A comparative study of titanium mesh and 3D-printed artificial vertebral body in cervical anterior cervical corpectomy and fusion (ACCF) based on clinical outcomes and biomechanical analysis

A comparative study of titanium mesh and 3D-printed artificial vertebral body in cervical anterior cervical corpectomy and fusion (ACCF) based on clinical outcomes and biomechanical analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comparative study of titanium mesh and 3D-printed artificial vertebral body in cervical anterior cervical corpectomy and fusion (ACCF) based on clinical outcomes and biomechanical analysis Jun Mei, xu xiao song, qiang Zhi Wang, feng Xue Tian, qing Qing Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7535092/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To delve into the preliminary clinical outcomes and biomechanical characteristics of titanium mesh (TMC) alongside 3D printed artificial vertebrae body (3D-PAVB), subsequent to an anterior cervical corpectomy and fusion (ACCF) procedure, and thereby furnish a basis for informed selection of implantable materials in clinical ACCF surgeries. Methods A retrospective evaluation was conducted on data from a consecutive cohort of patients diagnosed with cervical degenerative disorders, who underwent ACCF surgery utilizing two distinct implant types: TMC and 3D-PAVB, at author’s Hospital, spanning July 2014 to August 2020.Clinical outcomes were quantified employing the Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA) scores, and Neck Disability Index (NDI).Pre-operative computed tomography (CT) scans of the upper and lower vertebrae encompassing the surgical segments were acquired and analyzed for both groups. Specifically, the Hounsfield Unit (HU) values pertaining to early surgical segment subsidence were assessed via Receiver Operating Characteristic (ROC) curve analysis. Leveraging the outcomes from a logistic regression model, the study applied Restricted Cubic Spline (RCS) analysis to elucidate the linear correlation between preoperative cervical vertebral body CT HU values and the occurrence of early subsidence post-ACCF.Furthermore, an investigation into the biomechanical strength alterations at interfaces between titanium mesh cages and artificial vertebral endplates with lower CT values was conducted, utilizing the Finite Element Method (FEM) for detailed simulation and analysis. Results There were 85 patients in the TMC group with a mean age of 59.69 ± 7.98 years (41 males and 44 females),compared to 66 patients in 3D-PAVB group with a mean age of 56.36 ± 9.08 years (36 males and 30 females).Both groups displayed marked enhancements in postoperative JOA, VAS, and NDI scores. Analysis of the ROC curve areas revealed distinct outcomes: 0.87 for the TMC group with a threshold of 275.17 (sensitivity:87.50%, specificity:79.30%), and 0.77 for the 3D-PAVB group at a threshold of 272.65(sensitivity:74.50% specificity:78.90%).No statistically significant disparities were noted between the groups in terms of gender, BMI, diabetes, hypertension, disease type, surgical segment, operation time, hospital stay duration, or blood loss. The rate of early implant subsidence was 34.10% in TMC group,compared to the 28.80% in 3D-PAVB group.Notably, despite the absence of statistically significant differences in early subsidence between the two groups, a linear correlation was observed between the CT value of the surgery level and the subsidence of both materials.Further,finite element analysis illuminated that a decrease in the CT value of the lower vertebra corresponded to heightened stress at the titanium mesh-endplate interface under flexion-extension, rotation, and lateral flexion conditions, emphasizing the significance of preoperative CT assessment in predicting postoperative outcomes. Conclusion Utilizing the TMC or 3D-PAVB, a clinically satisfactory outcomes can be achieved for ACCF surgery. The preoperative CT scan value serves as a pivotal guide in selecting alternative materials for reconstructing the fused vertebral segment. The decisive cut-off point is derived from the model-estimated shift in Odds Ratio(OR)value. Specifically, when the CT value falls below 245.84 HU,the employment of an artificial vertebral body is advocated. anterior cervical corpectomy and fusion titanium mesh cage 3D-Print Artificial Vertebral Body Subsidence complication Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction ACCF stands as a widely adopted treatment protocol for cervical degenerative disorders,often facilitated by the utilization of TMC.While TMC effectively meets content clinical demands,it is not immune to a prevalent issue: postoperative fusion segment subsidence [1] . However, 3D-PAVB has emerged, initially excelling in spinal tumor surgeries with favorable outcomes [2-4] . Considering TMC's drawbacks and the proven success of 3D-PAVB in spinal tumor treatments, coupled with the ease of customization and the variety of models catering to individual patients, we have successfully applied 3D-PAVB in ACCF surgeries, achieving satisfactory therapeutic outcomes.Nevertheless,postoperative fusion segment subsidence remains a significant challenge with 3D-PAVB [5] . Currently, no matter what material is chosen, there seems to be a risk of vertebral fusion segment sinking.Assuming that there is a way to predict the risk of postoperative prosthesis sinking before surgery, it can guide the rational selection of prostheses before surgery and reduce the sinking rate. The current focus is on bone mineral density（BMD） [6-8] . Techniques for assessing BMD, encompassing dual-energy X-ray, quantitative computed tomography (QCT), and magnetic resonance imaging (MRI), each hold unique strengths and limitations. Recently, CT values have garnered attention for predicting the subsidence potential of lumbar and cervical implants [9-12] . However, there is a notable dearth of literature on predicting subsidence post-ACCF surgeries involving diverse internal implant materials, specifically utilizing CT values.To address this gap, we conducted a study where CT scans measured the HU of the two materials at the onset of subsidence. A comparative analysis yielded insightful conclusions. Furthermore, we used finite element modeling of cervical spine based on CT of cervical spondylosis patients to evaluate the biomechanics of the two materials, and uncovered a congruence with our clinical observations. Material and Methods Patients A retrospective analysis was conducted on 151 consecutive patients in our orthopedics department, who underwent ACCF surgery for cervical degenerative diseases between July 2014 and August 2020 in our hospital.According to the material of the operative segment, it was divided into TMC and 3D-PAVB groups.There were 85 patients in the TMC group (41 males and 44 females),and 66 patients in 3D-PAVB group (36 males and 30 females).The TMC group presented with 67 cases of cervical myelopathy,7 cases of cervicalspondylotic radiculopathy,and 11 cases of mixed cervical spondylosis, with surgical levels distributed as C4 (12), C5 (43), and C6 (30). The 3D-PAVB group featured 52 cases of cervical myelopathy,4 cases of cervicalspondylotic radiculopathy, and 10 cases of mixed cervical spondylosis, with surgical levels of C4 (12), C5 (20), and C6 (34).Operational metrics including operation time, blood loss, hospital length of stay, JOA scores, VAS pain ratings, and NID were documented for both groups. Preoperative assessments consisted of cervical spine X-rays, CT scans with 3D reconstructions, and MRI. Additionally, HU measurements were obtained from preoperative CT scans in all cases.Ethical clearance for this study was granted by our hospital's Ethics Committee, and informed consent was obtained from each participant prior to their inclusion. Surgical Procedure The entire surgical process was executed meticulously by a dedicated team of spinal surgeons. Subsequent to general anesthesia administration, the patient was positioned supine with a gentle hyperextension of the neck. A precisely measured transverse incision, approximately 5cm in length, was delicately made across the anterior aspect of the right neck, aligned parallel to the transverse neck creases. This facilitated the exposure of the cervical spine, meticulously isolated between the vascular and visceral sheaths.Utilizing C-arm fluoroscopy, the operative segment was accurately identified, proceeding with the installation of a retainer and meticulous management of the intervertebral space through the use of a curette. This involved the meticulous removal of the nucleus pulposus and annulus fibrosus, while the cartilaginous endplate was carefully scraped, preserving the bony endplate. The posterior longitudinal ligament was then excised, revealing the dura, and upon exploration, a complete alleviation of spinal cord compression was confirmed.Based on the extent of resection, replacement materials (TMC/3D-PAVB) of appropriate dimensions were selected and integrated, with a minor quantity of autologous cancellous bone fragments strategically implanted into the intervertebral space to augment the fusion. The positioning of the replacement material was rigorously verified through repeated C-arm fluoroscopy assessments.Subsequently, a titanium plate of appropriate length was securely affixed to the anterior surface of the cervical spine. The surgical site was thoroughly irrigated, and a negative pressure drainage tube was positioned. Finally, the incision was meticulously sutured in layers, completing the intricate surgical procedure. Clinical evaluation :Clinical assessment encompassed a comprehensive set of parameters, namely the VAS, JOA score, and NDI rating. (1) The VAS is a standardized 11-point numerical scale, with 0 signifying complete absence of pain and 10 representing the utmost imaginable intensity of pain. (2) The JOA scale comprises three vital domains—mobility, sensory function, and bladder functioning—with a maximum aggregate score of 17 points. (3) The NDI employs a 100-point scale to evaluate the extent of disability due to neck pain. Both pre- and post-operative evaluations, as well as subsequent follow-up assessments, were conducted. Patients were diligently monitored by the primary author post-discharge. Notably, follow-up data compilation was carried out impartially by medical professionals unaffiliated with the surgical teams. HU measurement :Before surgery, all patients underwent comprehensive CT scans coupled with 3D reconstruction technology (Siemens, Germany; employing a voltage of 120 kV and a current of 150mAs). Subsequently, HU values were