Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study

Zhongxiang Yu; Zhen Deng; Hanxi Chen; Linling Zhang; Yongfang Zhao; Hongsheng Zhan; Maohua Lin; Frank Vrionis; Huihao Wang

doi:10.1097/BSD.0000000000001920

Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study

Zhongxiang Yu, Zhen Deng, Hanxi Chen, Linling Zhang, Yongfang Zhao, Hongsheng Zhan, Maohua Lin, Frank Vrionis, Huihao Wang

Marcus Neuroscience Institute

Research output: Contribution to journal › Article › peer-review

Abstract

STUDY DESIGN: Finite element (FE) comparative study.

OBJECTIVE: This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).

SUMMARY OF BACKGROUND DATA: Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.

METHODS: We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.

RESULTS: The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.

CONCLUSIONS: The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.

Original language	English
Journal	Clinical spine surgery
DOIs	https://doi.org/10.1097/BSD.0000000000001920
State	E-pub ahead of print - Aug 25 2025

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10.1097/BSD.0000000000001920

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Yu, Z., Deng, Z., Chen, H., Zhang, L., Zhao, Y., Zhan, H., Lin, M., Vrionis, F., & Wang, H. (2025). Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study. Clinical spine surgery. Advance online publication. https://doi.org/10.1097/BSD.0000000000001920

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title = "Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study",

abstract = "STUDY DESIGN: Finite element (FE) comparative study.OBJECTIVE: This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).SUMMARY OF BACKGROUND DATA: Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.METHODS: We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.RESULTS: The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.CONCLUSIONS: The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.",

author = "Zhongxiang Yu and Zhen Deng and Hanxi Chen and Linling Zhang and Yongfang Zhao and Hongsheng Zhan and Maohua Lin and Frank Vrionis and Huihao Wang",

note = "Copyright {\textcopyright} 2025 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2025",

month = aug,

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doi = "10.1097/BSD.0000000000001920",

language = "English",

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T1 - Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy

T2 - A Finite Element Study

AU - Yu, Zhongxiang

AU - Deng, Zhen

AU - Chen, Hanxi

AU - Zhang, Linling

AU - Zhao, Yongfang

AU - Zhan, Hongsheng

AU - Lin, Maohua

AU - Vrionis, Frank

AU - Wang, Huihao

PY - 2025/8/25

Y1 - 2025/8/25

N2 - STUDY DESIGN: Finite element (FE) comparative study.OBJECTIVE: This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).SUMMARY OF BACKGROUND DATA: Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.METHODS: We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.RESULTS: The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.CONCLUSIONS: The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.

AB - STUDY DESIGN: Finite element (FE) comparative study.OBJECTIVE: This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).SUMMARY OF BACKGROUND DATA: Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.METHODS: We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.RESULTS: The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.CONCLUSIONS: The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.

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DO - 10.1097/BSD.0000000000001920

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C2 - 40853024

SN - 2380-0186

JO - Clinical spine surgery

JF - Clinical spine surgery

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