• Norihiro Nishida, Sudharshan Tripathi, Muzammil Mumtaz, Amey Kelkar, Yogesh Kumaran, Takashi Sakai, and Vijay K Goel.
• Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan. Electronic address: nishida3@yamaguchi-u.ac.jp.
• World Neurosurg. 2022 Aug 1; 164: e358-e366.

ObjectiveSoft tissue cervical spine injury (CSI) has the possibility of causing cervical segmental instability, which can lead to spinal cord injury. There is a lack of certainty in assessing whether soft tissue CSI is unstable or not. This biomechanical study aimed to investigate the risk factors of soft tissue CSI.MethodsA 3-dimensional finite element model of the ligamentous cervical spine (C2-C7) was created from medical images. Three soft tissue injury models were simulated at C4-C5: 1) posterior ligament complex (PLC) injury, 2) intervertebral disk (ID) with anterior longitudinal ligament injury (IDI), and 3) anterior longitudinal ligament, PLC, and ID injury (API) model. Pure moment with compressive follower load was applied, and the range of motion, annular stress, nucleus stress, and facet forces were analyzed.ResultsFor the IDI and API models, the range of motion increased at the injury level in extension (by 101%) and left/right axial rotations (>30%) compared with the intact model. The IDI and API models showed an increase of >50% in annular and nucleus stresses at the injury level in extension and left/right rotations compared with the intact model. The PLC injury showed similar stresses as the intact model except for flexion. The facet contact forces of IDI and API models increased more than 100% compared with other models in all motions.ConclusionsIn CSI, all soft tissues have a key role in stabilizing cervical spine, but ID is the most important component of all.Copyright © 2022 Elsevier Inc. All rights reserved.

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