automatically derived utilizing the Image Archiving and Communication System (PACS). Adhering to the previously outlined methodology [ 13 – 14 ] , HU measurements were precisely conducted via CT scanning. Specifically, the HU value for the end plate was ascertained by designating the upper and lower end plates as the regions of interest (ROI). Meanwhile, the average HU for each vertebral body was derived by averaging the HU values obtained from the axial planes situated below the upper endplate, centrally within the vertebral body, and above the lower endplate. During ROI selection, utmost care was taken to encompass maximal trabecular bone, meticulously avoiding cortical bone and any heterogeneous regions, including cortical bone margins, osteophytes, and areas of osteosclerosis. To ensure accuracy, each data point was measured three times and the results were averaged. Consequently, the average HU value derived from these three ROIs was considered representative of the HU value for an individual vertebra. Biomechanical analysis Based on the CT values of cervical spondylosis patients of different genders and ages, a cervical spine finite element model that is closer to the bone quality and shape of clinically degenerated cervical vertebrae is established to validate the effectiveness of the model. This model is further utilized to simulate ACCF surgery of a single cervical vertebra segment, during which CT values are assigned to the inferior vertebral body. The stresses of the superior endplate of the inferior vertebral body under various CT values are recorded and evaluated during flexion, extension, lateral flexion, and rotation (i.e., anterior left, middle left, posterior left, anterior middle, midcenter, posterior middle, anterior right, middle right, and posterior right). Statistical methods Categorical variables are expressed in absolute numbers and percentages, and continuous variables are expressed in mean standard deviation. The Shapiro-Wilk test was used to verify the normal distribution of continuous variables. Independent samples t-test was used to analyze variables following normal distribution. The test for nonconformity to normal distribution is the rank sum test. Categorical data (sex, disease, surgical segment) were tested by c2 test. Follow-up data, such as VAS, JOA, NDI,were obtained using a repeated-measures analysis of variance analysis. The predicted value of TMC/3D-PAVB subsidence was evaluated by the receiver operating characteristic (ROC) curve, and the area under the curve was calculated. The ROC curve was used to establish the most appropriate threshold (cut value) for HU with high sensitivity and specificity. SPSS software (version 22, USA) was used for statistical analysis. P < 0.05 is considered a statistically significant difference.Based on the results of the logistic regression model, Restricted Cubic Spline( R Version 4.2.3 package rms) is used to explore the linear relation between HU value in the cervical vertebral body and subsidence after ACCF. Result Demographic Information The TMC group comprised 41 males and 45 females, with a mean age of 59.69 ± 7.98 years, exhibiting a subsidence rate of 34.1%. In contrast, the 3D-PAVB group had 66 patients, including 36 males and 30 females, with a mean age of 56.36 ± 9.08 years and a subsidence rate of 28.8%.Statistical analysis revealed significant disparities in age and CT values of the inferior vertebral body between the two groups (P TMC =0.012, P 3D − PAVB =0.020). However, no notable differences were observed in terms of gender, body mass index (BMI), prevalence of diabetes and hypertension, disease type, surgical segment involved, operative duration, hospital stay duration,or blood loss between the TMC group and the 3D-PAVB group(Table 1 ).Afterwards, we conducted an intergroup comparison of the subsidence patients from the two groups. The results indicated that there were no statistically significant differences in age, gender, BMI, disease type, surgical segments, operative time, hospital stay, blood loss, comorbid conditions (such as diabetes and hypertension), and CT values between the titanium mesh group and the 3D-printed artificial vertebral body group(Table 2 ). Table 1 Demographic and surgery characteristics TMC Group 3D-PAVB Group Variable Subsidence Group Non-subsidence Group P value Subsidence Group Non-subsidence Group P value No.of patients 29 56 19 47 Age 63.09 ± 8.49 57.54 ± 9.84 0.012 59.79 ± 5.996 55.00 ± 7.871 0.020 Gender 0.996 0.458 male 14 27 9 27 female 15 29 10 20 BMI (kg/m 2 ) 25.35 ± 3.46 25.06 ± 3.11 0.701 24.35 ± 3.09 24.63 ± 3.36 0.759 Disease type myelopathy 23 44 14 38 radicular 3 4 2 2 mixed 3 8 3 7 Surgical section C4 5 7 4 8 C5 16 27 9 11 C6 8 22 6 28 Operation time(min) 105.69 ± 33.16 105.32 ± 25.78 0.955 108.68 ± 34.68 106.17 ± 41.81 0.818 Length of stay(days) 10.55 ± 2.31 11.39 ± 3.89 0.288 10.00 ± 3.30 10.17 ± 2.68 0.828 Blood loss(ml) 124.48 ± 124.17 133.93 ± 141.24 0.762 171.05 ± 223.65 143.40 ± 156.29 0.569 Hypertension Yes 8 13 5 18 No 21 43 14 29 Diabetes mellitus Yes 8 13 7 6 No 21 43 12 41 CT values of the upper vertebral 326.84 ± 64.76 423.56 ± 82.36 < 0.0001 342.00 ± 87.34 353.58 ± 74.50 0.588 CT values of the lower vertebral 251.44 ± 61.36 346.33 ± 71.01 < 0.0001 251.39 ± 52.62 317.06 ± 73.59 0.001 Table 2 Group comparison of demographic and surgery characteristics in subsidence TMC Group 3D-PAVB Group statistic P value Age 63.09 ± 8.49 59.79 ± 5.996 1.469 0.149 Gender 0.004 0.951 male 14 9 female 15 10 BMI(kg/m2 ) 25.35 ± 3.46 24.35 ± 3.09 1.02 0.313 Disease type 0.32 0.852 myelopathy 23 14 radicular 3 2 mixed 3 3 Surgical section 0.286 0.857 C4 5 4 C5 16 9 C6 8 6 Operation time(min) 105.69 ± 33.16 108.68 ± 34.68 −0.3 0.765 Length of stay(days) 10.55 ± 2.31 10.00 ± 3.30 0.68 0.5 Blood loss(ml) 124.48 ± 124.17 171.05 ± 223.65 −0.927 0.359 Hypertension 0.009 0.923 Yes 8 5 No 21 14 Diabetes mellitus 0.458 0.499 Yes 8 7 No 21 12 CT values of the upper vertebral 326.84 ± 64.76 342.00 ± 87.34 −0.69 0.494 CT values of the lower vertebral 251.44 ± 61.36 251.39 ± 52.62 0.003 0.998 Clinical results : In comparison to preoperative assessments, the JOA, VAS, and NDI scores of both groups displayed marked improvements at 3 days,3 months post-operatively,as well as during the final follow-up period.Nevertheless,no statistically significant intergroup differences were discernible(Table 3 ). However, when focusing specifically on the comparison between groups for patients experiencing sinking,a distinct statistical significance emerged in VAS scores favoring either the TMC group or the 3D-PAVB group, while such distinction was absent in JOA and NDI scores(Table 4 ). Table 3 Clinical parameters TMC Group 3D-PAVB Group Variable Total Subsidence Non- subsidence p value Total Subsidence Non- subsidence p value Preoperative VAS 5.02 ± 1.20 5.07 ± 1.19 5.00 ± 1.22 0.804 4.26 ± 1.91 4.37 ± 2.06 4.21 ± 1.86 0.914 JOA 7.48 ± 1.05 7.38 ± 1.05 7.54 ± 1.06 0.520 6.20 ± 2.34 6.42 ± 2.52 6.11 ± 2.28 0.641 NDI 28.93 ± 5.54 28.48 ± 6.09 29.16 ± 5.28 0.596 27.62 ± 9.22 27.05 ± 9.68 19.34 ± 5.72 0.760 Postoperative VAS 2.22 ± 0.88 2.17 ± 0.66 2.25 ± 0.98 0.666 0.83 ± 0.85 0.74 ± 0.87 0.87 ± 0.85 0.494 JOA 13.33 ± 1.37 13.14 ± 1.16 13.43 ± 1.48 0.359 11.64 ± 2.95 11.89 ± 2.87 11.53 ± 3.01 0.649 NDI 15.96 ± 3.03 15.93 ± 3.27 15.98 ± 2.92 0.942 18.86 ± 5.81 17.68 ± 6.05 27.85 ± 9.13 0.173 3 months after the operation VAS 2.19 ± 0.63 2.27 ± 0.65 2.14 ± 0.62 0.357 0.61 ± 0.70 0.58 ± 0.69 0.62 ± 0.71 0.863 JOA 13.20 ± 1.02 12.97 ± 0.94 13.32 ± 1.05 0.128 12.35 ± 2.74 12.26 ± 2.84 12.38 ± 2.73 0.960 NDI 15.26 ± 2.22 15.48 ± 2.40 15.14 ± 2.13 0.506 15.20 ± 4.53 14.42 ± 4.79 15.51 ± 4.44 0.275 The fnal follow-up VAS 2.08 ± 0.64 2.14 ± 0.58 2.05 ± 0.67 0.568 0.64 ± 0.80 0.74 ± 0.87 0.60 ± 0.77 0.545 JOA 13.16 ± 0.97 12.90 ± 0.98 13.30 ± 0.95 0.067 13.70 ± 2.37 13.47 ± 2.65 13.79 ± 2.27 0.762 NDI 15.06 ± 1.84 15.31 ± 1.87 14.93 ± 1.82 0.368 13.35 ± 4.13 12.21 ± 3.47 13.81 ± 4.31 0.127 * P < 0.05 compared with preoperative Table 4 Group comparison of clinical parameters in subsidence TMC Group 3D-PAVB Group statistic P value Preoperative VAS 5.07 ± 1.19 4.37 ± 2.06 1.493 0.142 JOA 7.38 ± 1.05 6.42 ± 2.52 1.831 0.074 NDI 28.48 ± 6.09 27.05 ± 9.68 0.629 0.532 Postoperative VAS 2.17 ± 0.66 0.74 ± 0.87 6.467 0.001 JOA 13.14 ± 1.16 11.89 ± 2.87 2.106 0.041 NDI 15.93 ± 3.27 17.68 ± 6.05 -1.299 0.200 3months after the operation VAS 2.27 ± 0.65 0.58 ± 0.69 8.598 0.001 JOA 12.97 ± 0.94 12.26 ± 2.84 1.252 0.217 NDI 15.48 ± 2.40 14.42 ± 4.79 1.016 0.315 The fnal follow-up VAS 2.14 ± 0.58 0.74 ± 0.87 6.702 0.001 JOA 12.90 ± 0.98 13.47 ± 2.65 -1.058 0.296 NDI 15.31 ± 1.87 12.21 ± 3.47 4.016 0.001 Analysis of statistical curves : Using independent risk factors, we performed ROC curve analysis. The sensitivity and specificity of the cut values and area under the curve (AUC) were calculated. The optimal intersection of specificity and sensitivity was used to obtain the cut point from the ROC curve. According to the ROC curve, the cutting point of the lower vertebral body was 275HU (sensitivity:87.5%; Specificity:79.3%) in TMC group and 272HU (sensitivity:78.9%; Specificity: 74.5%) in 3D-PAVB group.By comparison, the area under the ROC curve of the TMC group was AUC = 0.866, and the 3D-PAVB group was AUC = 0.772(Figure 1 ). Using the R software, pROC package, Delong test of the area under the ROC curve of TMC group and 3D-PAVB group, usingα = 0.05 as the test level, p = 0.2332 > 0.05, so the effect of the replacement materials in ACCF surgery was considered to be not statistically significant on subsidence. Table5 Predicted value of the Restricted Cubic Spline (RCS) TMC Group 3D-PAVB Group Preoperative CT value（HU） OR 95%CI Preoperative CT value（HU） OR 95%CI …… 242.104 9.764 (3.257,29.270) 242.764 8.327 (2.176,31.866) 243.350 9.228 (3.160,26.949) 243.823 8.304 (2.175,31.710) 244.597 8.724 (3.062,24.858) 244.882 8.273 (2.172,31.507) 245.844 8.250 (2.963,22.970) 245.941 8.232 (2.168,31.256) 247.090 7.805 (2.865,21.263) 247.000 8.184 (2.168,31.256) …… 305.679 1.008 (0.999,1.017) 305.247 1.299 (1.103,1.530) 306.925 0.978 (0.952,1.004) 306.307 1.242 (1.085,1.421) - 307.366 1.187 (1.067 1.322) 308.172 0.949 (0.891,1.010) 308.425 1.136 (1.049,1.229) 309.418 0.921 (0.834,1.017) 309.484 1.087 (1.032,1.144) 310.665 0.895 (0.781,1.025) 310.543 1.040 (1.015,1.066) 311.912 0.870 (0.732,1.033) 311.602 0.996 (0.993,0.998) Based on the results of the logistic regression model, Restricted Cubic Spline( R Version 4.2.3 package rms) is used to explore the linear relation between HU value in the cervical vertebral body and subsidence after ACCF.OR> 1 indicates a positive correlation between CT values and plant settlement, and OR <1 indicates a negative correlation between CT values and settlement. The TMC cut-off point/inflection point is 305.68HU; The 3D-PAVB cut-off point/ inflection point is 311.60HU. α =0.05 as the test level. Discussion 1.Titanium mesh and artificial vertebral body have equivalent clinical effects in ACCF surgery ACCF surgery constitutes a prevalent therapeutic approach for cervical degenerative disorders, with autologous iliac crest, titanium mesh, PEEK material, and other internal implants being frequently utilize [15-16] . TMC, manufactured by Medtronic (USA), is extensively adopted in clinical settings due to its robust strength, hollow mesh design, ability to promptly achieve stability reconstruction [17] . Our application of TMC in ACCF surgery has yielded satisfactory clinical outcomes(Figure 3).However, the titanium mesh necessitates a substantial amount of bone grafting, necessitating intraoperative adjustments to prune it to the appropriate size, thereby prolonging the operation time. The sharp edges resulting from pruning may potentially damage the endplate, leading to the settlement of the internal implant material. Ji et al [18] demonstrated that the contact between the titanium mesh and endplate is point contact, making it susceptible to endplate collapse and the settlement of the titanium mesh. Consequently, some patients may experience neurological symptoms and accelerated degeneration of adjacent segments [19] . 