A Finite Element Analysis of Anterior Cervical Discectomy and Fusion Compared with Percutaneous Full-endoscopic Anterior Cervical Discectomy

Percutaneous full-endoscopic anterior cervical discectomy (PEACD) is an effective treatment for cervical spondylosis radiculopathy (CSR).However, the biomechanical effects of PEACD on the range of motion (ROM) and intrasical pressure (IDP) of adjacent segments remain unclear. The aim of this study was to analyze the biomechanical changes after PECAD and compare them with anterior cervical decompression and fusion (ACDF), in order to provide a basis for surgeons to choose more appropriate surgical methods. An intact neck C4-C7 digital model was constructed and then modified to obtain a PEACD, ACDF finite element model. All models were subjected to the same load conditions during flexion, extension, axial rotation, and lateral bending. The ROM and IDP of the surgical segment and adjacent segments were calculated under different motion conditions. At the time of flexion, the C56 segment ROM of ACDF decreased by 70.3% compared with the intact model, and the C45 and C67 segments increased by 25.6% and 52.6%, respectively. In PEACD, the C45 segment increased by 25.6%, while the C45 and C67 segments decreased by 12.2% and 12.6%, respectively. ACDF surgery can cause hypermobility in adjacent segments, which was likely to be one of the factors affecting the increase of IDP in adjacent segments. The effect of PEACD surgery on adjacent segment ROM and IDP was much smaller than that of ACDF. That is to say, it can be closer to the physiological state of the normal cervical vertebra after PEACD. Therefore, PEACD may be a better way to treat CSR than ACDF.