Biomechanical characteristics of hybrid strategies of two noncontiguous levels of cervical spondylosis: a finite element analysis

doi:10.3969/j.issn.2095-4344.1499

Abstract

Abstract:

BACKGROUND: For treatments of contiguous levels of cervical spondylosis, there are lots of clinical reports about it, either by using anterior cervical discectomy and fusion (ACDF), anterior cervical discectomy and arthroplasty (ACDA) or hybrid surgery. However, it is a controversial topic for treatments of noncontiguous levels of cervical spondylosis with increasing number of clinical reports.
OBJECTIVE: To investigate the biomechanical effects of different strategies to provide guidance for clinical treatment, we performed a finite element analysis on four surgical strategies for two noncontiguous levels of cervical spondylosis.
METHODS: The imaging data of C₂_-₇ of a healthy female volunteer were collected by a 64-row spiral CT machine. The data were imported into Mimics to build three-dimensional models and solid models. The inp file was exported after the three-dimensional models were meshed. The volunteer signed informed consent. The protocol was approved by the Hospital Ethics Committee. The models of intervertebral disc, ligament and artificial intervertebral disc were established by using Hypermesh. The inp files were than imported into ABAQUS for materialization, contact pairs, load settings, constraint boundaries, and analysis.
RESULTS AND CONCLUSION: (1) The stress was concentrated in the fixed segments of the ACDF&ACDF model. The activities of fixed segments were reduced, and the range of motion of adjacent segments was increased compensatorily. (2) The range of motion of displacement segments increased in the ACDA&ACDA model. Part of the activities of the normal segments was compensated by the artificial disc, but the intervertebral stress was most consistent with the results of normal model. (3) For the adjacent segment, the retention of range of motion of ACDF&ACDA model was better than the ACDA&ACDF model. (4) However, as for the replacement segment, the increased degree of range of motion of the ACDA&ACDF model was greater than the ACDF&ACDA model. (5) It is concluded that the ACDA&ACDA strategy is the best choice for addressing neurological symptoms while ensuring overall cervical range of motion. The ACDF&ACDA strategy is a compromise strategy to avoid the of stress concentration in the lower segment, followed by the ACDA&ACDF strategy. The ACDF&ACDF strategy is the last consideration due to the compensatory potential risk in the range of motion of adjacent segments.

Key words: noncontiguous, skip-level, fusion, replacement, hybrid surgery, finite element analysis, range of motion, stress

CLC Number:

R459.9|R445|R318

Peng Jiajie, Wu Jianglin, Zhou Lin, Huang Yongquan, Fan Zhirong, Zhong Degui, Su Haitao. Biomechanical characteristics of hybrid strategies of two noncontiguous levels of cervical spondylosis: a finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(32): 5175-5180.

Figures/Tables 4

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