Biomechanical Effects of Different Surgical Approaches and Titanium Mesh Designs in Anterior Cervical Corpectomy: A Finite Element Engineering Review

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Anterior Cervical Corpectomy and Fusion (ACCF) is a well-established surgical procedure for managing cervical spine disorders requiring decompression and stabilization. Despite its widespread clinical use, postoperative complications—including implant failure, titanium mesh subsidence, and adjacent segment degeneration—remain important concerns. The reviewed study investigates how different anterior fixation techniques and titanium mesh configurations influence postoperative cervical biomechanics using finite element analysis. By comparing traditional anterior vertebral body screw-plate fixation and anterior cervical pedicle screw-plate fixation in combination with straight and curved titanium mesh cages, the research provides biomechanical evidence that may support more informed surgical decision-making. This review summarizes the study's methodology, principal findings, engineering contributions, and potential implications for spinal surgery and biomedical engineering.

Bibliographic Information

Item Information
Article Title Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study
Authors Dan Li; Ke Wang; Chao Dong; Lingyi Deng
Journal Engineering Reports
Volume 8
Issue 2
Publication Year 2026
Article Number e70621
DOI https://doi.org/10.1002/eng2.70621
Publisher John Wiley & Sons Ltd.
License Creative Commons Attribution License (CC BY)
ISSN Not provided by the publisher.
Keywords ACCF; anterior fixation; biomechanics; finite element; titanium mesh

1. Research Background

Anterior Cervical Corpectomy and Fusion (ACCF) has become one of the standard surgical procedures for treating cervical spinal disorders, including cervical fractures, tumors, disc herniation, and spinal stenosis. The procedure combines decompression with spinal reconstruction by replacing the removed vertebral body using titanium mesh while stabilizing the cervical spine through anterior fixation systems. Although ACCF generally produces favorable clinical outcomes, postoperative complications such as implant loosening, titanium mesh subsidence, stress concentration, and adjacent segment degeneration remain important biomechanical challenges.

Conventional ACCF most commonly employs the Anterior Vertebral Body Screw-Plate (AVBSP) fixation system. More recently, the Anterior Cervical Pedicle Screw-Plate (APSP) system has been introduced to provide stronger fixation because pedicle screws engage longer bone trajectories, potentially increasing postoperative stability. At the same time, titanium mesh cage technology has evolved from simple straight cylindrical cages to anatomically curved designs with end caps intended to improve load transfer and reduce cage subsidence.

Previous clinical and biomechanical investigations have independently examined fixation techniques and titanium mesh designs. However, relatively few studies have evaluated how different fixation methods interact with different titanium mesh geometries as an integrated surgical system. Since implant components function together rather than independently, understanding their biomechanical interactions is essential for optimizing surgical planning and reducing postoperative complications.

To address this gap, the reviewed study developed a comprehensive finite element model of the lower cervical spine (C3–C7) after ACCF surgery. Four combinations of anterior fixation systems and titanium mesh geometries were compared under multiple physiological loading conditions to evaluate vertebral motion, stress distribution, implant loading, and adjacent segment biomechanics.

Rather than relying solely on clinical observations, the research employs computational biomechanics to investigate internal mechanical behavior that cannot easily be measured in vivo. The findings provide engineering evidence supporting the selection of implant combinations capable of improving postoperative stability while minimizing biomechanical risks.

2. Research Objective

  • To investigate the biomechanical effects of different anterior fixation systems used in Anterior Cervical Corpectomy and Fusion (ACCF).
  • To compare the biomechanical performance of straight and curved titanium mesh cages combined with different fixation approaches.
  • To establish a validated finite element model capable of simulating postoperative cervical spine biomechanics.
  • To evaluate vertebral displacement, stress distribution, adjacent intervertebral disc loading, and implant biomechanics under multiple cervical movements.
  • To identify surgical combinations that improve postoperative cervical stability while reducing implant stress and the risk of postoperative complications.

3. Why This Research Matters

  • Improves evidence-based surgical planning. The study compares multiple implant combinations rather than evaluating fixation systems independently, providing surgeons with more comprehensive biomechanical information.
  • Supports implant optimization. Understanding how titanium mesh geometry interacts with fixation systems contributes to better implant design and selection.
  • Reduces postoperative complications. Lower implant stress and improved load distribution may decrease the likelihood of titanium mesh subsidence, implant failure, and adjacent segment degeneration.
  • Advances computational biomechanics. The validated finite element model demonstrates how engineering simulation can complement experimental and clinical investigations.
  • Bridges engineering and clinical practice. The research illustrates how biomechanical simulation can directly inform surgical decision-making and orthopedic implant development.

