Biomechanical Comparison of Three-level ACDF with Standalone Cages, Three-level ADR, and Hybrid Approach

Introduction: To evaluate the biomechanical performance of three cervical spine surgical approaches: Three-
Level Anterior Cervical Discectomy and Fusion (ACDF) with standalone cages, Three-Level
Artificial Disc Replacement (ADR) utilizing BAGUERA®C, and a hybrid approach combining
ACDF and ADR.

Methods: Finite Element Analysis (FEA) was employed to simulate the cervical spine (C3-T1) under
various loading conditions, including flexion, extension, lateral bending, and axial rotation.
High-resolution Computed Tomography (CT) data was processed into a 3D model using
segmentation software and refined for biomechanical analysis. Stress distribution, intradiscal
pressure (IDP), and range of motion (ROM) were measured across distinct surgical scenarios to
assess the impact of each technique on spinal mechanics and the risk of adjacent segment
degeneration (ASD).

Results: The ADR approach demonstrated reduced stress levels and improved load distribution,
preserving motion at the treated levels, particularly in flexion and lateral bending. In contrast, the
ACDF method exhibited higher stress concentrations at the operated levels, providing stability
but compromising natural movement, which may elevate the ASD risk. The hybrid approach
effectively mitigated these effects by reducing stress at adjacent levels while preserving some
motion preservation.

Conclusion : ADR promotes more natural spinal motion, albeit at the potential risk of ASD. ACDF offers
stability but compromises natural movement, potentially increasing the ASD risk. The hybrid
approach strikes a balance, preserving motion while controlling stress distribution. These
findings suggest that the selection of surgical technique should consider both stability
requirements and the associated risk of ASD.