Estimation of Cervical Spinal Loading and Internal Motion at Adjacent Segments after C5-C6 Fusion Using a Musculoskeletal Multi-Body Dynamics Model during the Head Flexion-Extension Movement

Cervical spinal fusion is the standard of care for treating intractable spinal diseases. However, frequent adjacent segment disease (ASD) has recently drawn a great deal of attention among clinicians and researchers. At present, the etiology of ASD remains controversial. The investigation of cervical spine biomechanics after fusion may contribute to understanding the causes of ASD. In the present study, a cervical spinal musculoskeletal fusion model, with multi-body dynamics method, was established. Dynamic head flexion-extension movements were simulated for both a fusion subject and a normal subject. The cervical spinal loading pattern, load sharing ratios, and translations of instant centers of the rotation at adjacent segments were then predicted. The average intervertebral compressive forces, shear forces, and facet joint forces against the intervertebral angle were also obtained. By comparison, some obvious differences in cervical spinal loading patterns were found between the fusion subject and the normal subject. Fusion surgery would alter the postoperative biomechanical surrounding of the cervical spine, especially the adjacent segments. These changes might affect the intervertebral disc-bearing capacity, and even weaken the physiological structure. From a purely biomechanical perspective, the cervical spinal fusion model can contribute to comprehending the etiology of ASD after spinal fusion.