Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration

doi:10.1016/j.compbiomed.2019.103519

Computers in Biology and Medicine

Volume 116, January 2020, 103519

https://doi.org/10.1016/j.compbiomed.2019.103519 Get rights and content

Highlights

•
In this study, six degenerative cervical finite element models were developed based on clinical statistics data.
•
The structures and tissue properties of the cervical disc were modified to more accurately simulate disc degeneration.
•
These degenerative models represent the majority of clinical cases and provide certain guidance for clinical treatment.

Abstract

Background

Understanding the biomechanical effects of cervical disc degeneration (CDD) on the cervical spine is fundamental for understanding the mechanisms of spinal disorders and improving clinical treatment. While the biomechanical effects of CDD on segmental flexibility and the posterior facets have been reported, a clear understanding of the effect of the motion loading method on facet joint forces after CDD is still lacking. Therefore, the objective of this study was to determine the effect of the motion loading method on facet joint forces after CDD.

Methods

A three-dimensional nonlinear finite element (FE) model of the cervical spine (C3–C7) was developed and validated to represent normal conditions. This normal model was modified to create six degenerative models simulating mild, moderate, and severe grades of disc degeneration at C5–C6. While under a follower compressive preload (73.6 N), a 1-Nm moment was applied to all models to determine range of motion (ROM). A displacement load was applied to all degenerative models under the same follower load, making the C5–C6 degeneration segment motion same to the ROM of C5–C6 in normal model, and facet joint forces were computed.

Results

Compared with the normal model, ROM of the C5–C6 degenerative segments dramatically declined in all postures with increasing degenerative pathologies in the disc. The ROM in the adjacent normal segments of the degenerative segments also declined, with the exception of C4–C5 during extension. Under a 1-Nm moment load, there were not obvious changes in facet joint forces in the C5–C6 degenerative segment with increasing grades of degeneration, but facet joint forces in the adjacent normal segments did increase. Under a displacement load, the facet joint forces of the C5–C6 degenerative segment increased with increasing grades of degeneration.

Conclusions

Facet joint forces were positively correlated with the ROM of the degenerative segment, demonstrating that the motion loading method had a significant effect on facet joint forces after CDD. Loading conditions must be strictly controlled in future finite element analysis studies to improve the comparability between models built by different units.

Section snippets

Introductions

Degenerative changes in the cervical disc and facet joints are common sources of neck pain [1,2]. Cervical disc degeneration (CDD) is caused by multiple factors, and CDD can lead to degeneration of the posterior facet joint [3,4]. After CDD, mechanical load sharing between the disc and posterior elements is altered, causing increased loading of the facet joints, which can cause pain both in the degenerative segment and its adjacent segments [[5], [6], [7]]. In addition, previous research has

Development of normal cervical spine model

A three-dimensional nonlinear FE model of a normal C3–C7 segment was created using a computed tomographic (CT) scan of a 30-year-old healthy male subject (Fig. 1). The detailed steps for building a normal FE model were obtained from previous research [22,36]. Briefly, the geometric information of the cervical spine (C3–C7) segment was obtained using a computed tomography scan. The CT data was imported into medical image control software (Mimics 10.0; Materialise Technologies, Leuven, Belgium)

Calibration and validation

Calibration processes are presented in Fig. 5(a–c) and validation results are presented in Fig. 6a-c and Fig. 7. Fig. 7 shows a comparison between the range of motion of the normal model and previous specimen experimental data [[53], [54], [55], [56], [57]]. The ROM of the normal model in six directions was within the standard deviations of previous experimental results; a slightly lower ROM was observed only in lateral bending of the C3–C4 segment. The models were therefore considered to be

Discussions

This study used a validated three-dimensional nonlinear FE model of a normal C3–C7 segment to simulate mild, moderate, and severe degeneration in the C5–C6 disc. Using these models, we calculated the ROM and facet joint forces in the C5–C6 segment and its adjacent normal segments. Finally, the effect of the motion loading method on facet joint forces after CDD was evaluated using the FE models.

