ArticleNeurospine2022
Biomechanical Analysis of 3-Level Anterior Cervical Discectomy and Fusion Under Physiologic Loads Using a Finite Element Model.
Article in Neurospine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 20 citations in OpenAlex.
- Approach to assess the effect of sagittal cervical alignment on three-dimensional movement of the cervical spine in spondylosis patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Can the Stand-Alone Cervical Interfacet Fusion Achieve Spinal Stability? A Comprehensive Finite Element Analysis.International journal of spine surgery · 2026Article
- Biomechanical effects of supplemental posterior cervical stabilization in one-to three-level anterior cervical discectomy and fusion: a finite element analysis of construct length-dependent stress shielding and adjacent segment mechanics.Frontiers in bioengineering and biotechnology · 2026Article
- Biomechanical Analysis Comparison of Different Cervical Posterior Screw Fixation Techniques: A Finite Element Study.Neurospine · 2026Article
- Long cervical fusions: are multiple segmental plates less likely to fail than a single long plate?Journal of spine surgery (Hong Kong) · 2025Article
- Comparing adjacent segment biomechanics between anterior and posterior cervical fusion using patient-specific finite element modeling.Asian spine journal · 2024Article
- Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation.Neurospine · 2024Article
- Finite element analysis of a new preoperative traction for cervical kyphosis: suspensory traction.Medical & biological engineering & computing · 2024Article
- Biomechanical Analysis of Hybrid Artificial Discs or Zero-Profile Devices for Treating 1-Level Adjacent Segment Degeneration in ACDF Revision Surgery.Neurospine · 2024Article
- Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling.Scientific reports · 2023Article
- Spinal Cord Stress After Anterior Cervical Diskectomy and Fusion: Results from a Patient-Specific Finite Element Model.Annals of biomedical engineering · 2023Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivePseudarthrosis and adjacent segment degeneration (ASD) are 2 common complications after multilevel anterior cervical discectomy and fusion (ACDF). We aim to identify the potential biomechanical factors contributing to pseudarthrosis and ASD following 3-level ACDF using a cervical spine finite element model (FEM).
methodsA validated cervical spine FEM from C2 to C7 was used to study the biomechanical factors in cervical spine intervention. The FEM model was used to simulate a 3-level ACDF with intervertebral spacers and anterior cervical plating with screw fixation from C4 to C7. The model was then constrained at the inferior nodes of the T1 vertebra, and physiological loads were applied at the top vertebra. The pure moment load of 2 Nm was applied in flexion, extension, and lateral bending. A follower axial force of 75 N was applied to reproduce the weight of the cranium and muscle force, was applied using standard procedures. The motion-controlled hybrid protocol was utilized to comprehend the adjustments in the spinal biomechanics.
resultsOur cervical spine FEM demonstrated that the cranial adjacent level (C3-4) had significantly more increase in range of motion (ROM) (+90.38%) compared to the caudal adjacent level at C7-T1 (+70.18%) after C4-7 ACDF, indicating that the cranial adjacent level has more compensatory increase in ROM than the caudal adjacent level, potentially predisposing it to earlier ASD. Within the C4-7 ACDF construct, the C6-7 level had the least robust fixation during fixation compared to C4-5 and C5-6, as reflected by the smallest reduction in ROM compared to intact spine (-71.30% vs. -76.36% and -77.05%, respectively), which potentially predisposes the C6-7 level to higher risk of pseudarthrosis.
conclusionBiomechanical analysis of C4-7 ACDF construct using a validated cervical spine FEM indicated that the C3-4 has more compensatory increase in ROM compared to C7-T1, and C6-7 has the least robust fixation under physiological loads. These findings can help spine surgeons to predicate the areas with higher risks of pseudarthrosis and ASD, and thus developing corresponding strategies to mitigate these risks and provide appropriate preoperative counseling to patients.
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