Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study.

Background: The development of adjacent segment degeneration (ASD) following ACDF is well established. There is no analytical study related to effects of plate profile on the biomechanics of the adjacent-level after ACDF. This study aimed to test the effects of plate profile on the adjacent-level biomechanics after single-level anterior cervical discectomy and fusion (ACDF).

Methods: A three-dimensional finite element model (FEM) of an intact C2-T1 segment was built and validated. From this intact model, two instrumentation models were constructed with the anchored zero-profile spacer or the standard plate-interbody spacer after a C5-C6 corpectomy and fusion. Motion patterns, the stresses in the disc, the endplate, and the facet joint at the levels cephalad and caudal to the fusion were assessed.

Results: Compared with the normal condition, the biomechanical responses in the adjacent levels were increased after fusion. Relative to the intact model, the average increase of range of motion (ROM) and stresses in the endplate, the disc, and the facet of the zero-profile spacer fusion model were slightly lower than that of the standard plate-interbody spacer fusion model. The kinematics ROM and stress variations above fusion segment were larger than that below. The biomechanical features of the adjacent segment after fusion were most affected during extension.

Conclusions: The FE analysis indicated that plate profile may have an impact on the biomechanics of the adjacent-level after a single-level ACDF. The impact may be long-term and cumulative. The current findings may help explain the decreasing incidence of ASD complications in the patients using zero-profile spacer compared with the patients using cage and plate construct.