Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine--a finite element based study.
BACKGROUND
Studies delineating the adjacent level effect of single level disc replacement systems have been reported in literature. The aim of this study was to compare the adjacent level biomechanics of bi-level disc replacement, bi-level fusion and a construct having adjoining level disc replacement and fusion system.


METHODS
In total, biomechanics of four models- intact, bi level disc replacement, bi level fusion and fusion plus disc replacement at adjoining levels- was studied to gain insight into the effects of various instrumentation systems on cranial and caudal adjacent levels using finite element analysis (73.6N+varying moment).


RESULTS
The bi-level fusion models are more than twice as stiff as compared to the intact model during flexion-extension, lateral bending and axial rotation. Bi-level disc replacement model required moments lower than intact model (1.5Nm). Fusion plus disc replacement model required moment 10-25% more than intact model, except in extension. Adjacent level motions, facet loads and endplate stresses increased substantially in the bi-level fusion model. On the other hand, adjacent level motions, facet loads and endplate stresses were similar to intact for the bi-level disc replacement model. For the fusion plus disc replacement model, adjacent level motions, facet loads and endplate stresses were closer to intact model rather than the bi-level fusion model, except in extension.


CONCLUSIONS
Based on our finite element analysis, fusion plus disc replacement procedure has less severe biomechanical effects on adjacent levels when compared to bi-level fusion procedure. Bi-level disc replacement procedure did not have any adverse mechanical effects on adjacent levels.
Engineering Center for Orthopaedic Research Excellence (E-CORE), University of Toledo, Toledo, OH 43606, USA.
Ahmad
A
Faizan
Vijay K
VK
Goel
Ashok
A
Biyani
Steven R
SR
Garfin
Christopher M
CM
Bono
D002574:Cervical Vertebrae / Q000503:physiopathology* / Q000601:surgery; D003131:Combined Modality Therapy; D019245:Compressive Strength; D003198:Computer Simulation; D020342:Finite Element Analysis; D006801:Humans; D007403:Intervertebral Disc / Q000503:physiopathology* / Q000601:surgery; D055959:Intervertebral Disc Degeneration / Q000503:physiopathology* / Q000601:surgery*; D008954:Models, Biological; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D013123:Spinal Fusion / Q000379:methods*