STUDY DESIGN: Determination of human cervical spine disc response under cyclic loading. PURPOSE: To explain the potential mechanisms of intervertebral disc injury caused by cyclic loading. OVERVIEW OF LITERATURE: Certain occupational environments in civilian and military populations may affect the cervical spine of individuals by cyclic loading. Research on this mechanism is scarce. METHODS: Here, we developed a finite element model of the human C4–C5 disc. It comprised endplates, five layers of fibers, a nucleus, and an annulus ground substance. The endplates, ground substance, and annular fibers were modeled with elastic, hyperviscoelastic, and hyper-elastic materials, respectively. We subjected the disc to compressive loading (150 N) for 10,000 cycles at frequencies of 2 Hz (low) and 4 Hz (high). We measured disc displacements over the entire loading period. We obtained maximum and minimum principal stress and strain and von Mises stress distributions at both frequencies for all components. Further, we used contours to infer potential mechanisms of internal load transfer within the disc components. RESULTS: The points of the model disc displacement versus the loading cycles were within the experimental corridors for both frequencies. The principal stresses were higher in the ground matrix, maximum stress was higher in the anterior and posterior annular regions, and minimum stress was higher along the superior and inferior peripheries. The maximum principal strains were radially directed, whereas the minimum principal strains were axially/obliquely directed. The stresses in the fibers were greater and concentrated in the posterolateral regions in the innermost layer. CONCLUSIONS: Disc displacement was lower at high frequency, thus exhibiting strain rate stiffening and explaining stress accumulation at superior and interior peripheries. Greater stresses and strains at the boundaries explain disc injuries, such as delamination. The greater development of stresses in the innermost annular fiber layer (migrating toward the posterolateral regions) explains disc prolapse.
Fatigue ; Finite Element Analysis ; Humans ; Intervertebral Disc ; Military Personnel ; Neck Pain ; Nerve Fibers, Myelinated ; Prolapse ; Spine

Methods: Patient-specific finite element modeling (FEM) of the cervical spine and spinal cord were created. Surgical simulation was performed for multi-segment anterior cervical discectomy fusion (ACDF) (C4–C7) and posterior cervical laminectomy with fusion (PCLF) (C5–6 laminectomy and C4–C7 fusion). Physiological motions were simulated by applying a 2 Nm moment and 75 N force. Results: At the superior adjacent segment, the ACDF model exhibited a higher range of motion (ROM) during neck flexion compared to PCLF. Conversely, in neck extension, PCLF showed a higher ROM than ACDF. At the superior adjacent segment, the ACDF model showed greater spinal cord stress during flexion. During extension, PCLF was associated with greater spinal cord stress. At the inferior adjacent segment, ACDF was associated with greater spinal cord stress than PCLF during flexion. At the superior adjacent segment, ACDF also led to increased intradiskal pressure and capsular ligament strain during flexion, whereas PCLF showed these increases during extension. Conclusions Our findings indicate the differential effect of ACDF and PCLF on biomechanics at the cervical spine’s adjacent segments, with the patient-specific model with ACDF showing greater changes and potential for degeneration. This study highlights the utility of patient-specific FEMs in enhancing surgical decision-making through personalized medicine.

Methods: Patient-specific finite element modeling (FEM) of the cervical spine and spinal cord were created. Surgical simulation was performed for multi-segment anterior cervical discectomy fusion (ACDF) (C4–C7) and posterior cervical laminectomy with fusion (PCLF) (C5–6 laminectomy and C4–C7 fusion). Physiological motions were simulated by applying a 2 Nm moment and 75 N force. Results: At the superior adjacent segment, the ACDF model exhibited a higher range of motion (ROM) during neck flexion compared to PCLF. Conversely, in neck extension, PCLF showed a higher ROM than ACDF. At the superior adjacent segment, the ACDF model showed greater spinal cord stress during flexion. During extension, PCLF was associated with greater spinal cord stress. At the inferior adjacent segment, ACDF was associated with greater spinal cord stress than PCLF during flexion. At the superior adjacent segment, ACDF also led to increased intradiskal pressure and capsular ligament strain during flexion, whereas PCLF showed these increases during extension. Conclusions Our findings indicate the differential effect of ACDF and PCLF on biomechanics at the cervical spine’s adjacent segments, with the patient-specific model with ACDF showing greater changes and potential for degeneration. This study highlights the utility of patient-specific FEMs in enhancing surgical decision-making through personalized medicine.

