Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study.

STUDY DESIGN

Finite element (FE) comparative study.

OBJECTIVE

This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).

SUMMARY OF BACKGROUND DATA

Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.

METHODS

We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.

RESULTS

The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.

CONCLUSIONS

The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.