Biomechanical analysis of single and multi-level artificial disc replacement (ADR) in cervical spine using multi-scale loadings: A finite element study
Restricted accessResearch articleFirst published online June, 2024
Biomechanical analysis of single and multi-level artificial disc replacement (ADR) in cervical spine using multi-scale loadings: A finite element study
Artificial disc replacement (ADR) is a clinical procedure used to diagnose cervical degenerative disc disease, preserving range of motion (ROM) at the fixation level and preventing adjacent segment degeneration (ASD). This study analyzed the biomechanics of ADR by examining range of motion (ROM), stress levels in bone and implants, and strain in the bone-implant interface using multi-scale loadings. The study focused on single- and double-level patients across various loading scales during physiological motions within the cervical spine. Results showed increased ROM in single-level and double-level fixations during physiological loadings, while ROM decreased at the adjacent level of fixation with the intact cervical spine model. The Prodisc-Implant metal endplate experienced a maximum von Mises stress of 432 MPa during axial rotation, confirming the long durability and biomechanical performance of the bone-implant interface.
RahmanWUJiangWZhaoF, et al. Biomechanical analysis of single-and double-level cervical disc arthroplasty using finite element modeling. Proc Inst Mech Eng H J Eng Med2023; 237(1): 91–103.
2.
BiswasJKRanaMMalasA, et al. Effect of single and multilevel artificial inter-vertebral disc replacement in lumbar spine: a finite element study. Int J Artif Organs2022; 45(2): 193–199.
3.
ChangU-KKimDHLeeMC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine2007; 7: 33–39.
4.
UpadhyayaCDWuJCTrostG, et al. Analysis of the three united states food and drug administration investigational device exemption cervical arthroplasty trials. J Neurosurg Spine2012; 16: 216–228.
5.
GaoFMaoTSunW, et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine2015; 40: 1816–1823.
6.
WongC-EHuH-THsiehM-P, et al. Optimization of three-level cervical hybrid surgery to prevent adjacent segment disease: a finite element study. Front Bioeng Biotechnol2020; 8: 154.
7.
ChoiHPurushothamanYBaisdenJ, et al. Unique biomechanical signatures of Bryan, Prodisc C, and Prestige LP cervical disc replacements: a finite element modelling study. Eur Spine J2020; 29: 2631–2639.
8.
DingDShaffreyME.Cervical disk arthroplasty: patient selection. Clin Neurosurg2012; 59: 91–97.
9.
LevenDMeaikeJRadcliffK, et al. Cervical disc replacement surgery: indications, technique, and technical pearls. Curr Rev Musculoskelet Med2017; 10: 160–169.
10.
BarbagalloGMAssiettiRCorbinoL, et al. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?Eur Spine J2009; 18: 29–39.
11.
ShinDAYiSYoonDH, et al. Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine2009; 34: 1153–1159.
12.
HeyHWDHongCCLongAS, et al. Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J2013; 22: 116–122.
13.
LuVMZhangLSchermanDB, et al. Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J2017; 26: 546–557.
14.
GandhiAAGroslandNMKallemeynNA, et al. Biomechanical analysis of the cervical spine following disc degeneration, disc fusion, and disc replacement: a finite element study. Int J Spine Surg2019; 13(6): 491–500.
15.
BhattacharyaSRoySRanaM, et al. Biomechanical performance of a modified design of dynamic cervical implant compared to conventional ball and socket design of an artificial intervertebral disc implant: a finite element study. J Mech Med Biol2019; 19(4): 1950017.
16.
LiXFLvZDYinHL, et al. Impact of adjacent pre-existing disc degeneration status on its biomechanics after single-level anterior cervical interbody fusion. Comput Methods Programs Biomed2021; 209: 106355.
17.
HuaWZhiJWangB, et al. Biomechanical evaluation of adjacent segment degeneration after one-or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: a finite element analysis. Comput Methods Programs Biomed2020; 189: 105352.
18.
ChenCYuchiCXGaoZ, et al. Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: a finite element study. J Orthop Translat2020; 23: 107–112.
