背景:退行性颈椎病(DCM)是由脊柱退行性改变引起的慢性机械负荷引起的慢动作脊髓损伤。可以发生一系列不同的退行性变化。有限元分析(FEA)可以预测脊髓上机械应力和应变的分布,以帮助理解任何机械载荷的含义。FEA的关键假设之一是每个解剖元素在负载下的行为(即,其材料属性)。
目的:本范围审查旨在进行一个结构化的过程,以选择最合适的材料特性用于DCMFEA。在这样做的时候,它还概述了脊髓疾病的现有建模方法以及对DCM的临床见解。
方法:我们使用定性综合进行了范围审查。讨论在健康或疾病(包括DCM)中使用涉及脊髓的FEA模型的观察性研究符合纳入审查的条件。我们遵循PRISMA-ScR(系统审查的首选报告项目和范围审查的Meta分析扩展)指南。搜索MEDLINE和Embase数据库至2021年9月1日。这补充了引文搜索,以检索用于定义材料属性的文献。进行重复标题和摘要筛选以及数据提取。使用我们开发的质量评估工具对证据质量进行评估,改编自纽卡斯尔-渥太华量表,并在DCM材料特性方面入围,并提供了最终建议。根据“无荟萃分析综合报告指南”对文献进行了定性综合。
结果:共包括60篇论文:41篇(68%)“FEA文章”和19篇(32%)“源文章。“大多数FEA文章(33/41,80%)分别对灰质和白质进行建模,对于通常基于表格数据的模型,不那么频繁,超弹性Ogden变体或线性弹性函数。在19篇来源文章中,14(74%)被确定为描述脊髓的材料特性,其中3(21%)被认为与DCM最相关。在41篇FEA文章中,15(37%)专注于DCM,其中9例(60%)集中在后纵韧带骨化上。我们对DCMFEA的汇总结果表明,脊髓负荷受退行性变化模式的影响,单独减压(例如,椎板切除术)足以解决这个问题,而不是减压结合其他手术(例如,椎板切除术和融合)。
结论:FEA是探索DCM病理生物学和临床护理的一种有前途的技术。这篇综述描述了一种结构化的方法,以帮助未来的研究人员为DCM部署FEA。然而,这些建议有局限性和更广泛的不确定性。很可能需要克服这些问题,以支持将FEA临床转化为DCM。
BACKGROUND: Degenerative cervical myelopathy (DCM) is a slow-motion spinal cord injury caused via chronic mechanical loading by spinal degenerative changes. A range of different degenerative changes can occur. Finite element analysis (FEA) can predict the distribution of mechanical stress and strain on the spinal cord to help understand the implications of any mechanical loading. One of the critical assumptions for FEA is the behavior of each anatomical element under loading (ie, its material properties).
OBJECTIVE: This scoping
review aims to undertake a structured process to select the most appropriate material properties for use in DCM FEA. In doing so, it also provides an overview of existing modeling approaches in spinal cord disease and clinical insights into DCM.
METHODS: We conducted a scoping
review using qualitative synthesis. Observational studies that discussed the use of FEA models involving the spinal cord in either health or disease (including DCM) were eligible for inclusion in the
review. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The MEDLINE and Embase databases were searched to September 1, 2021. This was supplemented with citation searching to retrieve the literature used to define material properties. Duplicate title and abstract screening and data extraction were performed. The quality of evidence was appraised using the quality assessment tool we developed, adapted from the Newcastle-Ottawa Scale, and shortlisted with respect to DCM material properties, with a final recommendation provided. A qualitative synthesis of the literature is presented according to the Synthesis Without Meta-Analysis reporting guidelines.
RESULTS: A total of 60 papers were included: 41 (68%) \"FEA articles\" and 19 (32%) \"source articles.\" Most FEA articles (33/41, 80%) modeled the gray matter and white matter separately, with models typically based on tabulated data or, less frequently, a hyperelastic Ogden variant or linear elastic function. Of the 19 source articles, 14 (74%) were identified as describing the material properties of the spinal cord, of which 3 (21%) were considered most relevant to DCM. Of the 41 FEA articles, 15 (37%) focused on DCM, of which 9 (60%) focused on ossification of the posterior longitudinal ligament. Our aggregated results of DCM FEA indicate that spinal cord loading is influenced by the pattern of degenerative changes, with decompression alone (eg, laminectomy) sufficient to address this as opposed to decompression combined with other procedures (eg, laminectomy and fusion).
CONCLUSIONS: FEA is a promising technique for exploring the pathobiology of DCM and informing clinical care. This
review describes a structured approach to help future investigators deploy FEA for DCM. However, there are limitations to these recommendations and wider uncertainties. It is likely that these will need to be overcome to support the clinical translation of FEA to DCM.