• 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, Yamaguchi, Japan. Electronic address: nishida3@yamaguchi-u.ac.jp.
• World Neurosurg. 2023 Mar 1; 171: e777e786e777-e786.

ObjectiveThis finite element analysis aimed to investigate the effects of surgical procedures for cervical spine injury.MethodsA three-dimensional finite element model of the cervical spine (C2-C7) was created from computed tomography. This model contained vertebrae, intervertebral discs, anterior longitudinal ligament, and posterior ligament complex. To create the cervical spine injury model, posterior ligament complex and anterior longitudinal ligament at C3-C4 were resected and the center of the intervertebral disc was resected. We created posterior-only fixation (PF), anterior-only fixation (AF), and combined anterior-posterior fixation (APF) models. A pure moment with a compressive follower load was applied, and range of motion, annular/nucleus stress, instrument stress, and facet forces were analyzed.ResultsIn all motion except for flexion, range of motion of PF, AF, and APF models decreased by 80%-95%, 85%-93%, and 97%-99% compared with the intact model. C3-C4 annulus stress of PF, AF, and APF models decreased by 28%-72%, 96%-100%, and 99%-100% compared with the intact model. Facet contact forces of PF, AF, and APF models decreased by 77%-79%, 97%-99%, and 77%-86% at C3-C4 compared with the intact model. Screw stress in the PF model was higher than in the APF model, and plate stress in the AF model was lower than in the APF model, but bone graft stress in the AF model was higher than in the APF model.ConclusionsCervical stabilization was preserved by the APF model. Regarding range of motion, the PF model had an advantage compared with the AF model except for flexion. An understanding of biomechanics provides useful information for the clinician.Copyright © 2022 Elsevier Inc. All rights reserved.

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