{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:37:01Z","timestamp":1793320621762,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anterior cervical corpectomy and fusion (ACCF) is a key surgical intervention for cervical spine pathologies, but multi-segment ACCF is associated with high risks of instability, implant failure, and adjacent segment degeneration (ASD). Conventional internal fixation system, vertebral body screw (VBS), titanium plate (TP), combine with titanium mesh cage (TMC) have limitations such as insufficient three-column fixation. Anterior transpedicular screws (ATPS) and 3D-printed artificial vertebral bodies (3D-AVB) have shown potential to improve biomechanical performance, but direct biomechanical comparisons of different internal fixation system systems in two-segment ACCF remain lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A finite element (FE) model of the C1-T1 cervical spine was constructed and validated. Four two-segment ACCF (C5-C6 corpectomy) models with different internal fixation systems were established: (1) Group 1: four VBS with TP and TMC; (2) Group 2: four oblique VBS with 3D-AVB; (3) Group 3: two superior VBS and two inferior ATPS with 3D-AVB; (4) Group 4: four ATPS with 3D-AVB. A 73.6\u00a0N axial load and 1.0\u00a0Nm moment were applied. Outcome measures included range of motion (ROM) of surgical (C4-C7) and adjacent segments, maximum von Mises stress of implants, bone-implant interfaces, and adjacent intervertebral discs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All four groups reduced C4-C7 ROM, with Group 4 showing the most significant reduction (\u224898% for flexion\/extension), followed by Group 3, Group 2, and Group 1 (68.5% flexion reduction). Group 4 exhibited slightly increased adjacent segment ROM (54.8% increase in C3-C4 extension). Implant stress was lowest in Group 4 (54.8\u00a0MPa) and highest in Group 2 (255.8\u00a0MPa). Group 4 also had the lowest bone-implant interface stress at C4 and T1, whereas Group 2 had the highest. Adjacent disc stress in Group 4 was comparable to the intact model, while other groups showed increases (46.9% in Group 1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Group 4 (4 ATPS + 3D-AVB system) is preferred for two-segment ACCF, as it provides superior surgical segment stability, reduces stress on implants, bone-implant interfaces, and adjacent discs. For cases where Group 4 is inapplicable, alternatives should be prioritized as follows: Group 3 (2 VBS +2 ATPS + 3D-AVB), Group 2 (4 oblique VBS + 3D-AVB), and Group 1 (4 VBS + TP + TMC). Long-term efficacy of these systems requires verification via future clinical trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2025.1691524","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:23:58Z","timestamp":1761632638000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical evaluation of four internal fixation systems for two-segment anterior cervical corpectomy and fusion: a finite element analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Wei","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruohan","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"100801","DOI":"10.1115\/1.4054439","article-title":"In vitro biomechanics of the cervical spine: a systematic review","volume":"144","author":"Ansaripour","year":"2022","journal-title":"J. Biomech. Eng."},{"key":"B2","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s00701-008-1574-1","article-title":"Anterior pedicle screw fixation for multilevel cervical corpectomy and spinal fusion","volume":"150","author":"Aramomi","year":"2008","journal-title":"Acta Neurochir. (Wien)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2324","DOI":"10.1097\/BRS.0b013e3181b4df92","article-title":"2009 ISSLS prize winner: what influence does sustained mechanical load have on diffusion in the human intervertebral disc? an in vivo study using serial postcontrast magnetic resonance imaging","volume":"34","author":"Arun","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s10143-018-0993-6","article-title":"Two-level cervical corpectomy-long-term follow-up reveals the high rate of material failure in patients, who received an anterior approach only","volume":"42","author":"Bayerl","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1016\/j.jbiomech.2013.03.022","article-title":"Finite element modeling mesh quality, energy balance and validation methods: a review with recommendations associated with the modeling of bone tissue","volume":"46","author":"Burkhart","year":"2013","journal-title":"J. Biomech."},{"key":"B6","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1093\/milmed\/usaa378","article-title":"Comparative finite element modeling study of anterior cervical arthrodesis Versus cervical arthroplasty with bryan disc or prodisc C","volume":"186","author":"Choi","year":"2021","journal-title":"Mil. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1097\/01.brs.0000166526.78058.3c","article-title":"Early failures following cervical corpectomy reconstruction with titanium mesh cages and anterior plating","volume":"30","author":"Daubs","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1097\/00007632-200004010-00005","article-title":"Anterior cervical plating reverses load transfer through multilevel strut-grafts","volume":"25","author":"DiAngelo","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/spi.2003.99.1.0003","article-title":"Titanium cage reconstruction after cervical corpectomy","volume":"99","author":"Dorai","year":"2003","journal-title":"J. Neurosurg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3390\/life14060651","article-title":"Management considerations for cervical corpectomy: updated indications and future directions","volume":"14","author":"Foreman","year":"2024","journal-title":"Life (Basel)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e53580","DOI":"10.1371\/journal.pone.0053580","article-title":"Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study","volume":"8","author":"Fu","year":"2013","journal-title":"PLoS One"},{"key":"B12","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.spinee.2012.12.009","article-title":"Update on the evidence for adjacent segment degeneration and disease","volume":"13","author":"Helgeson","year":"2013","journal-title":"Spine J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1260204","DOI":"10.3389\/fbioe.2023.1260204","article-title":"Biomechanical evaluation of a novel anterior transpedicular screw-plate system for anterior cervical corpectomy and fusion (ACCF): a finite element analysis","volume":"11","author":"Huang","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1097\/BRS.0000000000003360","article-title":"3D-printed titanium prosthetic reconstruction of the C2 vertebra: techniques and outcomes of three consecutive cases","volume":"45","author":"Hunn","year":"2020","journal-title":"Spine (Phila Pa 1976)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/j.spinee.2009.08.461","article-title":"Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study","volume":"9","author":"Hussain","year":"2009","journal-title":"Spine J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12891-019-3036-8","article-title":"Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion","volume":"21","author":"Ji","year":"2020","journal-title":"BMC Musculoskelet. Disord."},{"key":"B17","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/s00586-007-0573-x","article-title":"Cervical anterior transpedicular screw fixation (ATPS)--Part II. Accuracy of manual insertion and pull-out strength of ATPS","volume":"17","author":"Koller","year":"","journal-title":"Eur. Spine J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/s00586-007-0572-y","article-title":"Cervical anterior transpedicular screw fixation. Part I: study on morphological feasibility, indications, and technical prerequisites","volume":"17","author":"Koller","year":"","journal-title":"Eur. Spine J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1007\/s00586-010-1503-x","article-title":"The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping","volume":"19","author":"Koller","year":"2010","journal-title":"Eur. Spine J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1097\/BRS.0b013e3181f5cb87","article-title":"Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis","volume":"36","author":"Lee","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"E348","DOI":"10.1097\/BRS.0000000000002341","article-title":"Preparation and assessment of an individualized navigation template for lower cervical anterior transpedicular screw insertion using a three-dimensional printing technique","volume":"43","author":"Li","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e29316","DOI":"10.1097\/MD.0000000000029316","article-title":"Anterior cervical transpedicular screw fixation system in subaxial cervical spine: a finite element comparative study","volume":"101","author":"Li","year":"2022","journal-title":"Med. Baltim."},{"key":"B23","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1097\/00007632-199904010-00002","article-title":"The ligaments and anulus fibrosus of human adult cervical intervertebral discs","volume":"24","author":"Mercer","year":"1999","journal-title":"Spine (Phila Pa 1976)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"469","DOI":"10.3390\/jcm7120469","article-title":"Radiological and clinical outcome after multilevel anterior cervical discectomy and\/or corpectomy and fixation","volume":"7","author":"Oni","year":"2018","journal-title":"J. Clin. Med."},{"key":"B25","doi-asserted-by":"publisher","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":"Panjabi","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e31876","DOI":"10.1097\/MD.0000000000031876","article-title":"Robot-assisted anterior transpedicular screw fixation with 3D printed implant for multiple cervical fractures: a case report","volume":"101","author":"Pei","year":"2022","journal-title":"Med. Baltim."