{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T03:36:46Z","timestamp":1776224206674,"version":"3.50.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31460245"],"award-info":[{"award-number":["31460245"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The quadrilateral anterior cervical plate (ACP) is used extensively in anterior cervical discectomy and fusion (ACDF) to reconstruct the stability of the cervical spine and prevent cage subsidence. However, there have been no comparison studies on the biomechanical performance of quadrilateral ACP and triangular ACP. The objective of this study is to investigate the functional outcomes of quadrilateral ACP and triangular ACP usage in ACDF surgery. In this study, a finite element model of intact C1-C7 segments was established and verified. Additionally, two implant systems were built; one using triangle anterior cervical plates (TACP) and another using quadrilateral orion anterior cervical plate (QACP). Both models were then compared in terms of their postoperative biomechanical performance, under normal and excessive motion. Compared to QACP, the peak stress of the TACP screws and plates occurred at 359.2 MPa and 97.2 MPa respectively and were the highest during over extension exercises. Alternately, compared to TACP, the endplate peak stress and the cage displacement of QACP were the largest at over extension, with values of 7.5 MPa and 1.2 mm, respectively. Finally, the average stress ratio of bone grafts in TACP was relatively high at 31.6%. In terms of biomechanical performance, TACP can share the load more flexibly and reduce the risks of cage subsidence and slippage but the screws have high peak stress value, thereby increasing the risk of screw slippage and fracture. This disadvantage must be considered when designing a TACP based implant for a potential patient.<\/jats:p>","DOI":"10.1371\/journal.pone.0250270","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T01:12:27Z","timestamp":1618535547000},"page":"e0250270","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of biomechanical performance of single-level triangular and quadrilateral profile anterior cervical plates"],"prefix":"10.1371","volume":"16","author":[{"given":"Fu","family":"Cao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-7597","authenticated-orcid":true,"given":"Rongchang","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenyuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"issue":"4","key":"pone.0250270.ref001","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1007\/s00586-017-4988-8","article-title":"Smith-Robinson procedure with and without Caspar plating as a treatment for cervical spondylotic myelopathy: A 26-year follow-up of 23 patients.","volume":"26","author":"BW Burkhardt","year":"2017","journal-title":"Eur Spine J"},{"issue":"3","key":"pone.0250270.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0174822","article-title":"Discover cervical disc arthroplasty versus anterior cervical discectomy and fusion in symptomatic cervical disc diseases: A meta-analysis.","volume":"12","author":"L Shangguan","year":"2017","journal-title":"PLoS One"},{"issue":"9","key":"pone.0250270.ref003","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1016\/j.spinee.2010.07.221","article-title":"Subsidence and Nonunion after Anterior Cervical Interbody Fusion with Stand-Alone Polyetheretherketone (PEEK) Cage.","volume":"10","author":"JJ Yang","year":"2010","journal-title":"The Spine J"},{"key":"pone.0250270.ref004","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jocn.2017.10.022","article-title":"Is standalone PEEK cage the gold standard in multilevel anterior cervical discectomy and fusion (ACDF)? Results of a minimum 1-year follow up.","volume":"47","author":"YS Kim","year":"2018","journal-title":"J Clin Neurosci"},{"key":"pone.0250270.ref005","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1097\/BRS.0b013e318154c57e","article-title":"Anterior Cervical Discectomy and Fusion Associated Complications.","volume":"32","author":"KN Fountas","year":"2007","journal-title":"Spine"},{"key":"pone.0250270.ref006","doi-asserted-by":"crossref","first-page":"100","DOI":"10.25259\/SNI-191-2019","article-title":"A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF).","volume":"10","author":"NE Epstein","year":"2019","journal-title":"Surg Neurol Int."},{"issue":"3","key":"pone.0250270.ref007","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1080\/02688697.2017.1418290","article-title":"A new multipartite plate system for anterior cervical spine surgery; finite element analysis.","volume":"32","author":"H \u015eim\u015fek","year":"2018","journal-title":"Brit J Neurosurg"},{"issue":"18","key":"pone.0250270.ref008","doi-asserted-by":"crossref","first-page":"E1061","DOI":"10.1097\/BRS.0000000000002643","article-title":"Stiffness Matters: Part I-The Effects of Plate Stiffness on the Biomechanics of ACDF In Vitro.","volume":"43","author":"JM Peterson","year":"2018","journal-title":"Spine (Phila Pa 1976)."},{"key":"pone.0250270.ref009","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.clinbiomech.2015.11.016","article-title":"Comparative studies of cervical spine anterior stabilization systems\u2014Finite element analysis.","volume":"32","author":"A Mackiewicz","year":"2016","journal-title":"Clin Biomech (Bristol, Avon)."},{"issue":"24","key":"pone.0250270.ref010","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1097\/00007632-199812150-00007","article-title":"Cervical spine models for biomechanical research.","volume":"23","author":"MM Panjabi","year":"1998","journal-title":"Spine (Phila Pa 1976)."},{"issue":"10","key":"pone.0250270.ref011","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S1350-4533(00)00002-3","article-title":"Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads.","volume":"21","author":"S Kumaresan","year":"1999","journal-title":"Med Eng Phys"},{"issue":"5","key":"pone.0250270.ref012","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.medengphy.2010.03.001","article-title":"Validation of a C2-C7 cervical spine finite element model using specimen-specific flexibility data.","volume":"32","author":"N Kallemeyn","year":"2010","journal-title":"Med Eng Phys."