Correlation of ProDisc-C Failure Strength With Cervical Bone Mineral Content and Endplate Strength

Zhang, Xingkai; Ordway, Nathaniel R.; Tan, Rong; Rim, Byeong Cheol; Fayyazi, Amir H.

doi:10.1097/bsd.0b013e318157d382

Cited by 19 publications

(17 citation statements)

References 15 publications

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“…19,42 The two-part resin was viscous when mixed and therefore did not leach or interdigitate with the endplate. The intention was to level the superior surface prior to biomechanical testing to provide a uniform interface with the materials testing machine without affecting the internal structure of the vertebra.…”

Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

“…Factors influencing the limits included the weight of a human head ($50 N) for the minimum limit and the published failure load of the implant-endplate interface for the maximum limit (range: 754-2,238 N). 17,19,42 Since the intent was to examine the implant-endplate interface under cyclic loading, a maximum limit of 250 N was selected to allow a factor of safety with respect to the published ultimate failure loads.…”

Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

“…The average trabecular bone density for each vertebral centrum was measured by averaging the scans between (not including) the endplates of the vertebral body. 41,42 Biomechanical Testing Six cervical levels (C3 to T1) from the five specimens were dissected and cleaned of soft tissue (N ¼ 30). The cartilaginous endplates were removed; the uncinate processes were left undisturbed.…”

Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

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Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. Keywords: cervical endplate; fatigue; cyclic testing; biomechanics; subsidence Anterior cervical fusion has traditionally been a predictable and reliable surgical technique for treatment of multiple spinal pathologies. [1][2][3] The success has been due to factors that are addressed by the surgical procedure: the removal of the pathologic process; the decompression of the neural elements; the correction of sagittal balance; and the stabilization of the motion segment. Maintenance of sagittal balance and continued stabilization of the motion segment following anterior reconstruction is essential in obtaining a successful clinical outcome. Subsidence of an interbody graft or construct prior to bony fusion can be detrimental to sagittal balance and/or stabilization of the motion segment resulting in recurrent foraminal stenosis.Options available for reconstructing the anterior cervical column include a structural autograft, a structural allograft, a carbon fiber cage, a PEEK cage, a titanium mesh cage, or a trabecular metal spacer. Material properties and interface geometries vary, but the devices function similarly by providing mechanical integrity and stability to the construct while bony fusion takes place. Independent of the device, settling occurs following anterior interbody fusion, 4-6 the amount of which is affected by intraoperative endplate injury or removal, osteoporosis, and the cross-sectional area of the implant. 7,8 Obtaining contact between the endplate and implant surfaces is technically challenging, and a certain amount of settling occurs early post-operatively. With bony implants, additional settling occurs as the graft is resorbed prior to bone fusion. The amount of settling is often <1 mm. Other causes of post-op...

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Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

Section: Specimen Preparation and Bone Density Measurementmentioning

confidence: 99%

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Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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show abstract

“…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. The two types of artificial disc prostheses were implanted at the C5-C6 level [26], 5 where CDR is most frequently performed ( Figure 2F).…”

mentioning

confidence: 99%

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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“…36 ProDisc-C (Synthes Spine) is one of the cervical artificial discs in current use, and very promising clinical results have been reported for this device. 3,4 However, recent clinical studies have reported vertebral body split fractures associated with single and multilevel cervical arthroplasty using the ProDisc-C prostheses.…”

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confidence: 99%

Failure analysis of C-5 after total disc replacement with ProDisc-C at 1 and 2 levels and in combination with a fusion cage: finite-element and biomechanical models

Completo

Nascimento

Ramos

et al. 2015

SPI

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OBJECT The purpose of this study was to evaluate the failure risk of cervical vertebrae after total disc replacement with a keel-design prosthesis (ProDisc-C), taking into consideration the effects of vertebral body height, multilevel replacement, and the association with an adjacent fusion cage. Although promising clinical results have been reported for the ProDisc-C, some clinical studies have reported vertebral body–splitting fractures at single- and multilevel arthroplasty sites. This implant has central keels to provide solid initial stability, and some authors associate the potential risk of vertebral body failure with the keel design, especially in patients with small vertebral body height or when the implant is used at multiple levels. METHODS The study was performed using a specimen-specific C4–6 cervical-segment finite-element model to assess the compressive strains on the C-5 vertebral body for each cervical segment configuration, and synthetic polyurethane models to experimentally predict the compressive load at failure for 3 vertebral body heights. RESULTS The use of a keeled ProDisc-C prosthesis at multiple levels or in combination with a fusion cage increases by a factor of 2–3 the compressive strains at the C-5 vertebral body relative to single-level arthroplasty. All implanted segment configurations tested demonstrated a continuum of the load at failure and the vertebral body height, but no significant differences were found between the 3 vertebral body heights in each segment configuration. CONCLUSIONS The use of a keeled ProDisc-C prosthesis at 2 adjacent levels or combined with a fusion cage presented the lowest load-at-failure values, 2 times higher on average than the ones occurring during physiological tasks. This fact indicates an identical and limited risk of vertebral body failure for these 2 segment configurations, whereas vertebral body height appears to slightly affect this risk. However, for some tasks that place higher physical demands on the neck, beyond what was represented by our models, there may also be risk of microdamage initiation, which is not present in the single-level arthroplasty.

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Correlation of ProDisc-C Failure Strength With Cervical Bone Mineral Content and Endplate Strength

Abstract: This study demonstrates the utility of a preoperative QCT scan in predicting the failure stress of the cervical endplate before total disc replacement. This information may potentially decrease early complications of device subsidence or endplate fracture.

Cited by 19 publications

References 15 publications

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

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

Failure analysis of C-5 after total disc replacement with ProDisc-C at 1 and 2 levels and in combination with a fusion cage: finite-element and biomechanical models

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