Effect of lumbar disc replacement on the height of the disc space and the geometry of the facet joints

Kafchitsas, Konstantinos; Kokkinakis, Michail; Habermann, B.; Rauschmann, Michael

doi:10.1302/0301-620x.92b4.23175

Cited by 12 publications

(7 citation statements)

References 39 publications

(37 reference statements)

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“…This mutual dependence has been previously demonstrated in cadaver studies: segmental iatrogenic distraction leads to increased lordosis followed by a reduced overlapping area of articulation and an increase in the space within the facet joints, similar to a subluxation [36,37]. Rauschning [38] reported that subluxation of a joint leads to degeneration, which may explain the mechanism of FJD after TDR.…”

Section: Discussionsupporting

confidence: 54%

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

et al. 2013

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Purpose The aim of the second part of the study was to investigate the influence of parameters that lead to increased facet joint contact or capsule tensile forces (disc height, lordosis, and sagittal misalignment) on the clinical outcome after total disc replacement (TDR) at the lumbosacral junction. Methods A total of 40 patients of a prospective cohort study who received TDR because of degenerative disc disease or osteochondrosis L5/S1 were invited to an additional follow-up for clinical (ODI and VAS for overall, back, and leg pain) and radiographic analysis (a change in disc height, lordosis, or sagittal vertebral misalignment compared with the preoperative state). Based on the final ODI, patients were retrospectively distributed into groups N (normal: \25 %) or F (failure C25 %) for radiographic parameter comparison. A correlation analysis was performed between the clinical and radiological results. Results A total of 34 patients were available at a mean follow-up of 59.5 months. Both groups (N = 24; F = 10 patients) presented a significant improvement in overall pain, back pain, and ODI over time. At the final follow-up, higher clinical scores correlated with a larger disc height, increased lordosis, and posterior translation of the superior vertebra, which was also reflected by significant differences in these parameters in the group comparison. Conclusions Parameters associated with increased facet joint capsule tensile forces lead to an inferior clinical outcome at mid-term follow-up. When performing TDR, we therefore suggest avoiding iatrogenic posterior translation and overdistraction (and consecutive lordosis).

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Section: Discussionsupporting

confidence: 54%

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

et al. 2013

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“…Recently, a great deal of interest has been placed on developing and implementing spinal devices for disc treatment that restore the mobility of the spinal motion segment. Disc arthroplasty (i.e., arthroplasty) has been the focus of biomechanical and computational modeling, as well as clinical investigation [13,14,16,134,200,. Although there are many different designs for disc replacements, they are generally comprised of some sort of motion preserving component, such as a ball-andsocket, together with a motion limiter to mimic the normal functions of the disc.…”

Section: Artificial Disc Implantsmentioning

confidence: 99%

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

Jaumard¹,

Welch²,

Winkelstein³

2011

J. Biomech. Eng.

261

225

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The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.

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“…These findings are in agreement with previous studies. 9,10,33,54,56,69 The evaluation of disc height as normal is typically based on comparing adjacent cranially or caudally located discs, 38 since the preoperative condition of the disc is often already affected by cervical disc disease. Intrasubject measurements of intervertebral disc height of the lower cervical spine have shown little variation across motion segments, 20 which suggests that adjacent disc height comparison is a suitable approach for the assessment of intervertebral disc height postsurgery.…”

Section: 1357mentioning

confidence: 99%

Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients

McDonald¹,

Chang

McDonald³

et al. 2014

SPI

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Object Cervical arthroplasty with an artificial disc (AD) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis. This study aims to provide 3D motion analysis data comparing patients after ACDF and AD replacement. Methods Ten patients who underwent C5–6 ACDF and 7 who underwent C5–6 AD replacement were enrolled. Using biplanar fluoroscopy and a model-based track technique (accurate up to 0.6 mm and 0.6°), motion analysis of axial rotation and flexion-extension of the neck was performed. Three nonoperative segments (C3–4, C4–5, and C6–7) were assessed for both intervertebral rotation (coronal, sagittal, and axial planes) and facet shear (anteroposterior and mediolateral). Results There was no difference in total neck motion comparing ACDF and AD replacement for neck extension (43.3° ± 10.2° vs 44.3° ± 12.6°, p = 0.866) and rotation (36.0° ± 6.5° vs 38.2° ± 9.3°, p = 0.576). For extension, when measured as a percentage of total neck motion, there was a greater amount of rotation at the nonoperated segments in the ACDF group than in the AD group (p = 0.003). When comparing specific motion segments, greater normalized rotation was seen in the ACDF group at C3–4 (33.2% ± 4.9% vs 26.8% ± 6.6%, p = 0.036) and C6–7 (28.5% ± 6.7% vs 20.5% ± 5.5%, p = 0.009) but not at C4–5 (33.5% ± 6.4% vs 31.8% ± 4.0%, p = 0.562). For neck rotation, greater rotation was observed at the nonoperative segments in the ACDF group than in the AD group (p = 0.024), but the differences between individual segments did not reach significance (p ≥ 0.146). Increased mediolateral facet shear was seen on neck extension with ACDF versus AD replacement (p = 0.008). Comparing each segment, C3–4 (0.9 ± 0.5 mm vs 0.4 ± 0.1 mm, p = 0.039) and C4–5 (1.0 ± 0.4 mm vs 0.5 ± 0.2 mm, p = 0.022) showed increased shear while C6–7 (1.0 ± 0.4 mm vs 1.0 ± 0.5 mm, p = 0.767) did not. Conclusions This study illustrates increased motion at nonoperative segments in patients who have undergone ACDF compared with those who have undergone AD replacement. Further studies will be required to examine whether these changes contribute to adjacent-segment disease.

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Effect of lumbar disc replacement on the height of the disc space and the geometry of the facet joints

Cited by 12 publications

References 39 publications

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients

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