},{"issue":"Suppl 5","key":"pone.0250270.ref013","doi-asserted-by":"crossref","first-page":"S653","DOI":"10.1007\/s00586-009-1211-6","article-title":"Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation.","volume":"21","author":"A Faizan","year":"2012","journal-title":"Eur Spine J"},{"key":"pone.0250270.ref014","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1016\/j.wneu.2019.05.037","article-title":"Effects of New Cage Profiles on the Improvement in Biomechanical Performance of Multilevel Anterior Cervical Corpectomy and Fusion: A Finite Element Analysis.","volume":"129","author":"N Liu","year":"2019","journal-title":"World Neurosurg."},{"issue":"7","key":"pone.0250270.ref015","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/00007632-199904010-00002","article-title":"The ligaments and annulus fibrosus of human adult cervical intervertebral discs.","volume":"24","author":"S Mercer","year":"1999","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"pone.0250270.ref016","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s13246-013-0182-4","article-title":"Straightened cervical lordosis causes stress concentration: a finite element model study.","volume":"36","author":"W Wei","year":"2013","journal-title":"Phys Eng Sci Med"},{"issue":"6","key":"pone.0250270.ref017","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.spinee.2013.02.062","article-title":"Biomechanics of adjacent segments after a multilevel cervical corpectomy using anterior, posterior, and combined anterior-posterior instrumentation techniques: a finite element model study.","volume":"13","author":"M Hussain","year":"2013","journal-title":"The Spine J."},{"issue":"2","key":"pone.0250270.ref018","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s007010050275","article-title":"High cervical disc lesions in elderly patients\u2014presentation and surgical approach.","volume":"141","author":"S Nishizawa","year":"1999","journal-title":"Acta Neurochir"},{"issue":"8","key":"pone.0250270.ref019","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s002560050269","article-title":"Degenerative change in the cervical spine and load-carrying on the head.","volume":"26","author":"HJ J\u00e4ger","year":"1997","journal-title":"Skeletal radiol."},{"key":"pone.0250270.ref020","doi-asserted-by":"crossref","first-page":"105021","DOI":"10.1016\/j.clinbiomech.2020.105021","article-title":"Biomechanical comparison of the angle of inserted screws and the length of anterior cervical plate systems with allograft spacers.","volume":"76","author":"JW Kwon","year":"2020","journal-title":"Clin Biomech (Bristol, Avon)."},{"issue":"2","key":"pone.0250270.ref021","first-page":"226","volume":"12","author":"C-C Hsu","year":"2015","journal-title":"Biomechanical Comparison of Different Vertebral Plate Designs for Anterior Cervical Discectomy and Fusion Using Nonlinear C3-T2 Multi-Level Spinal Comput Aided Des Appl"},{"issue":"24","key":"pone.0250270.ref022","doi-asserted-by":"crossref","first-page":"2692","DOI":"10.1097\/00007632-200112150-00012","article-title":"Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves.","volume":"26","author":"MM Panjabi","year":"2001","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"pone.0250270.ref023","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jbiomech.2004.10.029","article-title":"Finite element analysis of moment-rotation relationships for human cervical spine","volume":"39","author":"QH Zhang","year":"2006","journal-title":"J Biomech"},{"key":"pone.0250270.ref024","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.spinee.2016.06.019","article-title":"A new cervical artificial disc prosthesis based on physiological curvature of end plate: a finite element analysis.","volume":"16","author":"CC Yu","year":"2016","journal-title":"Spine J"},{"issue":"8","key":"pone.0250270.ref025","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/01.BRS.0000060259.94427.11","article-title":"Effects of endplate removal on the structural properties of the lower lumbar vertebral bodies.","volume":"28","author":"TR Oxland","year":"2003","journal-title":"Spine (Phila Pa 1976)."},{"issue":"6","key":"pone.0250270.ref026","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/BF01834064","article-title":"Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc?","volume":"6","author":"S Roberts","year":"1997","journal-title":"Eur Spine J."},{"issue":"14","key":"pone.0250270.ref027","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1016\/j.jbiomech.2006.12.016","article-title":"Application of Taguchi method in optimization of cervical ring cage","volume":"40","author":"K Yang","year":"2007","journal-title":"J Biomech"},{"key":"pone.0250270.ref028","article-title":"Reoperation rate after anterior cervical discectomy and fusion using standalone cages in degenerative disease: a study of 2078 cases.","author":"S Mootaz","year":"2019","journal-title":"The Spine J."},{"key":"pone.0250270.ref029","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/10255840903208189","article-title":"Topology optimisation of spinal interbody cage for reducing stress shielding effect.","volume":"13","author":"H Chuah","year":"2009","journal-title":"Comput Method Biomec"},{"issue":"2","key":"pone.0250270.ref030","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0021-9290(72)90053-X","article-title":"Mechanical influences in bone remodeling. Experimental research on Wolff\u2019s law","volume":"5","author":"A Chamay","year":"1972","journal-title":"J Biomech"},{"issue":"5","key":"pone.0250270.ref031","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s00264-007-0369-y","article-title":"Anterior cervical locking plate-related complications; prevention and treatment recommendations.","volume":"32","author":"X Ning","year":"2008","journal-title":"Int Orthop"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T01:12:50Z","timestamp":1618535570000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250270"}},"subtitle":[],"editor":[{"given":"Dean","family":"Chou","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,15]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250270","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,15]]}}}