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Research Article
A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study
Zhonghai Li
First Affiliated Hospital of Dalian Medical University
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
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.
Keywords
Multilevel cervical spondylotic myelopathy, Anterior cervical corpectomy and fusion, Anterior cervical discectomy and fusion, Biomechanics, Finite element analysis
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Reviewer #4 agreed
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Reviewer #11 agreed
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Reviewer #6 agreed
On 18 Jan, 2021
Review #1 received
Received 12 Jan, 2021
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Reviewer #20 agreed
On 05 Jan, 2021
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On 05 Jan, 2021
Reviewer #24 agreed
On 05 Jan, 2021
Reviewer #44 agreed
On 05 Jan, 2021
Reviewer #36 agreed
On 05 Jan, 2021
Reviewer #37 agreed
On 05 Jan, 2021
Reviewer #29 agreed
On 05 Jan, 2021
Reviewer #43 agreed
On 05 Jan, 2021
Reviewer #39 agreed
On 05 Jan, 2021
Reviewer #46 agreed
On 05 Jan, 2021
Reviewer #25 agreed
On 05 Jan, 2021
Reviewer #18 agreed
On 05 Jan, 2021
Reviewer #26 agreed
On 05 Jan, 2021
Reviewer #38 agreed
On 05 Jan, 2021
Reviewer #45 agreed
On 05 Jan, 2021
Reviewer #1 agreed
On 05 Jan, 2021
Reviewer #17 agreed
On 05 Jan, 2021
Reviewer #41 agreed
On 05 Jan, 2021
Reviewer #19 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 30 Dec, 2020
Editor assigned
On 30 Dec, 2020
Editor invited
On 30 Dec, 2020
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On 30 Dec, 2020
First submitted
On 25 Dec, 2020
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study
Zhonghai Li
First Affiliated Hospital of Dalian Medical University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 04 Jan, 2021
No community comments so far
Reviewer #5 agreed
On 19 Jan, 2021
Reviewer #7 agreed
On 19 Jan, 2021
Review #8 received
Received 18 Jan, 2021
Review #3 received
Received 18 Jan, 2021
Review #2 received
Received 18 Jan, 2021
Reviewer #9 agreed
On 18 Jan, 2021
Reviewer #2 agreed
On 18 Jan, 2021
Reviewer #8 agreed
On 18 Jan, 2021
Reviewer #4 agreed
On 18 Jan, 2021
Reviewer #11 agreed
On 18 Jan, 2021
Reviewer #3 agreed
On 18 Jan, 2021
Reviewer #10 agreed
On 18 Jan, 2021
Reviewer #6 agreed
On 18 Jan, 2021
Review #1 received
Received 12 Jan, 2021
Review #9 received
Received 12 Jan, 2021
Review #5 received
Received 12 Jan, 2021
Review #25 received
Received 12 Jan, 2021
Review #17 received
Received 12 Jan, 2021
Review #18 received
Received 12 Jan, 2021
Review #10 received
Received 12 Jan, 2021
Review #24 received
Received 12 Jan, 2021
Review #20 received
Received 12 Jan, 2021
Review #27 received
Received 12 Jan, 2021
Review #6 received
Received 12 Jan, 2021
Review #7 received
Received 12 Jan, 2021
Review #19 received
Received 12 Jan, 2021
Review #26 received
Received 12 Jan, 2021
Review #22 received
Received 12 Jan, 2021
Reviewer #20 agreed
On 05 Jan, 2021
Reviewer #28 agreed
On 05 Jan, 2021
Reviewer #24 agreed
On 05 Jan, 2021
Reviewer #44 agreed
On 05 Jan, 2021
Reviewer #36 agreed
On 05 Jan, 2021
Reviewer #37 agreed
On 05 Jan, 2021
Reviewer #29 agreed
On 05 Jan, 2021
Reviewer #43 agreed
On 05 Jan, 2021
Reviewer #39 agreed
On 05 Jan, 2021
Reviewer #46 agreed
On 05 Jan, 2021
Reviewer #25 agreed
On 05 Jan, 2021
Reviewer #18 agreed
On 05 Jan, 2021
Reviewer #26 agreed
On 05 Jan, 2021
Reviewer #38 agreed
On 05 Jan, 2021
Reviewer #45 agreed
On 05 Jan, 2021
Reviewer #1 agreed
On 05 Jan, 2021
Reviewer #17 agreed
On 05 Jan, 2021
Reviewer #41 agreed
On 05 Jan, 2021
Reviewer #19 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 30 Dec, 2020
Editor assigned
On 30 Dec, 2020
Editor invited
On 30 Dec, 2020
Submission checks complete
On 30 Dec, 2020
First submitted
On 25 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF.