Motion Changes in Adjacent Segments due to Moderate and Severe Degeneration in C5–C6 Disc: A Poroelastic C3–T1 Finite Element Model Study

Study Design. Biomechanics of normal vertebral segments adjacent to a degenerated segment in the cervical spine. Objective. To test the hypothesis of higher motion changes in the segment immediately inferior to a degenerated segment. Summary of Background Data. Past research has shown how disc degeneration (DD) affects adjacent segments; however, these studies are conducted only on the lumbar spine or the experimental protocols used are characterized by the presence of degeneration in adjacent segments. The question arises as to how much of the degenerative effect in a particular segment is internal to degeneration at that segment and how much is caused by degeneration at adjacent segments. It would be clinically relevant to analyze biomechanical changes in adjacent segments in the cervical spine by considering DD at only one segment, where adjacent segments remain normal. Methods. A poroelastic, 3-dimensional finite element model of a normal C3–T1 segment was validated and then used for the degenerative study. Two additional C3–T1 models were developed with moderate and severe degenerative C5–C6 disc grades. Disc geometry and tissue material properties were modified to simulate C5–C6 DD. Intersegmental rotational motions (C4–C5, C5–C6, and C6–C7) for the 3 C3–T1 models were computed under moment loads. Results. With progressive C5–C6 DD, motion decreased at that segment. At adjacent segments, higher motion changes were observed mainly in flexion/extension. Inferior C6–C7 motion changes were higher than superior C4–C5 motion changes. The inferior C6–C7 motion was affected even when C5–C6 DD was moderate, and it was further affected by severe C5–C6 DD. The superior C4–C7 motion, however, was mostly affected by severe C5–C6 DD. Conclusion. The hypothesis of higher motion changes in the normal C6–C7 segment immediately inferior to a degenerated C5–C6 segment was found to be true. Future experiments on multisegmental cervical spines are recommended to verify the current data.

[1]  D. Grob,et al.  Clinical Validation of Functional Flexion/Extension Radiographs of the Cervical Spine , 1993, Spine.

[2]  A. Vasavada,et al.  Head and neck anthropometry, vertebral geometry and neck strength in height-matched men and women. , 2008, Journal of biomechanics.

[3]  F. Su,et al.  Lumbosacral kinematics in the sagittal plane: a radiographic study in vivo. , 1993, Journal of the Formosan Medical Association = Taiwan yi zhi.

[4]  A Ratcliffe,et al.  Compressive mechanical properties of the human anulus fibrosus and their relationship to biochemical composition. , 1994, Spine.

[5]  F. Eulderink,et al.  Degenerative changes in the cervical spine and their relationship to its mobility , 1980, The Journal of pathology.

[6]  A. Patwardhan,et al.  Load-Carrying Capacity of the Human Cervical Spine in Compression Is Increased Under a Follower Load , 2000, Spine.

[7]  John W. Emerson,et al.  Quantifying the Effects of Age, Gender, Degeneration, and Adjacent Level Degeneration on Cervical Spine Range of Motion Using Multivariate Analyses , 2008, Spine.

[8]  N Yoganandan,et al.  Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  L Penning,et al.  Rotation of the Cervical Spine: A CT Study in Normal Subjects , 1987, Spine.

[10]  Andrew Holmes,et al.  The Range and Nature of Flexion‐Extension Motion in the Cervical Spine , 1994, Spine.

[11]  A. Nordwall,et al.  Normal range of motion of the cervical spine. , 1989, Archives of physical medicine and rehabilitation.

[12]  J. Dvorak,et al.  In vivo flexion/extension of the normal cervical spine , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  J. Edeiken,et al.  Degenerative changes in the cervical spine. , 1959, The Journal of bone and joint surgery. American volume.

[14]  Manohar M. Panjabi,et al.  A Method to Simulate In Vivo Cervical Spine Kinematics Using In Vitro Compressive Preload , 2002, Spine.

[15]  K. Schellhas,et al.  Discography: can pain in a morphologically normal disc be due to an adjacent abnormal disc? , 2007, Archives of Orthopaedic and Trauma Surgery.

[16]  M M Panjabi,et al.  Cervical Human Vertebrae Quantitative Three‐Dimensional Anatomy of the Middle and Lower Regions , 1991, Spine.

[17]  L. Dai,et al.  Disc Degeneration and Cervical Instability: Correlation of Magnetic Resonance Imaging With Radiography , 1998, Spine.

[18]  T. Tamaki,et al.  Three-dimensional motion analysis of the upper cervical spine during axial rotation. , 1993, Spine.

[19]  M Nissan,et al.  The cervical and lumbar vertebrae--an anthropometric model. , 1984, Engineering in medicine.

[20]  D. M. Marchiori,et al.  A Cross‐Sectional Study Correlating Cervical Radiographic Degenerative Findings to Pain and Disability , 1996, Spine.

[21]  Masashi Miyazaki,et al.  Kinematic Analysis of the Relationship Between the Grade of Disc Degeneration and Motion Unit of the Cervical Spine , 2008, Spine.

[22]  Michael A. Adams,et al.  'Stress' distributions inside intervertebral discs , 1996 .

[23]  E. Teo,et al.  Evaluation of the role of ligaments, facets and disc nucleus in lower cervical spine under compression and sagittal moments using finite element method. , 2001, Medical engineering & physics.

[24]  N. Ordway,et al.  Peak Stresses Observed in the Posterior Lateral Anulus , 2001, Spine.

