BIOMECHANICAL STABILITY OF THE CERVICAL SPINE AFTER UNCINATE PROCESS RESECTION: A FINITE ELEMENT ANALYSIS

Abstract

When performing anterolateral foraminotomy for the treatment of cervical spondylotic radiculopathy, the extent of uncinate process resection affects the stability of the cervical spine. The aim of this study was to determine the stability of the cervical spine after resection of various amounts of the uncinate process. Based on computed tomography (CT) scans of an adult male volunteer, a three-dimensional geometric model of the cervical spine (C4-C6) was established using Mimics 13.1, SolidWorks 2012, and ANSYS 15.0 software packages. Next, the mechanical parameters of the tissues were assigned according to their different material characteristics. Using the tetrahedral mesh method, a three-dimensional finite element model of the cervical spine was then established. In modeling uncinated process resection, two excision protocols were compared. The first excision protocol, protocol A, mimicked the extent of resection used in current clinical surgical practice. The second excision protocol, protocol B, employed an optimal resection extent as predicted by the finite element model. Protocols A and B were then used to resect the left uncinate process of the C5 vertebra to either 50% or 60% of the total height of the uncinate process. The stability of the cervical spine was assessed by evaluating values of deformation and maximum equivalent stress during extension, flexion, lateral bending, and rotation. After protocol A resection, the total deformation was increased as was the maximum equivalent stress during left and right rotation. After protocol B resection, the total deformation was little changed and the maximum equivalent stress was visibly decreased during left and right rotation. As evidenced by these results, protocol B resection had relatively little effect on the stability of the cervical spine, suggesting that resection utilizing the limits proposed in protocol B appears to better maintain the stability of the cervical spine when compared with current clinical surgical practice as replicated in protocol A.