguous CDDD. Differences in the biomechanical changes between the intermediate and adjacent segments are unknown. PURPOSE This study was conducted to compare the biomechanical changes resulting from noncontiguous ACDFs and HS. STUDY DESIGN A finite element analysis study. METHODS A finite element model of a healthy cervical spine (C2-C7) was constructed. Three surgical models were developed: (1) ACDF at C3/4 and C5/6 (FF), (2) ACDF at C3/4 and CDA at C5/6 (FA) and (3) CDA at C3/4 and ACDF at C5/6 (AF). A 75-N follower load with 1.0 N·m moments was applied to the top of the C2 vertebra in the intact model to simulate flexion, extension, lateral bending, and axial rotation. Surgical models achieved identical motion angles of the intact model in each direction following the displacement-control protocols. RESULTS The FF model required much higher moments than did the AF and FA models to achieve the same amount of motion. In the FF model, the motion contributions of the unfused segments were unevenly increased. The magnitude of the increased motion in the intermediate segment was larger than those in the supra- or infra-adjacent segments. The facet contact force (FCF) and intradiscal pressure (IDP) at the intermediate segment were also more susceptible to impact. In the FA and AF models, the motion contributions of the untreated levels were evenly changed, and the intermediate segment did not experience additive motion, FCF, or IDP. The segment adjacent to the level of ACDF had greater FCF and IDP than did the segment adjacent to the level of CDA in the two HS constructs. CONCLUSIONS HS constructs resulted in less altered biomechanics and kinematics of the untreated levels and showed no additive biomechanical effects on the intermediate segments compared with ACDF at noncontiguous levels. However, the effects were associated with the relative location of the ACDF and CDA levels. CLINICAL SIGNIFICANCE This study provides a biomechanical rationale for the use of HS to treat patients with noncontiguous CDDD.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
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Wu TK, Meng Y, Wang BY, Rong X, Hong Y, Ding C, Chen H, Liu H. Biomechanics following skip-level cervical disc arthroplasty versus skip-level cervical discectomy and fusion: a finite element-based study. BMC Musculoskelet Disord 2019; 20:49. [PMID: 30704444 PMCID: PMC6357490 DOI: 10.1186/s12891-019-2425-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/18/2019] [Indexed: 02/05/2023] Open
Abstract
Background Moderately increased motion at the intermediate segment (IS) after skip-level fusion may accelerate disc degeneration. However, limited biomechanical data are available that examine the effects on the IS following cervical disc arthroplasty (CDA). The purpose of this study is to investigate the biomechanical changes in the IS of the cervical spine after skip-level fusion or skip-level arthroplasty. Methods A finite element model of a healthy cervical spine (C2-C7) was constructed. Two surgical models were developed: (1) skip-level fusion at C3/4 and C5/6 and (2) skip-level arthroplasty at C3/4 and C5/6. A 75-N follower load and 1.0-N·m moments were applied to the top of the C2 vertebra to produce flexion, extension, lateral bending and axial rotation in the intact model. The end-points in each direction corresponding to the intact model were applied to the surgical models under displacement-control protocols. Results The ranges of motion (ROMs) of the fusion model were markedly decreased at the operated levels, while the corresponding ROMs of the arthroplasty model were similar to those of the intact spine in all directions. In the fusion model, the ROMs of the IS (C4/5) were markedly increased in all directions. The ROMs in the arthroplasty model were similar to those in the intact spine, and the ROMs of untreated segments were evenly increased. In the fusion model, the intradiscal pressure and facet contact force at were C4/5 remarkably increased and unevenly distributed among the unfused segments. In the arthroplasty model, the IS did not experience additive stress. Conclusion The IS does not experience additive ROM or stress in the intervertebral disc or facet joints after skip-level arthroplasty, which has fewer biomechanical effects on the IS than does skip-level fusion. This study provides a biomechanical rationale for arthroplasty in treating patients with skip-level cervical degenerative disc disease.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China.
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Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three-Dimensional Finite Element Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:2798396. [PMID: 29991954 PMCID: PMC6016226 DOI: 10.1155/2018/2798396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/02/2018] [Indexed: 12/17/2022]
Abstract
Background Most studies report that the common position of cervical spinal manipulation (CSM) for treating symptomatic cervical disc herniation (CDH) is lateral bending to the herniated side. However, the rationality of lateral bending position on performing CSM for CDH is still unclear. Objective The purpose of this study is to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. Methods A finite element (FE) model of CDH (herniated on the left side) was generated in C5-6 segment based on the normal FE model. The FE model performed CSM in left lateral bending position, neutral position, and right lateral bending position, respectively. Cervical disc displacement, annulus fiber stress, and facet joint stress were observed during the simulation of CSM. Results The cervical disc displacement on herniated side moved forward during CSM, and the maximum forward displacements were 0.23, 0.36, and 0.45 mm in left lateral bending position, neutral position, and right lateral bending position, respectively. As the same trend of cervical disc displacement, the annulus fiber stresses on herniated side from small to large were 7.40, 16.39, and 22.75 MPa in left lateral bending position, neutral position, and right lateral bending position, respectively. However, the maximum facet stresses at left superior cartilage of C6 in left lateral bending position, neutral position, and right lateral bending position were 6.88, 3.60, and 0.12 MPa, respectively. Conclusion Compared with neutral position and right lateral bending position, though the forward displacement of cervical disc on herniated side was smaller in left lateral bending position, the annulus fiber stress on herniated side was declined by sharing load on the left facet joint. The results suggested that lateral bending to the herniated side on performing CSM tends to protect the cervical disc on herniated side. Future clinical studies are needed to verify that.
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Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine. Appl Bionics Biomech 2018; 2018:4542750. [PMID: 29849760 PMCID: PMC5904778 DOI: 10.1155/2018/4542750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/11/2018] [Accepted: 03/13/2018] [Indexed: 12/23/2022] Open
Abstract
The objective of the present study is to investigate the influence of neck muscle activation on whiplash neck injury of the occupants of a passenger vehicle under different severities of frontal and rear-end impact collisions. The finite element (FE) model has been used as a versatile tool to simulate and understand the whiplash injury mechanism for occupant injury prevention. However, whiplash injuries and injury mechanisms have rarely been investigated in connection with neck active muscle forces, which restricts the complete reappearance and understanding of the injury mechanism. In this manuscript, a mixed FE human model in a sitting posture with an active head-neck was developed. The response of the cervical spine under frontal and rear-end collision conditions was then studied using the FE model with and without neck muscle activation. The effect of the neck muscle activation on the whiplash injury was studied based on the results of the FE simulations. The results indicated that the neck active force influenced the head-neck dynamic response and whiplash injury during a collision, especially in a low-speed collision.
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