3D-PAVB(manufactured by Beijing Aikang Yicheng Medical Equipment Co, LTD, China) features a porous structure that facilitates surface contact with bone material, enhancing its ability to integrate with surrounding bone tissue [20-21] . This promotes bone fusion, minimizing implant settlement and effectively maintaining cervical spine height and physiological curvature. The technology was initially utilized in spinal tumor surgery and achieved commendable therapeutic outcomes [22] .Considering the drawbacks associated with titanium mesh and the proven efficacy of artificial vertebral bodies in spinal tumor cases, where the artificial vertebral body eliminates the need for pruning and offers a variety of models tailored to individual patients, we have attained satisfactory outcomes in ACCF surgery through the utilization of 3D-PAVB（Figure 4）.Our study demonstrated that both materials can attain immediate stability of surgical segments and exhibit satisfactory clinical outcomes, including JOA and VAS scores, following ACCF surgery. In the titanium mesh group, prosthesis subsidence was observed with a rate of 34.10%, compared to 28.80% in the 3D printed artificial vertebra group. However, this difference in subsidence rate was not statistically significant, aligning with findings reported in certain studies [23-27] . No statistically significant disparities were noted between the groups in terms of gender, BMI, diabetes, hypertension, disease type, surgical segment, operation time, hospital stay duration, or blood loss. Early implant subsidence was observed in both groups, and there were significant differences in age and CT values within both groups (P TMC =0.01, P 3D-PAVB =0.02). However, comparison between the groups showed no statistically significant differences. 2.Preoperative CT values can guide the selection of implant materials for ACCF surgery As aforementioned, both the TMC and 3D-PAVB groups exhibited early subsidence of internal plants. Consequently, we analyzed these two data sets to ascertain whether the disparity in plant material within the fusion segment correlated with premature settlement. Based on literature reviews, the subsidence of internal plant material generally takes place within a period of three months subsequent to the operation [28-29] . In our study, we established a criterion where a reduction in cervical intervertebral space height exceeding 3 mm within three months postsurgery was deemed significant.Studies have discovered a close correlation between early settlement and vertebral BMD, along with numerous methodologies for assessing BMD [30-32] . Literature indicates that there is a positive correlation between the CT value of cervical vertebral bodies and the bone mineral density (BMD) T-score obtained from Dual-energy X-ray(DXA) examinations. The HU value can accurately reflect the BMD of the patient's cervical spine, thereby assessing preoperative bone quality and predicting the subsidence of implant materials after anterior cervical fusion surgery [33-36] .Our study revealed that the HU of the upper and lower vertebrae in the subsidence groups was lower compared to the non-subsidence group. Furthermore, the CT value of the lower vertebra in the fusion segment emerged as an independent predictor of early subsidence during the postoperative period. The ROC curve CT threshold for the TMC Group was determined to be 272.65HU, whereas it was 275.17HU for the 3D-PAVB Group. According to the DeLong test on the area under the ROC curve (α=0.05, p=0.23), there was no statistically significant difference in early subsidence between the TMC Group and the 3D-PAVB Group. Potential reasons for this analysis may encompass a limited sample size, measurement inaccuracies, insufficient evaluation indicators, and the lack of an assessed fusion rate. Despite the absence of statistically significant differences in early subsidence between the two groups, we observed a linear correlation between the CT value of the fusion level and the subsidence of both materials.The restrictive cubic spline analysis revealed that for an OR greater than 1 and a preoperative CT value below 245.84 HU, the risk of subsidence rose as preoperative CT values decreased for both TMC and 3D-PAVB, with titanium mesh exhibiting a more substantial increase. Consequently, 3D-PAVB are advisable in such instances. When the OR exceeds 1 and the preoperative CT value lies between 245.84 HU and 306.93 HU, the risk of subsidence increases with decreasing preoperative CT values for both implants, yet this augmentation is more evident in 3D-PAVB, rendering TMC the preferred option. For CT values within the range of 306.93 HU to 311.60 HU, the TMC group exhibited an OR less than 1 (contrasting with an OR greater than 1 for the 3D-PAVB group), suggesting that the CT value acts as a protective factor against subsidence, thereby recommending TMC. When the CT value surpasses 311.60 HU, both TMC and 3D-PAVB groups display an OR less than 1, indicating that either implant can fulfill clinical requirements(Table5). 3.Biomechanical Analysis Based on Cervical Spine Patients Previous studies on cervical spine biomechanics have referenced models established using cervical spine parameters from normal individuals. To date, we have not found any reports using CT-assigned values to establish finite element models of the cervical spine for analyzing the biomechanical changes of implant materials. However, this approach may be closer to clinical practice and more instructive. Therefore, we initially analyzed the CT values of over 900 cervical spondylosis patients to establish a finite element model of the cervical spine based on CT values and validated its effectiveness. Subsequently, we analyzed the biomechanics of surgical segments of two materials at different CT values.Our research results indicate that, using the same material, the biomechanical strength of the superior endplate of the inferior vertebra within the fusion segment progressively augments as the CT value diminishes. This aligns with our clinical findings and corroborates the results documented in the literature [37-40] .Furthermore, under identical CT values, during flexion movements, the titanium mesh exhibits smaller stress values compared to the artificial vertebral body at the left posterior, anteromedial, and right posterior locations, whereas it displays larger stress values in other positions. During extension movements, the titanium mesh demonstrates lower stress values than the artificial vertebral body at the anteromedial and middle posterior sites, with higher stress values observed in the remaining positions. During lateral bending, the stress values of the titanium mesh are smaller than the artificial vertebral body at the anteromedial, middle posterior, and right posterior positions, while they are larger at other positions. The above results suggest that the stresses on the two materials during ACCF surgery are comparable, with the titanium mesh performing slightly inferior.During rotation, the stress values of the titanium mesh are smaller than those of the artificial vertebral body in all directions.This result may suggest to us that the biomechanical strength of the titanium mesh is better, which is an interesting thing, and we need to collect sufficient clinical data to further explain this phenomenon(Figure 2). This study has two characteristics.First,the feature of this study is on the early subsidence of titanium mesh and artificial cone after ACCF surgery based on CT value. In addition, the finite element model of cervical spondylosis patients is more close to the actual clinical situation for biomechanical analysis. However, there are still many deficiencies, such as the relatively small sample size, the short follow-up time, a retrospective study. Future studies with large sample, prospective and long-term follow-up are needed to further evaluate the application value of the two materials in cervical ACCF surgery, and to study the biomechanical conditions of different materials, different ages and different gender, especially the experimental data under rotation conditions with hierarchical research method. Conclusion In summary, despite neither material demonstrating statistical significance for early subsidence, the preoperative CT value can still serve as a guide for selecting vertebral substitute materials. Furthermore, it allows for the determination of a cut-off point based on the estimated OR value derived from the model. Specifically, if the CT value dips below 245.84HU, the employment of 3D-PAVB is advisable. Within the range of 245.84HU to 311.60HU, TMC is recommended. When the CT value surpasses 311.60HU, both materials are viable options. Abbreviations ACCF:Anterior Cervical Corpectomy and Fusion; TMC:titanium mesh;3D-PAVB:3D-Print Artificial Vertebral Body;VAS:Visual Analog Scale; JOA:Japanese Orthopedic Association;NDI:Neck Disability Index;CT:Computed Tomography;HU:Hounsfeld Units;ROC: Receiver Operating;RCS:Restricted Cubic Spline;FEM:Finite Element Method;OR:Odds Ratio;BMD:Bone Mineral Density;QCT:Quantitative Computed Tomography;MRI:Magnetic Resonance Imaging; PACS:The Picture Archiving and Communication System;ROI:Region Of Interest;AUC:Area Under The Curve;DXA:Dual-energy X-ray; Declarations Data Availability :All data generated or analyzed during this study are included in this published article. Conflicts of Interest: All authors agree to submit the article without any competing interests. Sources of Funding: This work was supported by the National Key Research and Development Plan (2022YFC3601900 and 2022YFC3601904). Ethics approval and consent to participate: The authors confirm that all experiment datas were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki).It has passed the ethical review of the author's unit. Ethical approval was obtained from the Institutional Ethics Committee of author’s Hospital. All patients signed the informed consent. Provenance and peer review: Not commissioned, externally peer-reviewed Acknowledgements :.None References Yu, Chen,Deyu, Chen,Yongfei, Guo et al. Subsidence of titanium mesh cage: a study based on 300 cases.