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Extragraft bone formation is crucial for obtaining a successful outcome after spinal fusion surgery. However, the cause of bone formation is not well investigated. In this study, it was hypothesised that extragraft bone formation is generated by mechanical stimuli. A preoperative plan for anterior cervical discectomy and fusion was applied to the finite element model of the C5–C6 motion segment. Extragraft bone formations posterior to the interbody cage were simulated using simultaneous and sequential algorithms. While the simultaneous algorithm predicted the formation of extragraft bone bridging under flexion and extension, the bridge was generated only under extension with the sequential algorithm. This was caused by an ill-defined design space in cases where the simultaneous algorithm was used. Our results using the sequential algorithm show how the progress of extragraft bone formation affects spine mechanics, and our results support the hypothesis that a mechanical stimulus is a major factor influencing extragraft bone formation.

Comparison of Extragraft Bone Formation after Anterior Cervical Discectomy and Fusion Using Simultaneous and Sequential Algorithms