Hussain, Mozammil

Object Biomechanical studies have shown that anterior cervical fusion construct stiffness and arthrodesis rates vary with different reconstruction techniques; however, the behavior of the adjacent segments in the setting of different procedures is poorly understood. This study was designed to investigate the adjacent-segment biomechanics after 3 different anterior cervical decompression and fusion techniques, including 3-level discectomy and fusion, 2-level corpectomy and fusion, and a corpectomy-discectomy hybrid technique. The authors hypothesized that biomechanical changes at the segments immediately superior and inferior to the multilevel fusion would be inversely proportional to the number of fused bone grafts and that these changes would be related to the type of fusion technique. Methods A previously validated 3D finite element model of an intact C3–T1 segment was used. Three C4–7 fusion models were built from this intact model by varying the number of bone grafts used to span the decompression: a 1-graft model (2-level corpectomy), a 2-graft model (C-5 corpectomy and C6–7 discectomy), and a 3-graft model (3-level discectomy). The corpectomy and discectomy models were also previously validated and compared well with the literature findings. Range of motion, disc stresses, and posterior facet loads at the segments superior (C3–4) and inferior (C7–T1) to the fusion construct were assessed. Results Motion, disc stresses, and posterior facet loads generally increased at both of the adjacent segments in relation to the intact model. Greater biomechanical changes were noted in the superior C3–4 segment than in the inferior C7–T1 segment. Increasing the number of bone grafts from 1 to 2 and from 2 to 3 was associated with a lower magnitude of biomechanical changes at the adjacent segments. Conclusions At segments adjacent to the fusion level, biomechanical changes are not limited solely to the discs, but also propagate to the posterior facets. These changes in discs and posterior facets were found to be lower for discectomy than for corpectomy, thereby supporting the current study hypothesis of inverse relationship between the adjacent-segment variations and the number of fused bone grafts. Such changes may go on to influence the likelihood of adjacent-segment degeneration accordingly. Further studies are warranted to identify the causes and true impact of these observed changes.

Many neck pain complaints are associated with degenerated discs in cervical spine. Disc degeneration (DD) consists of cascading stages of events with complex changes in disc tissue properties. This results in deterioration of the ability of the disc to perform its function normally. Several biomechanical and biochemical changes occur in the disc with degeneration. Increase in motion segment stiffness and peak stresses in the posterior annulus are some of the gross changes that occur in the disc with degeneration.

Collagen fibers in the annulus fibrosus (AF) play a significant role in maintaining the disc mechanical behavior. In healthy discs, AF fibers are concentrically arranged in a zigzag fashion. Tensile loads are transmitted to these fibers when the disc is loaded in compression. As a result, disc bulging occurs. Initiation and progression of mild cervical disc degeneration (DD) has been the subject of clinical concern [1]. The mild DD is associated with structural interruption in laminar organization of fibers in partial AF regions and incomplete length of fibers is a major form of structural interruption in AF fibers [2]. Moreover, a loss of lamellar fiber structure contributes to the progression of spinal deformity [3]. Past research have documented the biomechanical role of complete length of fibers in governing a healthy disc behavior [4]; however, there is a lack of clear understanding as to how incomplete length of fibers in different AF regions affect overall disc biomechanics and how they may play a role in initiating the propagation of DD. The focus of the current study is to investigate the disc biomechanical response due to incomplete length of fibers in outer, middle, and inner AF regions.