[J] .J Spinal Disord Tech, 2008, 21: 489-92. Mingjie, Dong,Yingjie, Gao,Hao, Fan et al. Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis.[J] .Front Oncol, 2024, 14: 1327319. H,Zhou,R J, Wang,Z J, Liu et al. 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Single-Level Anterior Cervical Corpectomy and Fusion Using a New 3D-Printed Anatomy-Adaptive Titanium Mesh Cage for Treatment of Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Retrospective Case Series Study.[J] .Med Sci Monit, 2017, 23: 3105-3114. Haiyang, Cheng,Gan, Luo,Dan, Xu et al. Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with Titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis.[J] .Front Surg, 2023, 9: 1077551. Haoyu, He,Lei, Fan,Guohua, Lü et al. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion?[J] .BMC Musculoskelet Disord, 2024, 25: 96. Y W, Li,X Z, Li,S F, Gu et al. [Clinical observation on the treatment of ossification of the posterior longitudinal ligament of the cervical spine using 3D printed self-stable zero-profile artificial vertebral body].[J] .Zhonghua Yi Xue Za Zhi, 2024, 104: 526-532. Tao, Fang,Ming, Zhang,Jing, Yan et al. Comparative Analysis of 3D-Printed Artificial Vertebral Body Versus Titanium Mesh Cage in Repairing Bone Defects Following Single-Level Anterior Cervical Corpectomy and Fusion.[J] .Med Sci Monit, 2021, 27: e928022. Yu, Chen,Deyu, Chen,Yongfei, Guo et al. Subsidence of titanium mesh cage: a study based on 300 cases.[J] .J Spinal Disord Tech, 2008, 21: 489-92. VHans-Peter W, van Jonbergen,Maarten, Spruit,Patricia G, Anderson et al. Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence.[J] .Spine J, 2005, 5: 645-9; discussion 649. Anika K, Anam,Karl, Insogna,Update on Osteoporosis Screening and Management.[J] .Med Clin North Am, 2021, 105: 1117-1134. M S, LeBoff,S L, Greenspan,K L, Insogna et al. The clinician's guide to prevention and treatment of osteoporosis.[J] .Osteoporos Int, 2022, 33: 2049-2102. Chinese Society of Osteoporosis and Bone Mineral Research. Guidelines for the diagnosis and treatment of primary osteoporosis（2022）［J］. Chinese General Practice，2023,26(14):1671-1691. Donald F, Colantonio,Sameer K, Saxena,Alan, Vanier et al. Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck.[J] .Clin Spine Surg, 2019, 33: E58-E62. Mary Lucy, Marques,Nuno, Pereira da Silva,Desirée, van der Heijde et al. Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis.[J] .RMD Open, 2022, 8: HE Lei,Zhou Fei fei,LI Shu yang,et al.Application of CT value of cervical vertebral body in preoperative bone quality assessment of patients with cervical degenerative diseases.[J] .Orthopaedics, 2019, 10(4):293-297. Ho Jin, Lee,Soon Tae, You,Jung Hee, Kim et al. Significance of Cervical Spine Computed Tomography Hounsfield Units to Predict Bone Mineral Density and the Subsidence After Anterior Cervical Discectomy and Fusion.[J] .Clin Spine Surg, 2021, 34: E450-E457. Su Zaifa,Jia Lian shun,Zhang Mei chao,et al.Development Of the three—dimensionaI finite element model of the lower cervical spine(C4-C7) with titanium mesh cage and plate after anterior cervical osteotomy corpectomy.[J] .Journal of Medical Biomechanics.2009,24(03):183-188. Pengrong, Ouyang,Teng, Lu,Xijing, He et al. Biomechanical Comparison of Integrated Fixation Cage Versus Anterior Cervical Plate and Cage in Anterior Cervical Corpectomy and Fusion (ACCF): A Finite Element Analysis.[J] .Med Sci Monit, 2019, 25: 1489-1498. Enze, Zhou,Huiwen, Huang,Yanbin, Zhao et al. The effects of titanium mesh cage size on the biomechanical responses of cervical spine after anterior cervical corpectomy and fusion: A finite element study.[J] .Clin Biomech (Bristol), 2021, 91: 105547. Jianfeng, Kang,Enchun, Dong,Xiangdong, Li et al. Topological design and biomechanical evaluation for 3D printed multi-segment artificial vertebral implants.[J] .Mater Sci Eng C Mater Biol Appl, 2021, 127: 112250. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7535092","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513406946,"identity":"eee97c65-22df-45e4-b172-547f215c0ca6","order_by":0,"name":"Jun Mei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYFACxgYDBgYbBgYJBgZmUrSkkaQFDA6ToEW3vbmhmHfHeXuD280bHxcw2MnpNjA/wKvF7MzBBmPeM7cTZ845Vmw8gyHZ2OwAmwF+LTcSgVrabifwS+SYSfMwHEjcdoAHv8PM7j8EaTlnzyaRY/6bOC03GEFaDjD2A21hJk7LmcQGw7ltyWC/SPMYAP1ymJBfjh9/ZvC2zQ4cYp95KuzkzI43P8BvDQMD3FADMCImduDRgN89o2AUjIJRMHIBALYEQs8SxHgmAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-3605-3177","institution":"Shanxi Bethune Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Mei","suffix":""},{"id":513406947,"identity":"3af00593-aaab-4a01-ad15-94063d52fff6","order_by":1,"name":"xu xiao song","email":"","orcid":"","institution":"Shanxi Bethune Hospital","correspondingAuthor":false,"prefix":"","firstName":"xu","middleName":"xiao","lastName":"song","suffix":""},{"id":513406948,"identity":"08770987-b99d-4ff6-992f-e718b8754016","order_by":2,"name":"qiang Zhi Wang","email":"","orcid":"","institution":"Shanxi Bethune Hospital","correspondingAuthor":false,"prefix":"","firstName":"qiang","middleName":"Zhi","lastName":"Wang","suffix":""},{"id":513406949,"identity":"53d96b50-63f7-44cf-ba6d-f63464e588bd","order_by":3,"name":"feng Xue Tian","email":"","orcid":"","institution":"City Hospital: Hospital Municipal","correspondingAuthor":false,"prefix":"","firstName":"feng","middleName":"Xue","lastName":"Tian","suffix":""},{"id":513406950,"identity":"8617e4b5-655b-42c6-9079-06c6eebc63c0","order_by":4,"name":"qing Qing Liu","email":"","orcid":"","institution":"Shanxi Bethune Hospital","correspondingAuthor":false,"prefix":"","firstName":"qing","middleName":"Qing","lastName":"Liu","suffix":""},{"id":513406951,"identity":"77458b74-492a-4cd0-8d69-7bfb80fcace6","order_by":5,"name":"Qiang Liu","email":"","orcid":"","institution":"Shanxi Bethune Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Liu","suffix":""},{"id":513406952,"identity":"7b49e8b2-f0a4-4216-b546-6f240aa72025","order_by":6,"name":"Lin Sun","email":"","orcid":"","institution":"Shanxi Bethune Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-09-04 10:24:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7535092/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7535092/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91654086,"identity":"17e0c1e6-5231-4b3f-8206-67cc69f294c7","added_by":"auto","created_at":"2025-09-18 17:42:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72174,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curve comparison diagram of TMC and 3D-PAVB groups\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7535092/v1/f5598b1ed66d6cb87bcce96e.png"},{"id":91654085,"identity":"12f6d00d-abb0-419a-9174-9fe6b88bc4e0","added_by":"auto","created_at":"2025-09-18 17:42:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":59876,"visible":true,"origin":"","legend":"\u003cp\u003eBiomechanical test results:Under the same CT value, during flexion, the stress values of the titanium mesh are smaller than those of the artificial vertebral body at the left posterior, anteromedial, and right posterior positions, while they are larger at other positions. During extension, the stress values of the titanium mesh are smaller than those of the artificial vertebral body at the anteromedial and middle posterior positions, while they are larger at other positions. During lateral bending, the stress values of the titanium mesh are smaller than those of the artificial vertebral body at the anteromedial, middle posterior, and right posterior positions, while they are larger at other positions. During rotation, the stress values of the titanium mesh are smaller than those of the artificial vertebral body in all directions.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7535092/v1/9162f2a5ca19cd36f76a6f4c.png"},{"id":91654658,"identity":"6295e97e-77ac-453b-8a69-1a53c4cf36e8","added_by":"auto","created_at":"2025-09-18 17:50:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":248607,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eACCF Surgery with TMC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA X-ray showed vertebral spaces were serious narrowed(C5-7）; B-C The CT and MR showed C5-7 disc herniation and mild calcification, spinal cord compression ; D-E Postoperative X-ray, achieving immediate stability; F X-ray at 6 months after surgery,the surgical segment was well fused and no cage sink was observed.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7535092/v1/9df04f5b0a94e0fbf351e761.png"},{"id":91654090,"identity":"3dc6d266-df77-46b6-bec8-dcefbb6ac077","added_by":"auto","created_at":"2025-09-18 17:42:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":375849,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eACCF Surgery with 3D-PAVB\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA-C X-ray showed vertebral spaces were narrowed（C4-6）and good cervical stability; D MR showed C4-6 disc herniation, spinal cord compression, spinal cord hyperintense signal change; E Postoperative X-ray, achieving immediate stability; F-I X-ray at 1 month, 2 months, 7 months and 1 year after surgery with 3D-PAVB,the surgical segment was well fused and no cage sink was observed.