Biomechanical Effect of Osteoporosis on Adjacent Segments After Anterior Cervical Corpectomy and Fusion

Abstract

Adjacent segmental degeneration (ASD) is one common long-term complication of anterior cervical corpectomy and fusion (ACCF), and osteoporosis is one basic disease in the elderly. After ACCF, patients may experience osteoporosis with age. However, the influence of osteoporosis on ASD remains unclear. The purpose of this study was to determine whether osteoporosis could affect the development of ASD following ACCF. Three finite element models of the cervical spine, including 1 normal model, 1 ACCF model, and 1 ACCF with osteoporosis model, were constructed. ACCF was simulated at the C4-C6 level. A 73.6N follower load and a 1 Nm moment were imposed on the normal model, and the same follower load together with an adjusted moment was applied to the ACCF model and the ACCF with osteoporosis model, to simulate movement in each direction. The range of motion, intradiscal pressure, shear stress on anulus fibrosus, and facet joint stress at C3-C4 and C6-C7 levels of the models were calculated. In this study, the normal model was well validated. In flexion, extension, right lateral bending, and right axial rotation, the overall range of motion was 8.92°, 19.7°, 15.37°, and 45.27° in the normal model, and the adjusted moment was 1.4 Nm, 2.7 Nm, 1.1 Nm, and 2.6 Nm in the ACCF model, and 1.3 Nm, 2.5 Nm, 1.1 Nm, and 2.4 Nm in the ACCF with osteoporosis model. Despite of a few exceptions, the maximum values of the outcome measurements were mostly found in the ACCF model, and the minimum values in the normal model. Compared with the ACCF model, most of the outcome measurements were decreased in the ACCF with osteoporosis model. Osteoporosis can retard the adverse influence of ACCF on adjacent segments.