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Abstract：
OBJECTIVE: The purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint.
METHODS: A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery.
RESULTS: The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments.
CONCLUSIONS: Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.
METHODS: A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery.
RESULTS: The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments.
CONCLUSIONS: Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.
摘要：
目的：本研究的目的是从生物力学的角度探讨前路经皮经皮内窥镜颈椎间盘切除术（ATc-PECD）对颈椎的长期影响。
方法：使用有限元方法建立了正常颈椎C2-T1的三维模型。随后，在正常模型的基础上构建椎间盘退变模型和手术退变模型。相同的加载条件用于模拟屈曲，扩展,颈椎的侧向弯曲和轴向旋转。我们计算了颈椎活动范围（ROM），椎间盘内压,不同运动下的椎体内压，观察颈椎术后生物力学的变化。同时,我们结合了ATc-PECD的长期随访结果，并使用成像方法测量椎骨和椎间盘的高度以及颈椎的活动度，使用日本骨科协会(JOA)评分和视觉模拟量表(VAS)评分评估疼痛缓解和神经功能恢复.
结果：长期随访结果显示，术前JOA评分，颈部VAS评分,手VAS评分,IDH,VBH,患者的ROM分别为9.49±2.16、6.34±1.68、5.14±1.48、5.95±0.22mm，15.41±1.68mm,和52.46±9.36°。变化为15.71±1.13(P<0.05),1.02±0.82(P<0.05),0.77±0.76(P<0.05),4.73±0.26mm(P<0.05),13.67±1.48mm(P<0.05),59.26±6.72°(P<0.05),分别,术后6年。有限元分析表明,建立颈椎病模型后,屈曲的整体运动范围，扩展,横向弯曲,旋转减少了3.298°，0.753°,3.852°,和1.131°。相反，建立骨隧道模型后，这些动作的运动范围增加了0.843°，0.65°,0.278°,和0.488°，与随访结果一致。此外，节段运动变化的分析表明，颈椎活动度的增加主要是由手术模型节段造成的。此外,有限元模型表明，骨隧道可能导致椎体和椎间盘内的应力增加手术段。
结论：长期随访研究表明ATc-PECD具有良好的临床疗效，ATc-PECD可作为CDH治疗的补充方法。FEM表明，ATc-PECD可导致手术节段椎体和椎间盘内应力增加，与ATc-PECD术后颈椎退变直接相关。
方法：使用有限元方法建立了正常颈椎C2-T1的三维模型。随后，在正常模型的基础上构建椎间盘退变模型和手术退变模型。相同的加载条件用于模拟屈曲，扩展,颈椎的侧向弯曲和轴向旋转。我们计算了颈椎活动范围（ROM），椎间盘内压,不同运动下的椎体内压，观察颈椎术后生物力学的变化。同时,我们结合了ATc-PECD的长期随访结果，并使用成像方法测量椎骨和椎间盘的高度以及颈椎的活动度，使用日本骨科协会(JOA)评分和视觉模拟量表(VAS)评分评估疼痛缓解和神经功能恢复.
结果：长期随访结果显示，术前JOA评分，颈部VAS评分,手VAS评分,IDH,VBH,患者的ROM分别为9.49±2.16、6.34±1.68、5.14±1.48、5.95±0.22mm，15.41±1.68mm,和52.46±9.36°。变化为15.71±1.13(P<0.05),1.02±0.82(P<0.05),0.77±0.76(P<0.05),4.73±0.26mm(P<0.05),13.67±1.48mm(P<0.05),59.26±6.72°(P<0.05),分别,术后6年。有限元分析表明,建立颈椎病模型后,屈曲的整体运动范围，扩展,横向弯曲,旋转减少了3.298°，0.753°,3.852°,和1.131°。相反，建立骨隧道模型后，这些动作的运动范围增加了0.843°，0.65°,0.278°,和0.488°，与随访结果一致。此外，节段运动变化的分析表明，颈椎活动度的增加主要是由手术模型节段造成的。此外,有限元模型表明，骨隧道可能导致椎体和椎间盘内的应力增加手术段。
结论：长期随访研究表明ATc-PECD具有良好的临床疗效，ATc-PECD可作为CDH治疗的补充方法。FEM表明，ATc-PECD可导致手术节段椎体和椎间盘内应力增加，与ATc-PECD术后颈椎退变直接相关。
