A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

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Abstract

Background

The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM.

Methods

An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed.

Results

Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress.

Conclusion

Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

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Most cited references 59

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Anterior cervical discectomy and fusion associated complications.

Kostas N Fountas, Eftychia Z Kapsalaki, Leonidas G Nikolakakos … (2007)

Retrospective review study with literature review. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months. The mortality rate in our current series was 0.1% (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.

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Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves.

T Oda, K Nibu, Shail Vasavada … (2001)

The mechanical properties of multilevel human cervical spines were investigated by applying pure rotational moments to each specimen and measuring multidirectional intervertebral motions. To document intervertebral main and coupled motions of the cervical spine in the form of load-displacement curves. Although a number of in vivo and in vitro studies have attempted to delineate normal movement patterns of the cervical spine, none has explored the complexity of the whole cervical spine as a three-dimensional structure. Sixteen human cadaveric specimens (C0-C7) were used for this study. Pure rotational moments of flexion-extension, bilateral axial torque, and bilateral lateral bending were applied using a specially designed loading fixture. The resulting intervertebral motions were recorded using stereophotogrammetry and depicted as a series of load-displacement curves. The resulting load-displacement curves were found to be nonlinear, and both rotation and translation motions were coupled with main motions. With flexion-extension moment loading, the greatest degree of flexion occurred at C1-C2 (12.3 degrees), whereas the greatest degree of extension was observed at C0-C1 (20.2 degrees). With axial moment loading, rotation at C1-C2 was the largest recorded (56.7 degrees). With lateral bending moments, the average range of motion for all vertebral levels was 7.9 degrees. The findings of the present study are relevant to the clinical practice of examining motions of the cervical spine in three dimensions and to the understanding of spinal trauma and degenerative diseases.

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Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study.

W Brodner, Thomas R Highland, Wai Mun Yue (2005)

A retrospective review. To determine the clinical and radiologic outcomes beyond 5 years after anterior cervical discectomy and fusion with allograft and plating. Anterior cervical discectomy and fusion is commonly performed for cervical disc disease. The routine use of allografts and plating, though increasing in popularity, has not been well studied for long-term results and complications. Seventy-one patients who had anterior cervical discectomy and fusion with allograft and plating an average of 7.2 years prior responded to an invitation to return for a follow-up clinical and radiographic review. At final review, symptom resolution remained greater than 82% and fusion occurred in 92.6% of the disc spaces operated on. No graft extrusion or migration occurred. Based on our strict criteria, the rates of collapse and subsidence were high, at 47.9% (34 patients) overall. However, in only 6 patients (8.5%) did segmental kyphosis result, none of whom required any revision surgery in the follow-up period. Implant complications occurred in 7 patients (9.9%), none of whom required revision surgeries. Adjacent level degeneration occurred in 52 patients (73.2%). Further cervical spine surgeries were required in 14 patients (19.7%), 2 for inadequate decompression, and 12 for adjacent level disease. Segmental and global cervical lordosis was restored and maintained by the surgery over the study period. The use of allografts and plate fixation in combination for anterior cervical discectomy and fusion does not compromise the radiologic and clinical outcomes while providing the advantages of donor site morbidity elimination, restoration of cervical segmental lordosis, and not requiring postoperative immobilization.

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Author and article information

Contributors

Zhonghai Li: lizhonghaispine@126.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 15 March 2021

Publication date PMC-release: 15 March 2021

Publication date Collection: 2021

Volume: 22

Electronic Location Identifier: 278

Affiliations

[1 ]GRID grid.452435.1, ISNI 0000 0004 1798 9070, Department of Orthopaedics, , First Affiliated Hospital of Dalian Medical University, ; Dalian, People’s Republic of China

[2 ]Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People’s Republic of China

[3 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Seventh Medical Center of PLA General Hospital, ; Beijing, People’s Republic of China

Article

Publisher ID: 4150

DOI: 10.1186/s12891-021-04150-7

PMC ID: 7962321

PubMed ID: 33722229

SO-VID: dccbd549-c24f-49db-8ca9-0bae189dcbce

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 26 December 2020

Date accepted : 3 March 2021

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: multilevel cervical spondylotic myelopathy,anterior cervical corpectomy and fusion,anterior cervical discectomy and fusion,biomechanics,finite element analysis

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ScienceOpen disciplines: Orthopedics

Keywords: multilevel cervical spondylotic myelopathy, anterior cervical corpectomy and fusion, anterior cervical discectomy and fusion, biomechanics, finite element analysis

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

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Abstract

Background

Methods

Results

Conclusion

Related collections

Orthopedics

Most cited references 59

Anterior cervical discectomy and fusion associated complications.

Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves.

Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study.

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