{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:12:25Z","timestamp":1784286745155,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,23]],"date-time":"2025-02-23T00:00:00Z","timestamp":1740268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82302785"],"award-info":[{"award-number":["82302785"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The principle of selecting a Zero\u2010P implant of an appropriate height remains a topic of debate, particularly when similarly sized implants seem to appropriately fit the intervertebral space. Thus, this study compared the biomechanical performance of smaller and larger Zero\u2010P implants within an appropriate height range with that of oversized Zero\u2010P implants for anterior cervical discectomy and fusion (ACDF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A three\u2010dimensional finite element (FE) model of the C2\u2013C7 cervical spine was constructed and validated. The implants were categorized as smaller (6\u2009mm), larger (7\u2009mm), and oversized (8\u2009mm) according to the average intervertebral height and implant specifications. Thus, the following four FE models were constructed: the intact cervical spine model (M1), the 6\u2009mm model (M2), the 7\u2009mm model (M3), and the 8\u2009mm (M4) Zero\u2010P implant C5\/6 segment ACDF surgical model. Then, a pure moment of 1.0\u2009N\u00b7m combined with a follower load of 75\u2009N was applied at C2 to simulate flexion, extension, lateral bending, and axial rotation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results indicated that the maximum stress on the vertebral body, intervertebral disc, and facet joints under self\u2010weight increased with increasing Zero\u2010P height. Under six different loading conditions, the maximum stress on the vertebral body in the surgical segment of the M4 model was generally greater than that in the M2 and M3 models. Following an increase in the height of the implant from 6\u2009mm to 8\u2009mm, the maximum stress increased, and the intervertebral disc stress of both segments reached its peak in the M4 model. In the M4 model, the implant experienced the highest stress, whereas the M2 model exhibited the lowest stress on the implant under both self\u2010weight and loading conditions. Furthermore, the stress on the posterior facet joints of the surgical segment increased with increasing Zero\u2010P height. The range of maximum stress on the posterior facet joints for the M3 model was situated between that of the M2 and M4 models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In summary, after determining the appropriate height range for the implant in accordance with the mean height of the intervertebral space, opting for a larger size appears to be more advantageous. This approach helps maintain the height of the intervertebral space and provides greater stress, promoting a tighter fit between the upper and lower endplates and the Zero\u2010P. This tighter fit is crucial for maintaining spinal stability, enhancing the early bony fusion rate, and potentially leading to better postoperative outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14374","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T21:26:51Z","timestamp":1741382811000},"page":"1172-1180","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical Effects of Zero\u2010P Height on Anterior Cervical Discectomy and Fusion: A Finite Element Study"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-816X","authenticated-orcid":false,"given":"Cheng\u2010yi","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010bo","family":"He","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7309-0041","authenticated-orcid":false,"given":"Xing\u2010Jin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting\u2010kui","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8755-1427","authenticated-orcid":false,"given":"Bei\u2010yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pain Treatment Tianjin Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002273"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.11.002"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2020.06.010"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-015-0546-x"},{"issue":"15","key":"e_1_2_12_6_1","first-page":"1168","article-title":"Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery: A Prospective Randomized Controlled Trial","volume":"105","author":"Sheng X. Q.","year":"2023","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002441"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-020-06561-x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2020.103760"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-020-10197-w"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000768"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31818ff9c4"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318154c57e"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.08.128"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-022-02940-w"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02421-6"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003209"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2023.1217274"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.14125"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2017.07.009"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2019.02.004"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2022.842382"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2020.05.102"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198805000-00001"},{"issue":"1","key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1227\/01.NEU.0000215430.86569.C4","article-title":"Cervical Spondylosis Anatomy: Pathophysiology and Biomechanics","volume":"60","author":"Shedid D.","year":"2007","journal-title":"Neurosurgery"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2003558"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2011.11.043"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2017.06.061"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.916629"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-020-02157-9"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2020.0635"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2021.0131"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2013.53.5.288"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2022.03.044"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.14322"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200211150-00005"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000160"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000843"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1757-7861.2011.00132.x"},{"key":"e_1_2_12_40_1","first-page":"245","article-title":"A Study of Weight Transmission Through the Cervical and Upper Thoracic Regions of the Vertebral Column in Man","volume":"148","author":"Pal G. P.","year":"1986","journal-title":"Journal of Anatomy"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2022.03.005"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.14374","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T07:00:57Z","timestamp":1743750057000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.14374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,23]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/os.14374"],"URL":"https:\/\/doi.org\/10.1111\/os.14374","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,23]]},"assertion":[{"value":"2024-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}