Range of motion and adjacent level degeneration after lumbar total disc replacement

Huang, Russel C.; Tropiano, Patrick; Marnay, Thierry; Girardi, Federico P.; Lim, Moe R.; Cammisa, Frank P.

doi:10.1016/j.spinee.2005.04.013

Cited by 128 publications

(65 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The disc heights had a proportionally linear relationship with the sagittal plane angle, and the anterior disc height increased with the increasing cervical extension angle [9]. Moreover, the loss of disc height was regarded as one sign of clinical vertebral degeneration and the restoration of disc height was documented to have a positive effect on ROM [14,16,30].…”

Section: Intervertebral Angulationmentioning

confidence: 99%

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

Kuo

Lan

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

The insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding of the cervical biomechanics and treating the cervical related dysfunction. The objective of this study was to quantitatively measure the continuous intervertebral translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. A total of 1,120 image sequences were analyzed for 56 healthy adult subjects by a precise image protocol during cervical flexion and extension. Our results showed there were no statistical angular differences among five spinal levels in either flexion or extension, except for the comparison between C2/3 (13.5°) and C4/5 (22.6°) angles. During cervical flexion, the smallest anterior translations were 0.7 mm at C2/3 level, followed by 0.9 mm at C6/7, 1.0 mm at C3/4, 1.1 mm at C5/6, and the largest 1.2 mm at C4/5 levels. The significantly greater translations were measured in the posterior direction at C3/4 (1.1 mm, P = 0.037), C4/5 (1.3 mm, P = 0.039), and C5/6 (1.2 mm, P = 0.005) levels than in the anterior one. The relatively fluctuant and small average posterior translation fashion at C6/7 level (0.4 mm) possibly originated from the variations in the direction of translation during cervical extension among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.5, 13.7, 16.6, 15.0, and 8.6% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.

show abstract

Section: Intervertebral Angulationmentioning

confidence: 99%

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

Kuo

Lan

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…One of the proposed fundamental theoretical advantages of TDR over fusion is the preservation of segmental mobility [10,13]. Beside the preservation of mobility per se, the quantity of postoperative range of motion after TDR seems also to be of notable interest.…”

Section: Discussionmentioning

confidence: 99%

The role of prosthesis design on segmental biomechanics

et al. 2010

View full text Add to dashboard Cite

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-

show abstract

“…Small amounts of TDR motion may considerably influence clinical outcome [6][7][8]15]. TDR motion greater than 5°has been suggested to reduce the incidence of adjacent level degeneration [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…However, unlike interboby fusion, the design of a total disc replacement (TDR) aims to provide the advantage of motion preservation at the operated level. With considerable ([5°) segmental flexion-extension range of motion (ROM), TDRs have been correlated to better clinical outcomes [7], and suggested to have reduced long-term risk in the development of radiographic adjacent level degeneration [8,18]. Correct surgical placement of the TDR has been reported to be essential in achieving these improved clinical outcomes as well as flexion-extension ROM [3,17].…”

Section: Introductionmentioning

confidence: 99%

Radiographic total disc replacement angle measurement accuracy using the Oxford Cobbometer: precision and bias

et al. 2008

View full text Add to dashboard Cite

Total disc replacement (TDR) clinical success has been reported to be related to the residual motion of the operated level. Thus, accurate measurement of TDR range of motion (ROM) is of utmost importance. One commonly used tool in measuring ROM is the Oxford Cobbometer. Little is known however on its accuracy (precision and bias) in measuring TDR angles. The aim of this study was to assess the ability of the Cobbometer to accurately measure radiographic TDR angles. An anatomically accurate synthetic L4-L5 motion segment was instrumented with a CHARITE artificial disc. The TDR angle and anatomical position between L4 and L5 was fixed to prohibit motion while the motion segment was radiographically imaged in various degrees of rotation and elevation, representing a sample of possible patient placement positions. An experienced observer made ten readings of the TDR angle using the Cobbometer at each different position. The Cobbometer readings were analyzed to determine measurement accuracy at each position. Furthermore, analysis of variance was used to study rotation and elevation of the motion segment as treatment factors. Cobbometer TDR angle measurements were most accurate (highest precision and lowest bias) at the centered position (95.5%), which placed the TDR directly inline with the x-ray beam source without any rotation. In contrast, the lowest accuracy (75.2%) was observed in the most rotated and off-centered view. A difference as high as 4°between readings at any individual position, and as high as 6°between all the positions was observed. Furthermore, the Cobbometer was unable to detect the expected trend in TDR angle projection with changing position. Although the Cobbometer has been reported to be reliable in different clinical applications, it lacks the needed accuracy to measure TDR angles and ROM. More accurate ROM measurement methods need to be developed to help surgeons and researchers assess radiological success of TDRs.

show abstract

Range of motion and adjacent level degeneration after lumbar total disc replacement

Cited by 128 publications

References 26 publications

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

The role of prosthesis design on segmental biomechanics

Radiographic total disc replacement angle measurement accuracy using the Oxford Cobbometer: precision and bias

Contact Info

Product

Resources

About