Comparison of Cervical Spine Biomechanics After Fixed- and Mobile-Core Artificial Disc Replacement

Lee, Sang Hun; Im, Yang Jin; Kim, Ki Tack; Kim, Yoon Hyuk; Park, Won Man; Kim, Kyung-Soo

doi:10.1097/brs.0b013e3181f5cb87

Cited by 142 publications

(84 citation statements)

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“…Modest increases (2-15 %) were observed at the Prodisc-C treated level in a finite element study [28]. An apparent increase of facet joint force and ligament tension was also reported at the operative segments [8]. Unlike the fusion condition, the hyper-mobility of the operative site was reversely compensated by a reduced ROM at the adjacent site.…”

Section: Discussionmentioning

confidence: 91%

“…The majority of these artificial discs adopt polymer-on-metal or metal-on-metal design to form a sliding articulation. Despite that these artificial discs have exhibited satisfactory clinical performance, biomechanical studies have shown that the sliding articulation may not well control the motion that will induce hyper-mobility at the operative segment [6][7][8], and the ligament tension was increased in this situation [8]. The wear debris, which was associated with chronic inflammation, was an inevitable situation caused by the sliding articulation design [9].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue

Zhao

Wang

et al. 2013

Eur Spine J

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Purpose Various design concepts have been adopted in cervical disc prostheses, including sliding articulation and standalone configuration. This study aimed to evaluate the biomechanical effects of the standalone U-shaped configuration on the cervical spine. Methods Based on an intact finite element model of C3-C7, a standalone U-shaped implant (DCI) was installed at C5-C6 and compared with a sliding articulation design (Prodisc-C) and an anterior fusion system. The range of motion (ROM), adjacent intradiscal pressure (IDP) and capsular ligament strain were calculated under different spinal motions. Results Compared to the intact configuration, the ROM at C5-C6 was reduced by 90 % after fusion, but increased by 70 % in the Prodisc-C model, while the maximum percentage change in the DCI model was 30 % decrease. At the adjacent segments, up to 32 % increase in ROM happened after fusion, while up to 34 % decrease occurred in Prodisc-C model and 17 % decrease in DCI model. The IDP increased by 11.6 % after fusion, but decreased by 5.6 and 6.3 % in the DCI and Prodisc-C model, respectively. The capsular ligament strain increased by 147 % in Prodisc-C and by 13 % in the DCI model. The DCI implant exhibited a high stress distribution. Conclusions Spinal fusion resulted in compensatory increase of ROM at the adjacent sites, thereby elevating the IDP. Prodisc-C resulted in hyper-mobility at the operative site that led to an increase of ligament force and strain. The U-shaped implant could maintain the spinal kinematics and impose minimum influence on the adjacent soft tissues, despite the standalone configuration encountering the disadvantages of high stress distribution.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue

Zhao

Wang

et al. 2013

Eur Spine J

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“…The intervertebral disc ( Figure 2B) between 4 vertebrae was partitioned into the annulus fibrosus and the nucleus pulposus. The 5 volume of the annulus, which had a five-layered ground substance surrounded by 6 six-layered annulus fibers was about 60% of the total volume of the intervertebral disc 7 [2,26]. Six layers of netlike annulus fibers were positioned between 15° and 45°, 8 against the horizontal plane.…”

mentioning

confidence: 99%

“…Then, a model consisted of vertebral bodies and 11 intervertebral discs was constructed ( Figure 2C). Table 1 [2,20,21,26,[28][29][30]. C3D4 is the tetrahedral solid element with 19 four nodes, C3D8 is the hexahedral solid element with eight nodes, C3D10 is the 20 decahedral with ten nodes, T3D2 is the truss element with two nodes in the ABAQUS 21 software, and the total numbers of nodes and elements are 377,877 and 330,648.…”

mentioning

confidence: 99%

“…C3D4 is the tetrahedral solid element with 19 four nodes, C3D8 is the hexahedral solid element with eight nodes, C3D10 is the 20 decahedral with ten nodes, T3D2 is the truss element with two nodes in the ABAQUS 21 software, and the total numbers of nodes and elements are 377,877 and 330,648. The two types of artificial disc prostheses were implanted at the C5-C6 level [26], 5 where CDR is most frequently performed ( Figure 2F). The intervertebral disc and The subsidence tendency is associated with high implant-bone interface stresses 18 and an inappropriate design of the prosthesis, leading to a stress increase of the CDR with the two prostheses did not affect ROM in the adjacent segments and 7 increased the ROM in the implanted segments.…”

mentioning

confidence: 99%

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A new cervical artificial disc prosthesis based on physiological curvature of end plate: a finite element analysis

Liu

Huang

et al. 2016

The Spine Journal

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Assessing the biofidelity of in vitro biomechanical testing of the human cervical spine

Wawrose

Howington

LeVasseur

et al. 2020

Journal Orthopaedic Research

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In vitro biomechanical studies of the osteoligamentous spine are widely used to characterize normal biomechanics, identify injury mechanisms, and assess the effects of degeneration and surgical instrumentation on spine mechanics. The objective of this study was to determine how well four standards in vitro loading paradigms replicate in vivo kinematics with regards to the instantaneous center of rotation and arthrokinematics in relation to disc deformation. In vivo data were previously collected from 20 asymptomatic participants (45.5 ± 5.8 years) who performed full range of motion neck flexion‐extension (FE) within a biplane x‐ray system. Intervertebral kinematics were determined with sub‐millimeter precision using a validated model‐based tracking process. Ten cadaveric spines (51.8 ± 7.3 years) were tested in FE within a robotic testing system. Each specimen was tested under four loading conditions: pure moment, axial loading, follower loading, and combined loading. The in vivo and in vitro bone motion data were directly compared. The average in vitro instant center of rotation was significantly more anterior in all four loading paradigms for all levels. In general, the anterior and posterior disc heights were larger in the in vitro models than in vivo. However, after adjusting for gender, the observed differences in disc height were not statistically significant. This data suggests that in vitro biomechanical testing alone may fail to replicate in vivo conditions, with significant implications for novel motion preservation devices such as cervical disc arthroplasty implants.

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Comparison of Cervical Spine Biomechanics After Fixed- and Mobile-Core Artificial Disc Replacement

Abstract: The results of our study presented an increase in ROM, facet joint force, and ligament tension at the ADR segments. The mobile-core model showed a higher increase in segmental motion, facet force, and ligament tension, but lower stress on the PE core than the fixed-core model.

Cited by 142 publications

References 0 publications

Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue

Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue

A new cervical artificial disc prosthesis based on physiological curvature of end plate: a finite element analysis

Assessing the biofidelity of in vitro biomechanical testing of the human cervical spine

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