Cervical Spinal Fusion and Total Disc Replacement - Computational Biomechanics of the Musculoskeletal System - page 199

16 Cervical Spinal Fusion and

Total Disc Replacement

Zhongjun Mo, Lizhen Wang, Ming Zhang, and Yubo Fan

ContentS
Summary ........................................................................................................................................ 199
16.1 Introduction ..........................................................................................................................200
16.1.1 Intervertebral Disc Disease ......................................................................................200
16.1.2 Gold Standard for the Treatment of Intervertebral Disc Disease: Spinal Fusion .....200
16.1.3 Promising Alternative to Spinal Fusion: Total Disc Replacement ........................... 201
16.1.4 Biomechanical Study of Spinal Fusion and Total Disc Replacement ...................... 202
16.2 Model Development .............................................................................................................. 203
16.2.1 Finite Element Modeling of an Intact Healthy Cervical Spine ................................ 203
16.2.2 Validation of the Intact Healthy Cervical Spine ....................................................... 205
16.3 Application 1: A Simulation of Cervical Spinal Arthrodesis ...............................................206
16.3.1 Model Development ..................................................................................................206
16.3.2 Cervical Spinal Motion after Anterior Fusion .......................................................... 207
16.3.3 Influence of Spinal Fusion on Facet Joint ................................................................. 207
16.3.4 Adjacent Segment Intradiscal Pressure after Spinal Fusion ..................................... 208
16.4 Application 2: Simulation of Cervical Spinal Arthroplasty ................................................. 209
16.4.1 Model Development ..................................................................................................209
16.4.2 Spinal Motion after Total Disc Replacement ........................................................... 210
16.4.3 Influence of Total Cervical Disc Replacement on Facet Joint .................................. 210
16.4.4 Intradiscal Pressure at Adjacent Segment after Total Disc Replacement ................ 211
Acknowledgments .......................................................................................................................... 211
References ...................................................................................................................................... 211

Summary
Cervical intervertebral disc degeneration is a leading source of neck and arm pain. The traditional
treatment for cervical disc disease was spinal fusion, which was regarded as the gold standard
method of treatment. However, a high rate of complications, including adjacent segment degenera-
tion, was often associated with such fusion. In an effort to avoid adjacent segment disease, non-
fusion techniques, including total disc replacement and nucleus replacement, were developed as
alternatives. Unfortunately, clinical research has indicated that cervical disc replacement did not
significantly reduce the postoperative rate of adjacent segment degeneration and adjacent segment
disease. Biomechanical factors play an important role in the degeneration or rehabilitation progress
of the musculoskeletal system. In the present study, the biomechanical effect of spinal fusion and
total disc replacement on the surrounding tissues was analyzed based on the finite element method.
The results showed that adjacent intervertebral disc pressure was not apparently different from the
intact healthy condition after either spinal fusion or total disc replacement. It also showed that total
disc replacement would increase the facet joint contact force and capsular ligament tension. The
increase in facet joint loading is a potential source of facet joint degeneration.

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