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7535092/v1/d52b8c652b9b05994d7b20dd.png"},{"id":105904289,"identity":"53dbbe2d-c88a-4f32-9b9b-23d658dfe4d5","added_by":"auto","created_at":"2026-04-01 10:07:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2056175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7535092/v1/80be66bd-0ca8-4a88-9980-87698c8ec0ad.pdf"}],"financialInterests":"","formattedTitle":"A comparative study of titanium mesh and 3D-printed artificial vertebral body in cervical anterior cervical corpectomy and fusion (ACCF) based on clinical outcomes and biomechanical analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eACCF stands as a widely adopted treatment protocol for cervical degenerative disorders,often facilitated by the utilization of TMC.While TMC effectively meets content clinical demands,it is not immune to a prevalent issue: postoperative fusion segment subsidence\u003csup\u003e[1]\u003c/sup\u003e. However, 3D-PAVB has emerged, initially excelling in spinal tumor surgeries with favorable outcomes\u003csup\u003e[2-4]\u003c/sup\u003e. Considering TMC's drawbacks and the proven success of 3D-PAVB in spinal tumor treatments, coupled with the ease of customization and the variety of models catering to individual patients, we have successfully applied 3D-PAVB in ACCF surgeries, achieving satisfactory therapeutic outcomes.Nevertheless,postoperative fusion segment subsidence remains a significant challenge with 3D-PAVB\u003csup\u003e[5]\u003c/sup\u003e. Currently, no matter what material is chosen, there seems to be a risk of vertebral fusion segment sinking.Assuming that there is a way to predict the risk of postoperative prosthesis sinking before surgery, it can guide the rational selection of prostheses before surgery and reduce the sinking rate. The current focus is on bone mineral density（BMD）\u003csup\u003e[6-8]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTechniques for assessing BMD, encompassing dual-energy X-ray, quantitative computed tomography (QCT), and magnetic resonance imaging (MRI), each hold unique strengths and limitations. Recently, CT values have garnered attention for predicting the subsidence potential of lumbar and cervical implants\u003csup\u003e[9-12]\u003c/sup\u003e. However, there is a notable dearth of literature on predicting subsidence post-ACCF surgeries involving diverse internal implant materials, specifically utilizing CT values.To address this gap, we conducted a study where CT scans measured the HU of the two materials at the onset of subsidence. A comparative analysis yielded insightful conclusions. Furthermore, we used finite element modeling of cervical spine based on CT of cervical spondylosis patients to evaluate the biomechanics of the two materials, and uncovered a congruence with our clinical observations.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003cp\u003eA retrospective analysis was conducted on 151 consecutive patients in our orthopedics department, who underwent ACCF surgery for cervical degenerative diseases between July 2014 and August 2020 in our hospital.According to the material of the operative segment, it was divided into TMC and 3D-PAVB groups.There were 85 patients in the TMC group (41 males and 44 females),and 66 patients in 3D-PAVB group (36 males and 30 females).The TMC group presented with 67 cases of cervical myelopathy,7 cases of cervicalspondylotic radiculopathy,and 11 cases of mixed cervical spondylosis, with surgical levels distributed as C4 (12), C5 (43), and C6 (30). The 3D-PAVB group featured 52 cases of cervical myelopathy,4 cases of cervicalspondylotic radiculopathy, and 10 cases of mixed cervical spondylosis, with surgical levels of C4 (12), C5 (20), and C6 (34).Operational metrics including operation time, blood loss, hospital length of stay, JOA scores, VAS pain ratings, and NID were documented for both groups. Preoperative assessments consisted of cervical spine X-rays, CT scans with 3D reconstructions, and MRI. Additionally, HU measurements were obtained from preoperative CT scans in all cases.Ethical clearance for this study was granted by our hospital's Ethics Committee, and informed consent was obtained from each participant prior to their inclusion.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSurgical Procedure\u003c/strong\u003e\u003cp\u003eThe entire surgical process was executed meticulously by a dedicated team of spinal surgeons. Subsequent to general anesthesia administration, the patient was positioned supine with a gentle hyperextension of the neck. A precisely measured transverse incision, approximately 5cm in length, was delicately made across the anterior aspect of the right neck, aligned parallel to the transverse neck creases. This facilitated the exposure of the cervical spine, meticulously isolated between the vascular and visceral sheaths.Utilizing C-arm fluoroscopy, the operative segment was accurately identified, proceeding with the installation of a retainer and meticulous management of the intervertebral space through the use of a curette. This involved the meticulous removal of the nucleus pulposus and annulus fibrosus, while the cartilaginous endplate was carefully scraped, preserving the bony endplate. The posterior longitudinal ligament was then excised, revealing the dura, and upon exploration, a complete alleviation of spinal cord compression was confirmed.Based on the extent of resection, replacement materials (TMC/3D-PAVB) of appropriate dimensions were selected and integrated, with a minor quantity of autologous cancellous bone fragments strategically implanted into the intervertebral space to augment the fusion. The positioning of the replacement material was rigorously verified through repeated C-arm fluoroscopy assessments.Subsequently, a titanium plate of appropriate length was securely affixed to the anterior surface of the cervical spine. The surgical site was thoroughly irrigated, and a negative pressure drainage tube was positioned. Finally, the incision was meticulously sutured in layers, completing the intricate surgical procedure.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical evaluation\u003c/b\u003e:Clinical assessment encompassed a comprehensive set of parameters, namely the VAS, JOA score, and NDI rating. (1) The VAS is a standardized 11-point numerical scale, with 0 signifying complete absence of pain and 10 representing the utmost imaginable intensity of pain. (2) The JOA scale comprises three vital domains\u0026mdash;mobility, sensory function, and bladder functioning\u0026mdash;with a maximum aggregate score of 17 points. (3) The NDI employs a 100-point scale to evaluate the extent of disability due to neck pain. Both pre- and post-operative evaluations, as well as subsequent follow-up assessments, were conducted. Patients were diligently monitored by the primary author post-discharge. Notably, follow-up data compilation was carried out impartially by medical professionals unaffiliated with the surgical teams.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHU measurement\u003c/b\u003e:Before surgery, all patients underwent comprehensive CT scans coupled with 3D reconstruction technology (Siemens, Germany; employing a voltage of 120 kV and a current of 150mAs). Subsequently, HU values were automatically derived utilizing the Image Archiving and Communication System (PACS). Adhering to the previously outlined methodology \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, HU measurements were precisely conducted via CT scanning. Specifically, the HU value for the end plate was ascertained by designating the upper and lower end plates as the regions of interest (ROI). Meanwhile, the average HU for each vertebral body was derived by averaging the HU values obtained from the axial planes situated below the upper endplate, centrally within the vertebral body, and above the lower endplate. During ROI selection, utmost care was taken to encompass maximal trabecular bone, meticulously avoiding cortical bone and any heterogeneous regions, including cortical bone margins, osteophytes, and areas of osteosclerosis. To ensure accuracy, each data point was measured three times and the results were averaged. Consequently, the average HU value derived from these three ROIs was considered representative of the HU value for an individual vertebra.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBiomechanical analysis\u003c/strong\u003e\u003cp\u003eBased on the CT values of cervical spondylosis patients of different genders and ages, a cervical spine finite element model that is closer to the bone quality and shape of clinically degenerated cervical vertebrae is established to validate the effectiveness of the model. This model is further utilized to simulate ACCF surgery of a single cervical vertebra segment, during which CT values are assigned to the inferior vertebral body. The stresses of the superior endplate of the inferior vertebral body under various CT values are recorded and evaluated during flexion, extension, lateral flexion, and rotation (i.e., anterior left, middle left, posterior left, anterior middle, midcenter, posterior middle, anterior right, middle right, and posterior right).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003cp\u003eCategorical variables are expressed in absolute numbers and percentages, and continuous variables are expressed in mean standard deviation. The Shapiro-Wilk test was used to verify the normal distribution of continuous variables. Independent samples t-test was used to analyze variables following normal distribution. The test for nonconformity to normal distribution is the rank sum test. Categorical data (sex, disease, surgical segment) were tested by c2 test. Follow-up data, such as VAS, JOA, NDI,were obtained using a repeated-measures analysis of variance analysis. The predicted value of TMC/3D-PAVB subsidence was evaluated by the receiver operating characteristic (ROC) curve, and the area under the curve was calculated. The ROC curve was used to establish the most appropriate threshold (cut value) for HU with high sensitivity and specificity. SPSS software (version 22, USA) was used for statistical analysis. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered a statistically significant difference.Based on the results of the logistic regression model, Restricted Cubic Spline( R Version 4.2.3 package rms) is used to explore the linear relation between HU value in the cervical vertebral body and subsidence after ACCF.\u003c/p\u003e\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cstrong\u003eDemographic Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe TMC group comprised 41 males and 45 females, with a mean age of 59.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98 years, exhibiting a subsidence rate of 34.1%. In contrast, the 3D-PAVB group had 66 patients, including 36 males and 30 females, with a mean age of 56.