Biomechanical effect of anterior cervical spine fusion on adjacent segments

The biomechanical effects of superior (C4-C5) and inferior (C5-C6) level fusions with different graft materials on the adjacent unaltered components were quantified using an anatomically accurate and experimentally validated C4-C5-C6 finite element model. Smith-Robinson and Bailey-Badgley fusion procedures were analyzed with five different types of inter-body fusion materials with varying stiffnesses. Intact and surgically altered finite element models were subjected to physiologic compression, flexion, extension and lateral bending. The external axial and angular stiffness, and the internal unaltered intervertebral disc (C5-C6 for the superior and C4-C5 for inferior fusion) and C5 vertebral body stresses were determined. The superior level fusion resulted in the highest increase in external response in lateral bending for all implant materials in both surgical procedures. In contrast, the inferior level fusion produced a higher increase in the C4-C5 disc and C5 vertebral body stresses in compression than the superior level fusion in both surgical procedures. The increased internal stress responses reflecting the changes in the load-sharing following inferior level fusion may explain clinical observations such as enhanced degeneration subsequent to surgery. Because of the inclusion of three levels in the present multi-segment finite element model, it was possible to determine these responses in the unaltered adjacent components of the cervical spine.