4. Research Methodology

The study employed a computational biomechanics approach using finite element analysis (FEA) to investigate the biomechanical behavior of the cervical spine following Anterior Cervical Corpectomy and Fusion (ACCF). Four postoperative reconstruction strategies were evaluated by combining two anterior fixation systems with two titanium mesh cage geometries. The numerical simulations assessed vertebral displacement, stress distribution, implant loading, and adjacent segment biomechanics under physiological cervical movements. The overall workflow included three-dimensional model construction, finite element model development, validation, loading simulation, and comparative biomechanical analysis.

Research Design

  • Comparative finite element analysis of four ACCF surgical configurations.
  • Evaluation of postoperative biomechanics under physiological loading conditions.
  • Comparison of fixation systems and titanium mesh geometries.

Finite Element Model Development

A three-dimensional model of the lower cervical spine (C3–C7) was established using anatomical data and reconstructed with dedicated three-dimensional modeling software. The model incorporated cortical bone, cancellous bone, endplates, annulus fibrosus, nucleus pulposus, facet cartilage, ligaments, titanium plates, screws, and titanium mesh cages. Material properties were assigned according to published biomechanical parameters to reproduce realistic mechanical behavior.

Two anterior fixation systems were investigated. The first employed the conventional Anterior Vertebral Body Screw-Plate (AVBSP) configuration, while the second used the Anterior Cervical Pedicle Screw-Plate (APSP) system. Each fixation approach was combined with either a straight titanium mesh cage or a curved titanium mesh cage equipped with end caps, resulting in four different surgical models:

  • AVBSP + Straight Titanium Mesh (AVBSP-S)
  • AVBSP + Curved Titanium Mesh (AVBSP-C)
  • APSP + Straight Titanium Mesh (APSP-S)
  • APSP + Curved Titanium Mesh (APSP-C)

Mesh Generation and Material Assignment

The cervical spine model was discretized into more than one million tetrahedral finite elements with additional triangular surface elements. Separate material properties were assigned to cortical bone, cancellous bone, intervertebral discs, cartilage, titanium plates, screws, and titanium mesh cages. Ligaments were represented using nonlinear load-deformation relationships to better reproduce physiological spinal behavior.

Boundary Conditions and Loading

The inferior surface of the C7 vertebra was fixed to simulate physiological support. A compressive load representing the weight of the human head was applied to the superior surface of C3 together with a bending moment to reproduce six physiological cervical motions:

  • Flexion
  • Extension
  • Left lateral bending
  • Right lateral bending
  • Left axial rotation
  • Right axial rotation

Model Validation

Prior to evaluating the surgical models, the finite element model was validated by comparing simulated cervical range of motion with previously published experimental biomechanical data. The predicted segmental motion remained within accepted deviation ranges, supporting the reliability of the computational model for postoperative biomechanical analysis.

Biomechanical Evaluation

The simulations evaluated several biomechanical indicators, including vertebral displacement, equivalent stress within adjacent intervertebral discs, stress distribution across vertebral endplates, implant stress, titanium mesh loading, and screw fixation behavior. These variables enabled comprehensive comparison of the four reconstruction strategies under identical physiological loading conditions.

5. Key Findings

Finite Element Model Successfully Represented Postoperative Cervical Biomechanics

The validated finite element model reproduced physiological cervical motion within acceptable experimental ranges, indicating that the numerical simulations provided a reliable platform for evaluating different ACCF reconstruction strategies.

All Surgical Configurations Maintained Postoperative Stability

Both anterior fixation systems effectively stabilized the operated cervical segments. Although slight differences in vertebral displacement were observed, all four surgical models maintained satisfactory postoperative stability throughout flexion, extension, lateral bending, and axial rotation.

Titanium Mesh Geometry Influenced Adjacent Segment Biomechanics

The geometry of the titanium mesh affected stress transmission to adjacent intervertebral discs. Curved titanium mesh generally reduced stress concentrations during flexion, whereas straight titanium mesh produced lower stress under certain extension conditions. These findings indicate that cage geometry influences postoperative load transfer depending on cervical motion.

Anterior Fixation Method Altered Implant Stress Distribution

The choice of fixation system substantially influenced stress distribution within titanium plates, screws, and titanium mesh cages. Different screw trajectories generated distinct stress concentration patterns on vertebral endplates and implant components, demonstrating that fixation design plays an important role in postoperative biomechanics.