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08 years and a subsidence rate of 28.8%.Statistical analysis revealed significant disparities in age and CT values of the inferior vertebral body between the two groups (P\u003csub\u003eTMC\u003c/sub\u003e=0.012, P\u003csub\u003e3D\u0026thinsp;\u0026minus;\u0026thinsp;PAVB\u003c/sub\u003e=0.020). However, no notable differences were observed in terms of gender, body mass index (BMI), prevalence of diabetes and hypertension, disease type, surgical segment involved, operative duration, hospital stay duration,or blood loss between the TMC group and the 3D-PAVB group(Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).Afterwards, we conducted an intergroup comparison of the subsidence patients from the two groups. The results indicated that there were no statistically significant differences in age, gender, BMI, disease type, surgical segments, operative time, hospital stay, blood loss, comorbid conditions (such as diabetes and hypertension), and CT values between the titanium mesh group and the 3D-printed artificial vertebral body group(Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic and surgery characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTMC Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e3D-PAVB Group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubsidence Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-subsidence Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubsidence Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-subsidence Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo.of patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003cp\u003e(kg/m\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisease type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emyelopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eradicular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.69\u0026thinsp;\u0026plusmn;\u0026thinsp;33.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.32\u0026thinsp;\u0026plusmn;\u0026thinsp;25.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108.68\u0026thinsp;\u0026plusmn;\u0026thinsp;34.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.17\u0026thinsp;\u0026plusmn;\u0026thinsp;41.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of stay(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood loss(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124.48\u0026thinsp;\u0026plusmn;\u0026thinsp;124.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e133.93\u0026thinsp;\u0026plusmn;\u0026thinsp;141.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171.05\u0026thinsp;\u0026plusmn;\u0026thinsp;223.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143.40\u0026thinsp;\u0026plusmn;\u0026thinsp;156.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT values of the upper vertebral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e326.84\u0026thinsp;\u0026plusmn;\u0026thinsp;64.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e423.56\u0026thinsp;\u0026plusmn;\u0026thinsp;82.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e342.00\u0026thinsp;\u0026plusmn;\u0026thinsp;87.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e353.58\u0026thinsp;\u0026plusmn;\u0026thinsp;74.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT values of the lower vertebral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251.44\u0026thinsp;\u0026plusmn;\u0026thinsp;61.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e346.33\u0026thinsp;\u0026plusmn;\u0026thinsp;71.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251.39\u0026thinsp;\u0026plusmn;\u0026thinsp;52.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e317.06\u0026thinsp;\u0026plusmn;\u0026thinsp;73.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGroup comparison of demographic and surgery characteristics in subsidence\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTMC Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3D-PAVB Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI(kg/m2 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisease type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emyelopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eradicular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.69\u0026thinsp;\u0026plusmn;\u0026thinsp;33.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108.68\u0026thinsp;\u0026plusmn;\u0026thinsp;34.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of stay(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood loss(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124.48\u0026thinsp;\u0026plusmn;\u0026thinsp;124.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171.05\u0026thinsp;\u0026plusmn;\u0026thinsp;223.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT values of the upper vertebral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e326.84\u0026thinsp;\u0026plusmn;\u0026thinsp;64.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e342.00\u0026thinsp;\u0026plusmn;\u0026thinsp;87.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT values of the lower vertebral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251.44\u0026thinsp;\u0026plusmn;\u0026thinsp;61.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251.39\u0026thinsp;\u0026plusmn;\u0026thinsp;52.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eClinical results\u003c/strong\u003e: In comparison to preoperative assessments, the JOA, VAS, and NDI scores of both groups displayed marked improvements at 3 days,3 months post-operatively,as well as during the final follow-up period.Nevertheless,no statistically significant intergroup differences were discernible(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). However, when focusing specifically on the comparison between groups for patients experiencing sinking,a distinct statistical significance emerged in VAS scores favoring either the TMC group or the 3D-PAVB group, while such distinction was absent in JOA and NDI scores(Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eTMC Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e3D-PAVB Group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubsidence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-\u003c/p\u003e\n \u003cp\u003esubsidence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubsidence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-\u003c/p\u003e\n \u003cp\u003esubsidence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months after the operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe fnal follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.81\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with preoperative\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGroup comparison of clinical parameters in subsidence\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTMC Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3D-PAVB Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3months after the operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe fnal follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of statistical curves\u003c/strong\u003e: Using independent risk factors, we performed ROC curve analysis. The sensitivity and specificity of the cut values and area under the curve (AUC) were calculated. The optimal intersection of specificity and sensitivity was used to obtain the cut point from the ROC curve. According to the ROC curve, the cutting point of the lower vertebral body was 275HU (sensitivity:87.5%; Specificity:79.3%) in TMC group and 272HU (sensitivity:78.9%; Specificity: 74.5%) in 3D-PAVB group.By comparison, the area under the ROC curve of the TMC group was AUC\u0026thinsp;=\u0026thinsp;0.866, and the 3D-PAVB group was AUC\u0026thinsp;=\u0026thinsp;0.772(Figure\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Using the R software, pROC package, Delong test of the area under the ROC curve of TMC group and 3D-PAVB group, using\u0026alpha;\u0026thinsp;=\u0026thinsp;0.05 as the test level, p\u0026thinsp;=\u0026thinsp;0.2332\u0026thinsp;\u0026gt;\u0026thinsp;0.05, so the effect of the replacement materials in ACCF surgery was considered to be not statistically significant on subsidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable5 \u0026nbsp;Predicted value of the Restricted Cubic Spline (RCS)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 267px;\"\u003e\n \u003cp\u003eTMC Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 268px;\"\u003e\n \u003cp\u003e3D-PAVB Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003ePreoperative CT value（HU）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003ePreoperative CT value（HU）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 550px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e242.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e9.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(3.257,29.270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e242.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(2.176,31.866)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e243.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e9.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(3.160,26.949)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e243.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(2.175,31.710)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e244.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e8.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(3.062,24.858)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e244.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(2.172,31.507)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e245.844\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.250\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(2.963,22.970)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e245.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(2.168,31.256)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e247.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e7.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(2.865,21.263)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e247.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(2.168,31.256)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 550px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e305.679\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.999,1.017)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e305.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.103,1.530)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e306.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(0.952,1.