Sun Xiangyao, Huang Jiang, Zhang Qingming, Cao Li, Liu Yuqi, Song Zelong, Tang Wei, Sun Siyuan, Wang Juyong
Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Geriatric Diseases, Beijing, China.
Front Bioeng Biotechnol. 2024 Apr 3;12:1345319. doi: 10.3389/fbioe.2024.1345319. eCollection 2024.
The treatment of skip-level cervical degenerative disease (CDD) with no degenerative changes observed in the intervening segment (IS) is complicated. This research aims to provide a reference basis for selecting treatment approaches for noncontiguous CDD. To establish accurate finite element models (FEMs), this study included computed tomography (CT) data from 21 patients with CDD (10 males and 11 females) for modeling. The study primarily discusses four cross-segment surgical approaches: upper (C3/4) anterior cervical discectomy and fusion (ACDF) and lower (C5/6) cervical disc arthroplasty (CDA), FA model; upper CDA (C3/4) and lower ACDF (C5/6), AF model; upper ACDF (C3/4) and lower ACDF (C5/6), FF model; upper CDA (C3/4) and lower CDA (C5/6), AA model. An initial axial load of 73.6 N was applied at the motion center using the follower load technique. A moment of 1.0 Nm was applied at the center of the C2 vertebra to simulate the overall motion of the model. The statistical analysis was conducted using STATA version 14.0. Statistical significance was defined as a value less than 0.05. The AA group had significantly greater ROM in flexion and axial rotation in other segments compared to the FA group ( < 0.05). The FA group consistently exhibited higher average intervertebral disc pressure in C2/3 during all motions compared to the AF group ( < 0.001); however, the FA group displayed lower average intervertebral disc pressure in C6/7 during all motions ( < 0.05). The AA group had lower facet joint contact stresses during extension in all segments compared to the AF group ( < 0.05). The FA group exhibited significantly higher facet joint contact stresses during extension in C2/3 ( < 0.001) and C6/7 ( < 0.001) compared to the AF group. The use of skip-level CDA is recommended for the treatment of non-contiguous CDD. The FA construct shows superior biomechanical performance compared to the AF construct.
治疗节段间未观察到退变改变的跳跃型颈椎退变疾病（CDD）较为复杂。本研究旨在为非连续性CDD治疗方法的选择提供参考依据。为建立准确的有限元模型（FEMs），本研究纳入了21例CDD患者（10例男性和11例女性）的计算机断层扫描（CT）数据进行建模。该研究主要探讨了四种跨节段手术方法：上位（C3/4）颈椎前路椎间盘切除融合术（ACDF）和下位（C5/6）颈椎间盘置换术（CDA），FA模型；上位CDA（C3/4）和下位ACDF（C5/6），AF模型；上位ACDF（C3/4）和下位ACDF（C5/6），FF模型；上位CDA（C3/4）和下位CDA（C5/6），AA模型。使用跟随载荷技术在运动中心施加73.6 N的初始轴向载荷。在C2椎体中心施加1.0 Nm的力矩以模拟模型的整体运动。使用STATA 14.0版本进行统计分析。统计学显著性定义为P值小于0.05。与FA组相比，AA组在其他节段的前屈和轴向旋转活动度明显更大（P<0.05）。与AF组相比，FA组在所有运动过程中C2/3节段的平均椎间盘压力始终更高（P<0.001）；然而，FA组在所有运动过程中C6/7节段的平均椎间盘压力更低（P<0.05）。与AF组相比，AA组在所有节段伸展时小关节接触应力更低（P<0.05）。与AF组相比，FA组在C2/3（P<0.001）和C6/7（P<0.001）节段伸展时小关节接触应力明显更高。推荐使用跳跃型CDA治疗非连续性CDD。与AF结构相比，FA结构显示出更好的生物力学性能。