Curved Titanium Mesh Combined with AVBSP Showed Favorable Mechanical Performance

Among the evaluated reconstruction strategies, the combination of curved titanium mesh with the conventional anterior vertebral body screw-plate system generally produced lower overall implant stress. This configuration demonstrated a more balanced mechanical load distribution, suggesting potential advantages for reducing implant-related complications.

Adjacent Segment Loading Varied According to Surgical Configuration

Stress within the adjacent nucleus pulposus changed according to both fixation approach and titanium mesh geometry. Although stress patterns remained similar across cervical motions, the magnitude of loading differed among the four surgical strategies, indicating that implant selection influences postoperative biomechanics beyond the operated segment.

Stress Concentrations Were Movement Dependent

Flexion generally produced the highest stress within adjacent intervertebral discs, whereas lateral bending and rotational movements generated different stress concentration locations on vertebral endplates and fixation components. These findings emphasize that cervical movement strongly affects implant biomechanics after ACCF surgery.

6. Scientific Contribution

  • Provides an integrated biomechanical comparison. The study simultaneously evaluates fixation systems and titanium mesh geometries rather than examining each implant independently.
  • Advances finite element applications in spinal biomechanics. The validated computational model offers a reliable framework for investigating postoperative cervical spine mechanics.
  • Clarifies implant interaction. The research demonstrates that the biomechanical performance of titanium mesh depends not only on cage geometry but also on the selected fixation method.
  • Improves understanding of postoperative stress transfer. The study illustrates how implant configuration influences vertebral loading, adjacent segment biomechanics, and stress concentration throughout physiological cervical motion.
  • Supports engineering-driven implant development. The findings provide biomechanical evidence that can guide future optimization of cervical fixation systems and fusion devices.
  • Contributes to computational surgical planning. The numerical approach offers engineers and clinicians an efficient tool for evaluating implant performance before clinical implementation.

    • 7. Industrial Implications

    • Supports evidence-based spinal implant selection. The biomechanical comparison provides surgeons and biomedical engineers with quantitative information for selecting combinations of anterior fixation systems and titanium mesh cages that best suit specific clinical situations.
    • Improves implant design. Understanding stress distribution within screws, plates, and titanium mesh can assist medical device manufacturers in developing cervical fixation systems with enhanced mechanical performance and durability.
    • Reduces implant-related complications. Surgical configurations that minimize stress concentration may lower the risks of titanium mesh subsidence, implant loosening, hardware failure, and adjacent segment degeneration.
    • Enhances computer-aided surgical planning. Finite element simulation offers a practical engineering tool for evaluating implant performance before surgery, supporting personalized treatment strategies.
    • Accelerates medical device development. Computational analysis enables engineers to compare multiple implant configurations efficiently while reducing dependence on expensive experimental testing during product development.
    • Encourages interdisciplinary collaboration. The research demonstrates how mechanical engineering, computational simulation, and orthopedic surgery can be integrated to improve spinal healthcare technologies.

    8. Research Limitations

    • The study relies exclusively on finite element simulations and does not include experimental or clinical validation of the four postoperative reconstruction strategies.
    • The finite element model represents a single cervical spine geometry and therefore may not capture patient-specific anatomical variations encountered in clinical practice.
    • Only two anterior fixation systems and two titanium mesh geometries were investigated. Other implant designs and fixation techniques were outside the scope of the study.
    • The simulations considered physiological loading conditions but did not evaluate long-term biological responses such as bone remodeling, fusion progression, implant wear, or tissue healing.
    • Material properties were assumed to be homogeneous and isotropic, which simplifies the complex mechanical behavior of biological tissues.
    • The numerical analysis focused primarily on biomechanical performance and did not include clinical outcomes such as neurological recovery, pain reduction, or patient quality of life.

    9. Future Research Opportunities

    • Validate the numerical findings through laboratory biomechanical experiments using cadaveric cervical spine specimens.
    • Conduct prospective clinical studies to determine whether the predicted biomechanical advantages translate into improved postoperative outcomes.
    • Develop patient-specific finite element models using medical imaging to support personalized surgical planning.
    • Investigate additional fixation systems, cage geometries, biomaterials, and surface treatments for cervical reconstruction.
    • Evaluate long-term implant behavior by incorporating bone remodeling, fusion processes, fatigue loading, and implant wear into computational simulations.
    • Integrate musculoskeletal modeling with finite element analysis to simulate realistic muscle forces during daily cervical movements.
    • Apply optimization algorithms and artificial intelligence to identify implant configurations that maximize stability while minimizing stress concentrations.
    • Examine biomechanical responses in patients with osteoporosis, severe spinal deformities, multilevel cervical disease, and other complex clinical conditions.
    • Perform comparative investigations between ACCF and other cervical reconstruction procedures using standardized biomechanical evaluation methods.

