DOI: https://doi.org/10.21203/rs.3.rs-136245/v1
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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Table. 1 Material properties and element types of the spine soft tissues and hard tissues used in the finite element moadel.
|
Component |
Element Type |
Young’s modulus (MPa) |
Cross-section (mm2) |
Poisson’s ratio |
|
Bone |
|
|
|
|
|
Cortical bone |
Shell elements |
10,000 |
- |
0.29 |
|
Cancellous bone |
3-D solid elements (4 node) |
100 |
- |
0.29 |
|
Disc |
|
|
|
|
|
Annulus (ground) |
3-D solid elements (8 node) |
4.2 |
- |
0.45 |
|
Annulus (fiber) |
3-D solid elements (8 node) |
450 |
- |
0.30 |
|
Nucleus |
3-D solid elements (8 node) |
1 |
- |
0.49 |
|
End plate |
3-D solid elements |
500 |
- |
0.40 |
|
Ligaments |
|
|
|
|
|
Anterior longitudinal ligament |
3-D tension truss elements |
30 |
33 |
0.30 |
|
Posterior longitudinal ligament |
3-D tension truss elements |
20 |
33 |
0.30 |
|
Ligamentum flavum |
3-D tension truss elements |
5 |
50.1 |
0.30 |
|
Capsular ligaments |
3-D tension truss elements |
20 |
46.6 |
0.30 |
|
Interspinous ligament |
3-D tension truss elements |
1.5 |
13 |
0.39 |
|
Implants |
|
|
|
|
|
PEEK cage |
3-D solid elements (4 node) |
3600 |
- |
0.30 |
|
Titanium plate |
3-D solid elements (4 node) |
120,000 |
- |
0.30 |
|
Titanium screw |
3-D solid elements (4 node) |
120,000 |
- |
0.30 |