Load-Sharing Between Anterior and Posterior Elements in a Lumbar Motion Segment Implanted With an Artificial Disc

Dooris, Andrew; Goel, Vijay K.; Grosland, Nicole M.; Gilbertson, Lars G.; Wilder, David G.

doi:10.1097/00007632-200103150-00004

Cited by 244 publications

(136 citation statements)

References 33 publications

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“…A variety of studies have carefully analyzed the biomechanical properties and motion characteristics of different artificial disc-design prosthesis [12,13,16,17,22,24,25,36,47,50,53,54]. Reported problems associated with TDR include excessive ligament torsions, increased facet pressures, a high risk of instability at the index and adjacent level, up to 2.59 increased load on posterior structures and altered load patterns with sudden rather than gradual load increase in the facet joints [17,39].…”

Section: Biomechanical Studiesmentioning

confidence: 99%

“…Reported problems associated with TDR include excessive ligament torsions, increased facet pressures, a high risk of instability at the index and adjacent level, up to 2.59 increased load on posterior structures and altered load patterns with sudden rather than gradual load increase in the facet joints [17,39]. Furthermore, it has been shown that TDR with Charité III did not restore the physiological segmental rotational stability with additive destabilising effects for multilevel versus monosegmental TDRs [13,47].…”

Section: Biomechanical Studiesmentioning

confidence: 99%

“…However, an increasing number of radiological studies, biomechanical in vitro-and finite-element models (FEM) have recently focussed on the influence of TDR on the lumbar facet joints [16,17,22,24,27,41,47,51,55,62]. The authors reported problems associated with biomechanical alterations such as segmental hyperlordosis, increased segmental instability, increased load on facet joints with abnormal stress distribution patterns as well as subluxation of the facet joints.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Section: Biomechanical Studiesmentioning

confidence: 99%

Section: Biomechanical Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…However, there are several finite-element studies, which have already addressed similar problems and which came to the conclusion that an anterior centre of rotation, in case of semi-constrained prosthesis, would result in a decrease of the flexion ability [7,21,23,29]. The limited value of this study is based on the fact that only the flexion ability (and not flexion/extension) was analysed and that the difference between the centre of rotation (anterior vs. posterior) averaged 8 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Although some TDRs are in use for several years and are clinically established, such as the Charité-Prosthesis with its unconstrained and the Prodisc-Prosthesis with its semi-constrained disc kinematic, little is known about the impact of different disc kinematics on biomechanical behaviour of the lumbar spinal unit. Also the variable centre of rotation in case of semi-constrained prosthesis is supposed to be of crucial importance for segmental biomechanics [2,7]. Further insight into the biomechanical behaviour of TDR could help to assess clinical outcome better.…”

Section: Introductionmentioning

confidence: 99%

The role of prosthesis design on segmental biomechanics

et al. 2010

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The purpose of this study was to evaluate the influence of different implant designs of total lumbar disc replacements on the segmental biomechanics of the lumbar spine. The unconstrained Charité, the semi-constrained Prodisc and a semi-constrained Prototype with more posterior centre of rotation than the Prodisc were tested in vitro using six human, lumbar spines L2-L5. The segmental lordosis was measured on plain radiographs and the range of motion (ROM) for all six degrees of freedom with a previously described spine tester. All prostheses were implanted at level L3-

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Human Spine, Biomechanics of

Goel

Biyani

Ferrara

et al. 2006

Encyclopedia of Medical Devices and Instrumentation

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The basic anatomy of the human spine is described to highlight the interaction among spinal components that provides the desired function in a normal person. The factors that lead to instability–abnormal motion are described. Abnormal motion may be due to external environmental factors to which the spine is subjected to during activities of daily living (e.g., impact, repetitive loading, lifting) degeneration, infectious diseases, injury or trauma, disorders, and/or surgery. The biomechanics encompasses the mechanical aspects of conservative treatments, surgical procedures and spinal stabilization techniques. These issues are narrated in this article. However, the field of spinal biomechanics is very broad and it is not practical to cover all aspects in one article. For example, this article does not deal with whiplash mechanisms, impact loads, injury biomechnaics due to falls, and in sports to name a few.

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Load-Sharing Between Anterior and Posterior Elements in a Lumbar Motion Segment Implanted With an Artificial Disc

Abstract: The models suggest that, by altering placement of the artificial disc in the anteroposterior direction, a surgeon can modulate motion-segment flexuralstiffness and posterior load-sharing, even though the specific disc replacement design has no inherent rotational stiffness.

Cited by 244 publications

References 33 publications

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

The role of prosthesis design on segmental biomechanics

Human Spine, Biomechanics of

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