19.
SrinivasanSKumarDShruthiR, et al. Effect of heterotopic ossification after bryan-cervical disc arthroplasty on adjacent level range of motion: a finite element study. J Clin Orthop Trauma2021; 15: 99–103.
20.
ManickamPSRoyS.The biomechanical effects of S-type dynamic cage using Ti and PEEK for ACDF surgery on cervical spine varying loads. Int J Artif Organs2021; 44(10): 748–755.
21.
MoZJZhaoYBWangLZ, et al. Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue. Euro Spine J2014; 23(3): 613–621.
22.
RhoJYHobathoMCAshmanRB.Relations of mechanical properties to density and CT numbers in human bone. Med Eng Phys1995; 17(5): 347–355.
23.
ZhangQHTeoECNgHW, et al. Finite element analysis of moment-rotation relationships for human cervical spine. J Biomech2006; 39(1): 189–193.
24.
RoySPandaDKhutiaNChowdhuryAR.Pore geometry optimization of titanium (Ti6Al4V) alloy, for its application in the fabrication of customized hip implants. Int J Biomater2014; 2014: 313975.
25.
BiswasJKDeySKarmakarSK, et al. Design of patient specific spinal implant (Pedicle Screw Fixation) using FE analysis and soft computing techniques. Curr Med Imaging2020; 16(4): 371–382.
26.
BiswasJKKalitaKRoychowdhuryA.Symbolic regression metamodel-based optimal design of patient-specific spinal implant (pedicle screw fixation). Eng Comput2020; 38: 999–1014.
27.
ChoudhurySRajaDRoyS, et al. Stress analysis of different types of cages in cervical vertebrae: a finite element study. IOP Conf Ser Mater Sci Engg2020; 912(2): 022025.
28.
ChoudhurySDhasonRRoyS, et al. Design optimization of peek hybrid composite cervical cage. Int J Multiscale Computat Eng2022; 20(4): 1–16.
29.
ManickamPSRoyS.The biomechanical study of cervical spine: a finite element analysis. Int J Artif Organs2022; 45(1): 89–95.
30.
KumarRKumarA.Biomechanical analysis of a single-level customized cage screw fixation for anterior cervical discectomy and fusion in the cervical spine: an in-silico study. Biomed Phys Eng Express2023; 9(4): 045018.
31.
ManickamPSRoySShettyGM.Biomechanical evaluation of a novel S-type, dynamic zero-profile cage design for anterior cervical discectomy and fusion with variations in bone graft shape. a finite element analysis. World Neurosurg2021; 154: 199–214.
32.
ManickamPSGhoshGShettyGM, et al. Biomechanical analysis of the novel S-type dynamic cage by implementation of teaching learning based optimization algorithm-An experimental and finite element study. Med Eng Phys2023; 112: 103955.
33.
PanjabiMMCriscoJJVasavadaA, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load displacement curves. Spine2001; 26(24): 2692–2700.
34.
CoelhoPGFernandesPCFolgadoJ, et al. Development of a spinal fusion cage by multiscale modelling: application to the human cervical spine. Procedia Eng2015; 110: 183–190.
35.
BiswasJKMalasAMajumdarS, et al. A comparative finite element analysis of artificial intervertebral disc replacement and pedicle screw fixation of the lumbar spine. Comput Methods Biomech Biomed Eng2022; 25(16): 1812–1820.
36.
BiswasJKRoySMajumderS, et al. Artificial intervertebral disc replacement to provide dynamic stability to the lumbar spine: a finite element study. J Long-Term Eff Med Implants2018; 28(2): 101–109.
37.
LeeJHParkWMKimYH, et al. A biomechanical analysis of an artificial disc with a shock-absorbing core property by using whole-cervical spine finite element analysis. Spine2016; 41: E893–E901.
38.
SunCLiYFengR, et al. Study on biomechanical analysis of two-level cervical Mobi-C and arthrodesis. Am J Transl Res2021; 13: 12714.