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e306.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.085,1.421)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 267px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e307.366\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.187\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.067 1.322)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e308.172\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(0.891,1.010)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e308.425\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.136\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.049,1.229)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e309.418\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(0.834,1.017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e309.484\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.087\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.032,1.144)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e310.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(0.781,1.025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e310.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e(1.015,1.066)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e311.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.870\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e(0.732,1.033)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e311.602\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.996\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.993,0.998)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBased on the results of the logistic regression model, Restricted Cubic Spline( R Version 4.2.3 package rms) is used to explore the linear relation between HU value in the cervical vertebral body and subsidence after ACCF.OR\u0026gt; 1 indicates a positive correlation between CT values and plant settlement, and OR \u0026lt;1 indicates a negative correlation between CT values and settlement. The TMC cut-off point/inflection point is 305.68HU; The 3D-PAVB cut-off point/ inflection point is 311.60HU. \u0026alpha; =0.05 as the test level.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e1.Titanium mesh and artificial vertebral body have equivalent clinical effects in ACCF surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eACCF surgery constitutes a prevalent therapeutic approach for cervical degenerative disorders, with autologous iliac crest, titanium mesh, PEEK material, and other internal implants being frequently utilize\u003csup\u003e[15-16]\u003c/sup\u003e. TMC, manufactured by Medtronic (USA), is extensively adopted in clinical settings due to its robust strength, hollow mesh design, ability to promptly achieve stability reconstruction\u003csup\u003e\u0026nbsp;[17]\u003c/sup\u003e. Our application of TMC in ACCF surgery has yielded satisfactory clinical outcomes(Figure 3).However, the titanium mesh necessitates a substantial amount of bone grafting, necessitating intraoperative adjustments to prune it to the appropriate size, thereby prolonging the operation time. The sharp edges resulting from pruning may potentially damage the endplate, leading to the settlement of the internal implant material. Ji et al\u003csup\u003e[18]\u003c/sup\u003e demonstrated that the contact between the titanium mesh and endplate is point contact, making it susceptible to endplate collapse and the settlement of the titanium mesh. Consequently, some patients may experience neurological symptoms and accelerated degeneration of adjacent segments\u003csup\u003e[19]\u003c/sup\u003e. 3D-PAVB(manufactured by Beijing Aikang Yicheng Medical Equipment Co, LTD, China) features a porous structure that facilitates surface contact with bone material, enhancing its ability to integrate with surrounding bone tissue\u003csup\u003e[20-21]\u003c/sup\u003e. This promotes bone fusion, minimizing implant settlement and effectively maintaining cervical spine height and physiological curvature. The technology was initially utilized in spinal tumor surgery and achieved commendable therapeutic outcomes\u003csup\u003e[22]\u003c/sup\u003e.Considering the drawbacks associated with titanium mesh and the proven efficacy of artificial vertebral bodies in spinal tumor cases, where the artificial vertebral body eliminates the need for pruning and offers a variety of models tailored to individual patients, we have attained satisfactory outcomes in ACCF surgery through the utilization of 3D-PAVB（Figure 4）.Our study demonstrated that both materials can attain immediate stability of surgical segments and exhibit satisfactory clinical outcomes, including JOA and VAS scores, following ACCF surgery. In the titanium mesh group, prosthesis subsidence was observed with a rate of 34.10%, compared to 28.80% in the 3D printed artificial vertebra group. However, this difference in subsidence rate was not statistically significant, aligning with findings reported in certain studies \u003csup\u003e[23-27]\u003c/sup\u003e. No statistically significant disparities were noted between the groups in terms of gender, BMI, diabetes, hypertension, disease type, surgical segment, operation time, hospital stay duration, or blood loss. Early implant subsidence was observed in both groups, and there were significant differences in age and CT values within both groups (P\u003csub\u003eTMC\u003c/sub\u003e=0.01, P\u003csub\u003e3D-PAVB\u003c/sub\u003e=0.02). However, comparison between the groups showed no statistically significant differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.Preoperative CT values can guide the selection of implant materials for ACCF surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs aforementioned, both the TMC and 3D-PAVB groups exhibited early subsidence of internal plants. Consequently, we analyzed these two data sets to ascertain whether the disparity in plant material within the fusion segment correlated with premature settlement. Based on literature reviews, the subsidence of internal plant material generally takes place within a period of three months subsequent to the operation\u003csup\u003e[28-29]\u003c/sup\u003e. In our study, we established a criterion where a reduction in cervical intervertebral space height exceeding 3 mm within three months postsurgery was deemed significant.Studies have discovered a close correlation between early settlement and vertebral BMD, along with numerous methodologies for assessing BMD\u003csup\u003e[30-32]\u003c/sup\u003e. Literature indicates that there is a positive correlation between the CT value of cervical vertebral bodies and the bone mineral density (BMD) T-score obtained from Dual-energy X-ray(DXA) examinations. The HU value can accurately reflect the BMD of the patient's cervical spine, thereby assessing preoperative bone quality and predicting the subsidence of implant materials after anterior cervical fusion surgery\u003csup\u003e[33-36]\u003c/sup\u003e.Our study revealed that the HU of the upper and lower vertebrae in the subsidence groups was lower compared to the non-subsidence group. Furthermore, the CT value of the lower vertebra in the fusion segment emerged as an independent predictor of early subsidence during the postoperative period. The ROC curve CT threshold for the TMC Group was determined to be 272.65HU, whereas it was 275.17HU for the 3D-PAVB Group. According to the DeLong test on the area under the ROC curve (α=0.05, p=0.23), there was no statistically significant difference in early subsidence between the TMC Group and the 3D-PAVB Group. Potential reasons for this analysis may encompass a limited sample size, measurement inaccuracies, insufficient evaluation indicators, and the lack of an assessed fusion rate. Despite the absence of statistically significant differences in early subsidence between the two groups, we observed a linear correlation between the CT value of the fusion level and the subsidence of both materials.The restrictive cubic spline analysis revealed that for an OR greater than 1 and a preoperative CT value below 245.84 HU, the risk of subsidence rose as preoperative CT values decreased for both TMC and\u0026nbsp;3D-PAVB, with titanium mesh exhibiting a more substantial increase. Consequently,\u0026nbsp;3D-PAVB\u0026nbsp;are advisable in such instances. When the OR exceeds 1 and the preoperative CT value lies between 245.84 HU and 306.93 HU, the risk of subsidence increases with decreasing preoperative CT values for both implants, yet this augmentation is more evident in\u0026nbsp;3D-PAVB, rendering TMC the preferred option. For CT values within the range of 306.93 HU to 311.60 HU, the TMC group exhibited an OR less than 1 (contrasting with an OR greater than 1 for the\u0026nbsp;3D-PAVB\u0026nbsp;group), suggesting that the CT value acts as a protective factor against subsidence, thereby recommending TMC. When the CT value surpasses 311.60 HU, both TMC and\u0026nbsp;3D-PAVB\u0026nbsp;groups display an OR less than 1, indicating that either implant can fulfill clinical requirements(Table5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.Biomechanical Analysis Based on Cervical Spine Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevious studies on cervical spine biomechanics have referenced models established using cervical spine parameters from normal individuals. To date, we have not found any reports using CT-assigned values to establish finite element models of the cervical spine for analyzing the biomechanical changes of implant materials. However, this approach may be closer to clinical practice and more instructive. Therefore, we initially analyzed the CT values of over 900 cervical spondylosis patients to establish a finite element model of the cervical spine based on CT values and validated its effectiveness. Subsequently, we analyzed the biomechanics of surgical segments of two materials at different CT values.Our research results indicate that, using the same material, the biomechanical strength of the superior endplate of the inferior vertebra within the fusion segment progressively augments as the CT value diminishes. This aligns with our clinical findings and corroborates the results documented in the literature\u003csup\u003e[37-40]\u003c/sup\u003e.Furthermore, under identical CT values, during flexion movements, the titanium mesh exhibits smaller stress values compared to the artificial vertebral body at the left posterior, anteromedial, and right posterior locations, whereas it displays larger stress values in other positions. During extension movements, the titanium mesh demonstrates lower stress values than the artificial vertebral body at the anteromedial and middle posterior sites, with higher stress values observed in the remaining positions. During lateral bending, the stress values of the titanium mesh are smaller than the artificial vertebral body at the anteromedial, middle posterior, and right posterior positions, while they are larger at other positions. The above results suggest that the stresses on the two materials during ACCF surgery are comparable, with the titanium mesh performing slightly inferior.During rotation, the stress values of the titanium mesh are smaller than those of the artificial vertebral body in all directions.This result may suggest to us that the biomechanical strength of the titanium mesh is better, which is an interesting thing, and we need to collect sufficient clinical data to further explain this phenomenon(Figure 2).