Methods: Patient-specific finite element modeling (FEM) of the cervical spine and spinal cord were created. Surgical simulation was performed for multi-segment anterior cervical discectomy fusion (ACDF) (C4–C7) and posterior cervical laminectomy with fusion (PCLF) (C5–6 laminectomy and C4–C7 fusion). Physiological motions were simulated by applying a 2 Nm moment and 75 N force. Results: At the superior adjacent segment, the ACDF model exhibited a higher range of motion (ROM) during neck flexion compared to PCLF. Conversely, in neck extension, PCLF showed a higher ROM than ACDF. At the superior adjacent segment, the ACDF model showed greater spinal cord stress during flexion. During extension, PCLF was associated with greater spinal cord stress. At the inferior adjacent segment, ACDF was associated with greater spinal cord stress than PCLF during flexion. At the superior adjacent segment, ACDF also led to increased intradiskal pressure and capsular ligament strain during flexion, whereas PCLF showed these increases during extension. Conclusions Our findings indicate the differential effect of ACDF and PCLF on biomechanics at the cervical spine’s adjacent segments, with the patient-specific model with ACDF showing greater changes and potential for degeneration. This study highlights the utility of patient-specific FEMs in enhancing surgical decision-making through personalized medicine.

Results: Pullout strength decreased by 36% when the size of the revision screw was increased by 1 mm, while it increased by 35% when the size of the revision screw was increased by 2 mm compared to the index screw value. While the morphologies of the load paths were similar in all cases, they differ between the two groups: the larger screw responded with generally elevated stiffer path than the smaller screw, suggesting that revision surgery using a larger screw has more purchase along the inserted body-pedicle axis. Conclusions A larger screw enhances strength and increases biomechanical stability in revision surgeries, although the final surgical decision is made by the clinician, which includes the patient’s anatomy and associated characteristics.

Methods: A validated C2–T1 finite element model was subjected to flexion-extension. CDAs were simulated at the C5–C6 level with the Secure-C, Mobi-C, Prestige LP, and Prodisc C prosthetic disks. We used a hybrid loading protocol to apply sagittal moments. Normalized motions at the index and adjacent levels, and intradiscal pressures and facet column loads were also obtained. Results: The ranges of motion at the index level increased after CDA. The Mobi-C prosthesis demonstrated the highest amount of flexion, followed by the Secure-C, Prestige LP, and Prodisc C. The Secure-C demonstrated the highest amount of extension, followed by the Mobi-C, Prodisc C, and Prestige LP. The motion decreased at the rostral and caudal adjacent levels. Facet forces increased at the index level and decreased at the rostral and caudal adjacent levels following CDA. Intradiscal pressures decreased at the adjacent levels for the Mobi-C, Secure-C, and Prodisc C. Conversely, the use of the Prestige LP increased intradiscal pressure at both adjacent levels. Conclusions While all artificial disks were useful in restoring the index level motion, the Secure-C and Mobi-C translating abilities allowed for lower intradiscal pressures at the adjacent segments and may be the driving mechanism for minimizing adjacent segment degenerative arthritic changes. The facet joint integrity should also be considered in the clinical decision-making process for CDA selection.

Methods: A validated C2–T1 finite element model was subjected to flexion-extension. CDAs were simulated at the C5–C6 level with the Secure-C, Mobi-C, Prestige LP, and Prodisc C prosthetic disks. We used a hybrid loading protocol to apply sagittal moments. Normalized motions at the index and adjacent levels, and intradiscal pressures and facet column loads were also obtained. Results: The ranges of motion at the index level increased after CDA. The Mobi-C prosthesis demonstrated the highest amount of flexion, followed by the Secure-C, Prestige LP, and Prodisc C. The Secure-C demonstrated the highest amount of extension, followed by the Mobi-C, Prodisc C, and Prestige LP. The motion decreased at the rostral and caudal adjacent levels. Facet forces increased at the index level and decreased at the rostral and caudal adjacent levels following CDA. Intradiscal pressures decreased at the adjacent levels for the Mobi-C, Secure-C, and Prodisc C. Conversely, the use of the Prestige LP increased intradiscal pressure at both adjacent levels. Conclusions While all artificial disks were useful in restoring the index level motion, the Secure-C and Mobi-C translating abilities allowed for lower intradiscal pressures at the adjacent segments and may be the driving mechanism for minimizing adjacent segment degenerative arthritic changes. The facet joint integrity should also be considered in the clinical decision-making process for CDA selection.