Moment loads [25,26,30,31,39] and displacement loads [8,36,37,42] are both very common loading methods

Conclusions

In summary, we compared facet joint forces following CDD by applying a moment load and a displacement load. We found that the motion loading method had a significant effect on facet joint forces after CDD. Specifically, when the ROM of the degenerative segment was limited, facet joint forces did not significantly increase with progressing CDD. When the ROM of the degenerative segment was larger, facet joint forces increased significantly with increasing grades of CDD. Therefore, facet joint

Ethics approval and consent to participate

Patients with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) between January 2012 and December 2018 were enrolled in this study. All patients were from department of Orthopaedic Surgery, Beijing TianTan Hospital, Capital Medical University, China. All patients provided informed consent to allow their information to be used for research purposes.

Declaration of competing interest

The authors declare that they have no conflict of interest.

Acknowledgement

Financial support for this work was provided by the National Natural Science Foundation of China (NSFC No. 11432016, No. 11602172, No. 11702191, No. 81972084, and No. 81772370).

Financial support for this work was provided by the Beijing Natural Science Foundation (Grant No. 7162058).

<au id="1"/> Xin-Yi Cai currently studying at Tianjin University of Technology. My graduate tutor is a knowledgeable scholar. With the guidance and help of the teacher, I have the ability to complete scientific papers.

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¹: These authors contributed equally.

View full text

Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Introductions

Development of normal cervical spine model

Calibration and validation

Discussions

Conclusions

Ethics approval and consent to participate

Declaration of competing interest

Acknowledgement

J. Orthop. Res.

Eur. J. Radiol.

J. Orthop. Sci.

Spine J.

Med. Eng. Phys.

World Neurosurg.

Spine J.

Clin. Biomech.

Med. Eng. Phys.

J. Biomech.

Med. Eng. Phys.

Spine J.

J. Biomech.

The pathogenesis of cervical spondylosis

Clin. Orthop. Relat. Res.

Degenerative disc disease of the cervical spine: a comparative study of asymptomatic and symptomatic patients

J. Bone Jt. Surg.

Discs degenerate before facets

Spine

Lumbar segmental mobility according to the grade of the disc, the facet joint, the muscle, and the ligament pathology by using kinetic magnetic resonance imaging

Spine

Mechanism of facet load transmission as a hypothesis for low-back pain

Spine

Intrinsic disc pressure as a measure of integrity of the lumbar spine

Spine

Discography: can pain in a morphologically normal disc be due to an adjacent abnormal disc?

Arch. Orthop. Trauma Surg.

The relationship between disc degeneration and morphologic changes in the intervertebral foramen of the cervical spine: a cadaveric MRI and CT study

J. Korean Med. Sci.

Lumbar disc degeneration and sagittal flexibility

J. Spinal Disord.

The influence of age and gender on lumbar spine sagittal plane range of motion. A study of 1126 healthy subjects

Spine

The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine

Spine

Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates

Spine

Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine

Surg. Radiol. Anat.

The internal mechanical properties of cervical intervertebral discs as revealed by stress profilometry

Eur. Spine J.

Peak stresses observed in the posterior lateral anulus

Spine

A study of weight transmission through the cervical and upper thoracic regions of the vertebral column in man

J. Anat.

The vertical stability of the cervical spine

Spine

The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading

Spine

Biomechanical response of lumbar facet joints under follower preload: a finite element study

BMC Muscoskelet. Disord.

Influence of cervical disc degeneration after posterior surgical techniques in combined flexion-extension—a nonlinear analytical study

J. Biomech. Eng.

Kinematic study of the relation between the instantaneous center of rotation and degenerative changes in the cervical intervertebral disc

Eur. Spine J.

Biomechanics following skip-level cervical disc arthroplasty versus skip-level cervical discectomy and fusion: a finite element-based study

BMC Muscoskelet. Disord.