\u003c/p\u003e\n\u003cp\u003eThis study has two characteristics.First,the feature of this study is on the early subsidence of titanium mesh and artificial cone after ACCF surgery based on CT value. In addition, the finite element model of cervical spondylosis patients is more close to the actual clinical situation for biomechanical analysis.\u003c/p\u003e\n\u003cp\u003eHowever, there are still many deficiencies, such as the relatively small sample size, the short follow-up time, a retrospective study. Future studies with large sample, prospective and long-term follow-up are needed to further evaluate the application value of the two materials in cervical ACCF surgery, and to study the biomechanical conditions of different materials, different ages and different gender, especially the experimental data under rotation conditions with hierarchical research method.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, despite neither material demonstrating statistical significance for early subsidence, the preoperative CT value can still serve as a guide for selecting vertebral substitute materials. Furthermore, it allows for the determination of a cut-off point based on the estimated OR value derived from the model. Specifically, if the CT value dips below 245.84HU, the employment of 3D-PAVB is advisable. Within the range of 245.84HU to 311.60HU, TMC is recommended. When the CT value surpasses 311.60HU, both materials are viable options.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACCF:Anterior Cervical Corpectomy and Fusion; TMC:titanium mesh;3D-PAVB:3D-Print Artificial Vertebral Body;VAS:Visual Analog Scale; JOA:Japanese Orthopedic Association;NDI:Neck Disability Index;CT:Computed Tomography;HU:Hounsfeld Units;ROC: Receiver Operating;RCS:Restricted Cubic Spline;FEM:Finite Element Method;OR:Odds Ratio;BMD:Bone Mineral Density;QCT:Quantitative Computed Tomography;MRI:Magnetic Resonance Imaging; PACS:The Picture Archiving and Communication System;ROI:Region Of Interest;AUC:Area Under The Curve;DXA:Dual-energy X-ray;\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e:All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e All authors agree to submit the article without any competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Funding:\u003c/strong\u003eThis work was supported by the National Key Research and Development Plan (2022YFC3601900 and 2022YFC3601904).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe authors confirm that all experiment datas were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki).It has passed the ethical review of the author's unit. Ethical approval was obtained from the Institutional Ethics Committee of author’s Hospital. All patients signed the informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review:\u0026nbsp;\u003c/strong\u003eNot commissioned, externally peer-reviewed\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:.None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYu, Chen,Deyu, Chen,Yongfei, Guo et al. Subsidence of titanium mesh cage: a study based on 300 cases.[J] .J Spinal Disord Tech, 2008, 21: 489-92.\u003c/li\u003e\n\u003cli\u003eMingjie, Dong,Yingjie, Gao,Hao, Fan et al. Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis.[J] .Front Oncol, 2024, 14: 1327319.\u003c/li\u003e\n\u003cli\u003eH,Zhou,R J, Wang,Z J, Liu et al. 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Single-Level Anterior Cervical Corpectomy and Fusion Using a New 3D-Printed Anatomy-Adaptive Titanium Mesh Cage for Treatment of Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Retrospective Case Series Study.[J] .Med Sci Monit, 2017, 23: 3105-3114.\u003c/li\u003e\n\u003cli\u003eHaiyang, Cheng,Gan, Luo,Dan, Xu et al. Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with Titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis.[J] .Front Surg, 2023, 9: 1077551. \u003c/li\u003e\n\u003cli\u003eHaoyu, He,Lei, Fan,Guohua, L\u0026uuml; et al. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion?[J] .BMC Musculoskelet Disord, 2024, 25: 96. \u003c/li\u003e\n\u003cli\u003eY W, Li,X Z, Li,S F, Gu et al. 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Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck.[J] .Clin Spine Surg, 2019, 33: E58-E62. \u003c/li\u003e\n\u003cli\u003eMary Lucy, Marques,Nuno, Pereira da Silva,Desir\u0026eacute;e, van der Heijde et al. Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis.[J] .RMD Open, 2022, 8: \u003c/li\u003e\n\u003cli\u003eHE Lei,Zhou Fei fei,LI Shu yang,et al.Application of CT value of cervical vertebral body in preoperative bone quality assessment of patients with cervical degenerative diseases.[J] .Orthopaedics, 2019, 10(4):293-297.\u003c/li\u003e\n\u003cli\u003eHo Jin, Lee,Soon Tae, You,Jung Hee, Kim et al. 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Topological design and biomechanical evaluation for 3D printed multi-segment artificial vertebral implants.[J] .Mater Sci Eng C Mater Biol Appl, 2021, 127: 112250.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anterior cervical corpectomy and fusion, titanium mesh cage, 3D-Print Artificial Vertebral Body, Subsidence, complication","lastPublishedDoi":"10.21203/rs.3.rs-7535092/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7535092/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo delve into the preliminary clinical outcomes and biomechanical characteristics of titanium mesh (TMC) alongside 3D printed artificial vertebrae body (3D-PAVB), subsequent to an anterior cervical corpectomy and fusion (ACCF) procedure, and thereby furnish a basis for informed selection of implantable materials in clinical ACCF surgeries.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA retrospective evaluation was conducted on data from a consecutive cohort of patients diagnosed with cervical degenerative disorders, who underwent ACCF surgery utilizing two distinct implant types: TMC and 3D-PAVB, at author\u0026rsquo;s Hospital, spanning July 2014 to August 2020.Clinical outcomes were quantified employing the Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA) scores, and Neck Disability Index (NDI).Pre-operative computed tomography (CT) scans of the upper and lower vertebrae encompassing the surgical segments were acquired and analyzed for both groups. Specifically, the Hounsfield Unit (HU) values pertaining to early surgical segment subsidence were assessed via Receiver Operating Characteristic (ROC) curve analysis. Leveraging the outcomes from a logistic regression model, the study applied Restricted Cubic Spline (RCS) analysis to elucidate the linear correlation between preoperative cervical vertebral body CT HU values and the occurrence of early subsidence post-ACCF.Furthermore, an investigation into the biomechanical strength alterations at interfaces between titanium mesh cages and artificial vertebral endplates with lower CT values was conducted, utilizing the Finite Element Method (FEM) for detailed simulation and analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere were 85 patients in the TMC group with a mean age of 59.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98 years (41 males and 44 females),compared to 66 patients in 3D-PAVB group with a mean age of 56.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08 years (36 males and 30 females).Both groups displayed marked enhancements in postoperative JOA, VAS, and NDI scores. Analysis of the ROC curve areas revealed distinct outcomes: 0.87 for the TMC group with a threshold of 275.17 (sensitivity:87.50%, specificity:79.30%), and 0.77 for the 3D-PAVB group at a threshold of 272.65(sensitivity:74.50% specificity:78.90%).No statistically significant disparities were noted between the groups in terms of gender, BMI, diabetes, hypertension, disease type, surgical segment, operation time, hospital stay duration, or blood loss. The rate of early implant subsidence was 34.10% in TMC group,compared to the 28.80% in 3D-PAVB group.Notably, despite the absence of statistically significant differences in early subsidence between the two groups, a linear correlation was observed between the CT value of the surgery level and the subsidence of both materials.Further,finite element analysis illuminated that a decrease in the CT value of the lower vertebra corresponded to heightened stress at the titanium mesh-endplate interface under flexion-extension, rotation, and lateral flexion conditions, emphasizing the significance of preoperative CT assessment in predicting postoperative outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUtilizing the TMC or 3D-PAVB, a clinically satisfactory outcomes can be achieved for ACCF surgery. The preoperative CT scan value serves as a pivotal guide in selecting alternative materials for reconstructing the fused vertebral segment. The decisive cut-off point is derived from the model-estimated shift in Odds Ratio(OR)value. Specifically, when the CT value falls below 245.84 HU,the employment of an artificial vertebral body is advocated.\u003c/p\u003e","manuscriptTitle":"A comparative study of titanium mesh and 3D-printed artificial vertebral body in cervical anterior cervical corpectomy and fusion (ACCF) based on clinical outcomes and biomechanical analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-18 17:42:25","doi":"10.21203/rs.3.rs-7535092/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5799f71-fca6-4d51-aac4-110bb00fe500","owner":[],"postedDate":"September 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T18:20:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-18 17:42:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7535092","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7535092","identity":"rs-7535092","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}