    10. Potential for Public Policy Citation

    Although the study focuses primarily on computational biomechanics rather than healthcare policy, its findings have potential relevance for evidence-based clinical guidelines concerning cervical spine reconstruction. The biomechanical comparison of fixation systems and titanium mesh configurations may assist professional medical organizations in developing recommendations for implant selection and postoperative stabilization strategies. In addition, the research demonstrates the value of engineering simulation in medical device evaluation, supporting broader adoption of computational modeling within regulatory science and medical technology assessment. Hospitals, healthcare providers, and medical device manufacturers may also benefit from incorporating validated finite element analysis into preclinical implant evaluation and design optimization processes.

    11. Who Should Read This Paper?

    • Orthopedic spine surgeons
    • Neurosurgeons specializing in spinal disorders
    • Biomedical engineers
    • Biomechanics researchers
    • Finite element analysis specialists
    • Medical device engineers
    • Researchers in computational mechanics
    • Graduate students in biomedical and mechanical engineering
    • Developers of spinal fixation systems
    • Healthcare professionals interested in spinal implant technologies

    12. Final Thoughts

    This study presents a comprehensive finite element investigation of how anterior fixation techniques and titanium mesh geometries influence the biomechanical performance of the cervical spine following Anterior Cervical Corpectomy and Fusion. By comparing four different reconstruction strategies under multiple physiological loading conditions, the research demonstrates that implant configuration substantially affects stress distribution, vertebral stability, and adjacent segment biomechanics. The findings suggest that selecting compatible fixation systems and titanium mesh designs may reduce implant stress while improving postoperative mechanical stability.

    Beyond its immediate clinical relevance, the study highlights the growing role of computational biomechanics in modern orthopedic engineering. The validated finite element framework provides an efficient platform for evaluating implant performance before clinical application, supporting safer implant development and evidence-based surgical planning. As numerical simulation continues to advance alongside biomedical engineering, studies of this type are expected to play an increasingly important role in optimizing spinal reconstruction technologies.

    13. Suggested Citations

    Teknomekanik (UNP)

    Li, D., Wang, K., Dong, C., & Deng, L. (2026). Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study. Engineering Reports, 8(2), e70621. https://doi.org/10.1002/eng2.70621

    APA (7th Edition)

    Li, D., Wang, K., Dong, C., & Deng, L. (2026). Biomechanical effects of different approaches and titanium mesh in combined anterior cervical corpectomy decompression and fusion: A finite element study. Engineering Reports, 8(2), e70621. https://doi.org/10.1002/eng2.70621

    IEEE Style

    D. Li, K. Wang, C. Dong, and L. Deng, "Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study," Engineering Reports, vol. 8, no. 2, Art. no. e70621, 2026, doi:10.1002/eng2.70621.

    Harvard Style

    Li, D., Wang, K., Dong, C. & Deng, L., 2026. Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study. Engineering Reports, 8(2), e70621. Available at: https://doi.org/10.1002/eng2.70621.

    Vancouver Style

    Li D, Wang K, Dong C, Deng L. Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study. Engineering Reports. 2026;8(2):e70621. doi:10.1002/eng2.70621.

    Chicago (Author–Date)

    Li, Dan, Ke Wang, Chao Dong, and Lingyi Deng. 2026. "Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study." Engineering Reports 8 (2): e70621. https://doi.org/10.1002/eng2.70621.

    MLA (9th Edition)

    Li, Dan, et al. "Biomechanical Effects of Different Approaches and Titanium Mesh in Combined Anterior Cervical Corpectomy Decompression and Fusion: A Finite Element Study." Engineering Reports, vol. 8, no. 2, 2026, article e70621. Wiley, https://doi.org/10.1002/eng2.70621.

    14. Editorial Note

    This article is an independent scholarly review prepared for Engineering Research Insights. The review is intended to summarize and communicate the engineering significance of the published research while encouraging wider academic discussion. Readers are strongly encouraged to consult and cite the original peer-reviewed article when conducting research, preparing scientific publications, or applying the reported findings in academic or professional practice.

    15. SEO Meta Description

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    16. SEO Keywords

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