Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study
Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study
复制标题
微创颈椎手术与颈椎前路椎间盘切除融合术后相邻节段生物力学的比较分析：有限元研究。
DOI：
10.1016/j.jot.2020.03.006
复制
发表时间：
2020-07-01
影响因子：
6.6
通讯作者：
Yang, Qiang
中科院分区：
文献类型：
--
作者：
Chen, Chao;Yuchi, Chen-Xi;Yang, Qiang
目的：经皮全内窥镜颈椎前路椎间盘切除术（PEACD）和颈椎后路椎间孔切开术（PCF）作为颈椎前路椎间盘切除融合术（ACDF）的替代方法，广泛用于治疗神经根型颈椎病患者。这些方法的理论优势在于可以避免融合导致相邻节段加速退变的风险;然而，缺乏来自生物力学数据的支持性证据。因此，本研究从生物力学角度研究并比较PCF、PEACD和ACDF对相邻节段和手术节段的影响。方法：建立正常完整的C4-C7三维有限元数字化模型并进行验证，通过修改C4-C7模型获得PEACD、PCF和ACDF的有限元模型。在屈曲、伸展、轴向旋转和侧弯过程中，所有模型均暴露于相同的载荷条件。结果：常规ACDF对手术节段及邻近节段的活动度（ROM）、椎间盘压力（IDP）、关节突接触力（FJCF）有显著影响。在PEACD模型中，ROM的变化不明显;手术节段的IDP明显较小，而相邻节段的IDP变化不明显。在PCF模型中，所有节段的ROM和IDP均未受到影响，在伸展过程中，ACDF后的小关节接触力变化显著，PECAD和PCF后的小关节接触力变化较小。通过有限元法对比分析PCF、PEACD、ACDF术后颈椎的生物力学变化，从生物力学角度来看，PCF和PEACD比ACDF更适合神经根型颈椎病的手术治疗，PCF可能优于PEACD。
Purpose: Percutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) as alternatives to anterior cervical discectomy and fusion (ACDF) are extensively used in the treatment of patients with cervical spondylotic radiculopathy. The possibility of avoiding the risk of accelerated degeneration of the adjacent segments caused by fusion is claimed to be the theoretical advantage of these approaches; however, there is a paucity of supportive evidence from biomechanical data. Therefore, this study investigated and compared the effects of PCF, PEACD, and ACDF on the adjacent segments and operative segments of the cervical spine from a biomechanical standpoint.Method: A normal and intact three-dimensional finite element digital model of C4-C7 was constructed and validated, and the finite element models of PEACD, PCF, and ACDF were obtained by modifying the C4-C7 model. All models were exposed to identical conditions of load during flexion, extension, axial rotation, and lateral bending. We calculated the range of motion (ROM), intervertebral disc pressure (IDP), and facet joint contact force (FJCF) of the operative segment and the adjacent segment in different motion conditions.Result: The conventional ACDF had a remarkable influence on the ROM and IDP of the operative segment and the adjacent segments. In the PEACD model, the change of ROM was not noticeable; the IDP of the operative segment was significantly smaller, whereas the change of IDP of the adjacent segment was insignificant. In the PCF model, the ROM and IDP of all segments remained unaffected.During extension, the facet joint contact force changed significantly after ACDF, and it changed slightly after PECAD and PCF.Conclusion: By comparatively analyzing the biomechanical changes of the cervical spine after PCF, PEACD, and ACDF using the finite element method, we suggested that PCF and PEACD were more suitable for surgical intervention of cervical spondylotic radiculopathy than ACDF from a biomechanical point of view and PCF may outperform PEACD.