},{"key":"B27","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/00007632-200301150-00009","article-title":"Early reconstruction failures after multilevel cervical corpectomy","volume":"28","author":"Sasso","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"214","DOI":"10.3171\/spi.2000.93.2.0214","article-title":"Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders","volume":"93","author":"Schultz","year":"2000","journal-title":"J. Neurosurg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"842382","DOI":"10.3389\/fbioe.2022.842382","article-title":"Biomechanical evaluation of intervertebral fusion process after anterior cervical discectomy and fusion: a finite element study","volume":"10","author":"Shen","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2352","DOI":"10.1097\/01.BRS.0000085344.22471.23","article-title":"Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine","volume":"28","author":"Singh","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"B31","doi-asserted-by":"publisher","first-page":"051013","DOI":"10.1115\/1.3118763","article-title":"Stress changes in intervertebral discs of the cervical spine due to partial discectomies and fusion","volume":"131","author":"Tchako","year":"2009","journal-title":"J. Biomech. Eng."},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.24.00204","article-title":"Anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion for 2-Level degenerative cervical myelopathy: a systematic review and meta-analysis","volume":"13","author":"Verma","year":"2025","journal-title":"JBJS Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1097\/01.BRS.0000061998.62204.D7","article-title":"Graft migration or displacement after multilevel cervical corpectomy and strut grafting","volume":"28","author":"Wang","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e343","DOI":"10.1016\/j.wneu.2020.12.055","article-title":"Effectiveness of 2 types of drill templates for cervical anterior transpedicular screw placements: a comparative study","volume":"147","author":"Wang","year":"2021","journal-title":"World Neurosurg."},{"key":"B35","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3171\/2019.6.SPINE198","article-title":"Perioperative complications with multilevel anterior and posterior cervical decompression and fusion","volume":"32","author":"Wewel","year":"2020","journal-title":"J. Neurosurg. Spine"},{"key":"B36","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3389\/fbioe.2020.00154","article-title":"Optimization of three-level cervical hybrid surgery to prevent adjacent segment disease: a finite element study","volume":"8","author":"Wong","year":"2020","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"061003","DOI":"10.1115\/1.4036393","article-title":"A novel anterior transpedicular screw artificial vertebral body system for lower cervical spine fixation: a finite element study","volume":"139","author":"Wu","year":"2017","journal-title":"J. Biomech. Eng."},{"key":"B38","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s00586-014-3607-1","article-title":"Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis","volume":"24","author":"Xiao","year":"2015","journal-title":"Eur. Spine J."},{"key":"B39","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1186\/s13018-021-02885-6","article-title":"Effects of cervical rotatory manipulation on the cervical spinal cord: a finite element study","volume":"16","author":"Xue","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1352996","DOI":"10.3389\/fbioe.2024.1352996","article-title":"Biomechanical study of anterior transpedicular root screw intervertebral fusion system of lower cervical spine: a finite element analysis","volume":"12","author":"Ye","year":"2024","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1016\/j.wneu.2018.02.062","article-title":"The influence of artificial cervical disc prosthesis height on the cervical biomechanics: a finite element study","volume":"113","author":"Yuan","year":"2018","journal-title":"World Neurosurg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.wneu.2019.03.238","article-title":"Three-dimensional printing-assisted cervical anterior bilateral pedicle screw fixation of artificial vertebral body for cervical tuberculosis","volume":"127","author":"Zhang","year":"2019","journal-title":"World Neurosurg."},{"key":"B43","doi-asserted-by":"publisher","first-page":"881979","DOI":"10.3389\/fbioe.2022.881979","article-title":"Biomechanical effects of a novel anatomic titanium mesh cage for single-level anterior cervical corpectomy and fusion: a finite element analysis","volume":"10","author":"Zhang","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1111\/j.1757-7861.2011.00145.x","article-title":"A new technique for anterior cervical pedicle screw implantation","volume":"3","author":"Zhao","year":"2011","journal-title":"Orthop. Surg."},{"key":"B45","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1007\/s00586-014-3473-x","article-title":"Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine","volume":"23","author":"Zhao","year":"2014","journal-title":"Eur. Spine J."},{"key":"B46","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.clinbiomech.2018.09.008","article-title":"Biomechanical analysis on of anterior transpedicular screw-fixation after two-level cervical corpectomy using finite element method","volume":"60","author":"Zhao","year":"2018","journal-title":"Clin. Biomech. (Bristol)"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1691524\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:23:59Z","timestamp":1761632639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1691524\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":46,"alternative-id":["10.3389\/fbioe.2025.1691524"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1691524","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"article-number":"1691524"}}