Abstract
BackgroundThe plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF.MethodsWe constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed.ResultsThe von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending.ConclusionsThe PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.
Highlights
The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF)
We randomly selected 10 participants and built 10 threedimensional finite element (FE) models based on computed tomography (CT) scans with interval 0.625 mm of the cervical spine of these 10 healthy volunteers
All the 10 FE models were meshed in stress converged mesh resolution (Mesh 2 level)
Summary
The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). Disc degeneration can potentially cause compression of the nerve roots or spinal cord, resulting in radiculopathy (annual incidence of approximately 83/100000) or myelopathy (annual incidence of approximately 4/100000) [3,4,5,6,7]. This can manifest as a range of symptoms, including axial neck pain, radicular pain, motor weakness and sensory loss [1, 4]. Anterior cervical discectomy and fusion (ACDF) is considered a standard surgical treatment for affected patients in whom nonsurgical treatments fail [9,10,11]. It has been reported that the cervical arthrodesis with plate can change the biomechanical environment of cervical spine, eventually result in adjacent segment degeneration (ASD) [14,15,16]
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