[25]  F. Eulderink,et al.  Mobility and degenerative changes of the ageing cervical spine. A macroscopic and statistical study. , 1981, Gerontology.

[26]  M. Hamada,et al.  Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. , 1987, Clinical orthopaedics and related research.

[27]  M. Adams,et al.  The internal mechanical properties of cervical intervertebral discs as revealed by stress profilometry , 2007, European Spine Journal.

[28]  V. Goel,et al.  Prediction of Load Sharing Among Spinal Components of a C5‐C6 Motion Segment Using the Finite Element Approach , 1998, Spine.

[29]  Y. Yamada,et al.  Analysis of head movements coupled with trunk drift in healthy subjects , 2006, Medical and Biological Engineering and Computing.

[30]  V C Mow,et al.  Degeneration affects the anisotropic and nonlinear behaviors of human anulus fibrosus in compression. , 1998, Journal of biomechanics.

[31]  G. Andersson,et al.  Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments--a finite element model study. , 2009, Journal of biomechanics.

[32]  J. Bendo,et al.  Adjacent segment degeneration following spinal fusion for degenerative disc disease. , 2007, Bulletin of the NYU hospital for joint diseases.

[33]  Jiri Dvorak,et al.  On the Understanding of Clinical Instability , 1994, Spine.

[34]  H. Jäger,et al.  Degenerative change in the cervical spine and load-carrying on the head , 1997, Skeletal Radiology.

[35]  G B Andersson,et al.  The influence of lumbar disc height and cross-sectional area on the mechanical response of the disc to physiologic loading. , 1999, Spine.

[36]  R. Dhingsa,et al.  Magnetic resonance imaging of the cervical spine: frequency of degenerative changes in the intervertebral disc with relation to age. , 2003, Clinical radiology.

[37]  Y. Morimoto,et al.  Intraoperative Measurement of Lumbar Spinal Instability , 1992, Spine.

[38]  J. P. Thompson,et al.  Preliminary Evaluation of a Scheme for Grading the Gross Morphology of the Human Intervertebral Disc , 1990, Spine.

[39]  N Bogduk,et al.  The ligaments and annulus fibrosus of human adult cervical intervertebral discs. , 1999, Spine.

[40]  Hideki Yoshikawa,et al.  Kinematics of the Cervical Spine in Lateral Bending: In Vivo Three-Dimensional Analysis , 2006, Spine.

[41]  V C Mow,et al.  Alterations in the mechanical behavior of the human lumbar nucleus pulposus with degeneration and aging , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[42]  L. Martí-Bonmatí,et al.  Upper thoracic-spine disc degeneration in patients with cervical pain , 2003, Skeletal Radiology.

[43]  Yoshinobu Sato,et al.  Kinematics of the Upper Cervical Spine in Rotation: In Vivo Three-Dimensional Analysis , 2004, Spine.

[44]  S M McGill,et al.  Passive stiffness of the human neck in flexion, extension, and lateral bending. , 1994, Clinical biomechanics.

[45]  A Shirazi-Adl,et al.  Poroelastic creep response analysis of a lumbar motion segment in compression. , 1996, Journal of biomechanics.

[46]  M Kormano,et al.  Disc degeneration in magnetic resonance imaging. A comparative biochemical, histologic, and radiologic study in cadaver spines. , 1991, Spine.

[47]  Z. Friedenberg,et al.  DEGENERATIVE DISC DISEASE OF THE CERVICAL SPINE. , 1963, The Journal of bone and joint surgery. American volume.

[48]  T. Tamaki,et al.  Three-Dimensional Motion Analysis of the Cervical Spine with Special Reference to the Axial Rotation , 1989, Spine.

[49]  E. Lysell.  Motion in the cervical spine. An experimental study on autopsy specimens. , 1969, Acta orthopaedica Scandinavica.

[50]  L. Penning.  Normal movements of the cervical spine. , 1978, AJR. American journal of roentgenology.

[51]  N. Theodore,et al.  Adjacent level degeneration after anterior cervical fusion: a clinical review. , 2005, Neurosurgery clinics of North America.

[52]  D S McNally,et al.  'Stress' distributions inside intervertebral discs. The effects of age and degeneration. , 1996, The Journal of bone and joint surgery. British volume.

[53]  N Yoganandan,et al.  Finite element modeling approaches of human cervical spine facet joint capsule. , 1998, Journal of biomechanics.

[54]  V C Mow,et al.  The anisotropic hydraulic permeability of human lumbar anulus fibrosus. Influence of age, degeneration, direction, and water content. , 1999, Spine.

[55]  Van C. Mow,et al.  Is the Nucleus Pulposus a Solid or a Fluid? Mechanical Behaviors of the Nucleus Pulposus of the Human Intervertebral Disc , 1996, Spine.

[56]  M. Kaneko,et al.  High Cervical Disc Lesions in Elderly Patients – Presentation and Surgical Approach , 1999, Acta Neurochirurgica.

[57]  M. Nakamura,et al.  MRI of cervical intervertebral discs in asymptomatic subjects. , 1998, The Journal of bone and joint surgery. British volume.

[58]  J. Cusick,et al.  Morphology of young and old cervical spine intervertebral disc tissues. , 2000, Biomedical sciences instrumentation.

[59]  M M Panjabi,et al.  Functional Radiographic Diagnosis of the Cervical Spine: Flexion/Extension , 1988, Spine.

[60]  Phillip Pollintine,et al.  Strength of the Cervical Spine in Compression and Bending , 2005, Spine.

[61]  J. Pooni,et al.  Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine , 2006, Surgical and Radiologic Anatomy.