Yu Zhongxiang, Deng Zhen, Chen Hanxi, Zhang Linling, Zhao Yongfang, Zhan Hongsheng, Lin Maohua, Vrionis Frank, Wang Huihao
Shi's Center of Orthopedics and Traumatology (Institute of Orthopaedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.
Department of Orthopedics and Traumatology, Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.
Clin Spine Surg. 2025 Aug 25. doi: 10.1097/BSD.0000000000001920.
Finite element (FE) comparative study.
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).
Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.
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.
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.
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.
有限元比较研究。
本研究旨在评估经皮内镜下颈椎椎间孔切开术和椎间盘切除术（PECFD）后中医手法治疗（CMT）对颈椎的生物力学影响。
神经根型颈椎病（CSR）是一种具有挑战性的疾病，颈椎手术后常复发，这引发了人们对CMT等替代治疗方式的兴趣。
我们建立了一个经过验证的从C2到T1颈椎的三维有限元模型。创建了另外三个模型（M1 - M3）来模拟PECFD后不同程度的椎间盘切除。在模拟CMT和生理运动的条件下，将这些模型与完整模型（M0）一起进行评估。测量了手术节段和相邻节段的关键生物力学参数，包括最大位移（MD）、旋转角度（RA）、纤维环应力、椎间盘压力（IDP）和小关节韧带应变。
分析表明，与其他负荷相比，负荷1产生的最大位移更大。模型M3在右侧弯曲和旋转时旋转角度减小，但伸展时增加。纤维环上的应力随着椎间盘切除程度的增加而升高。虽然大多数节段的椎间盘压力保持相对稳定，但在PECFD模型的手术C5 - C6节段明显更高。这些模型中的小关节韧带应力明显大于完整模型，尤其是在M3中。
研究结果表明，虽然纤维环的切除对整体稳定性影响有限，但CMT可能会导致髓核已被切除区域的再突出和不稳定。这表明在PECFD后推荐CMT时需要谨慎。
