Total Disc Replacement Positioning Affects Facet Contact Forces and Vertebral Body Strains

Rundell, S. A.; Auerbach, Joshua D.; Balderston, Richard A.; Kurtz, Steven M.

doi:10.1097/brs.0b013e318186b258

Cited by 78 publications

(61 citation statements)

References 61 publications

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“…Ahn et al [267] also incorporated different disc designs in their C5-C6 model and reported that facet loads increase when the center of rotation of the spherical joint of the implant is constrained. Additional studies find that the antero-posterior placement of an artificial disc also affects the flexural stiffness of the motion segment at the level of the implant and the loads transferred to the facet during all modes of loading [264,266,268,274]. In general, all of these studies have found that a posterior position of a disc implant can unload the facets although the influence of this parameter should be considered in conjunction with the influence of other parameters such as the implant design, anatomical modeling, and constitutive equations employed in the individual finite element models.…”

Section: Models Simulating Clinicalmentioning

confidence: 99%

“…Mathematical and finite element models offer great utility for investigating spinal tissue responses because they provide an alternative to experimental approaches that can present a wide variety of challenges owing to a scarcity of specimens and a potential poor tissue quality due to advanced age or degeneration. In addition, mathematical models enable an infinite number of model conditions and variations that can be set up to investigate the influence of biological and mechanical conditions that alter tissue properties [310,311], or to compare effects of surgical procedures such as laminectomy, facetectomy, or disc arthroplasty [264][265][266]274,[312][313][314] on the mechanical behavior of the spine. Computational approaches can extend beyond experiments that can be limited in their utility if restricted to cadaveric tissue only.…”

Section: Mathematical and Finite Element Modelsmentioning

confidence: 99%

“…In the same way as elemental modification is used to model facetectomy, computational models have also been modified by replacing the intervertebral disc elements with those modeling the geometric and material properties of disc implants in order to evaluate the influence of disc arthroplasty on spinal kinematics and facet loads [200,264,[266][267][268]270,273,274,314,329,330]. Those FE models are useful because they can be altered to study the influence of parameters like implant size or its placement on the mobility of the motion segment and the contact pressure developed in the facet articular cartilage.…”

Section: Models Simulating Clinicalmentioning

confidence: 99%

See 2 more Smart Citations

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

Jaumard¹,

Welch²,

Winkelstein³

2011

J. Biomech. Eng.

270

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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Section: Models Simulating Clinicalmentioning

confidence: 99%

Section: Mathematical and Finite Element Modelsmentioning

confidence: 99%

Section: Models Simulating Clinicalmentioning

confidence: 99%

See 1 more Smart Citation

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

Jaumard¹,

Welch²,

Winkelstein³

2011

J. Biomech. Eng.

270

225

View full text Add to dashboard Cite

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“…To implant disc prosthesis, resection of both anterior longitudinal ligament (ALL) and anterior annulus is required. As a direct result of loss of these structures, a significant increases in range of axial rotation and facet loading would occurred [23,24], and a motion segment where disc prosthesis was implanted became vulnerable to rotatory instability. By nature, the role of facet joint is to limit the axial rotation and maintain the stability of motion segment [25], however, with asymmetry of facet joint, uneven rotatory movement would occur [10] and that would be more worsened by absence of ALL and anterior annulus after prosthesis implantation and accordingly, accelerate or give birth to the development of PFA after TDR.…”

Section: Discussionmentioning

confidence: 99%

Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L®

et al. 2013

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Purpose The purpose of this retrospective study was to examine the association of facet tropism and progressive facet arthrosis (PFA) after lumbar total disc replacement (TDR) surgery using ProDisc-L Ò . Methods A total of 51 segments of 42 patients who had undergone lumbar TDR using ProDisc-L Ò between October 2003 and July 2007 and completed minimum 36-month follow-up period were retrospectively reviewed. The changes of facet arthrosis were categorized as non-PFA and PFA group. Comparison between non-PFA and PFA group was made according to age, sex, mean follow-up duration, grade of preoperative facet arthrosis, coronal and sagittal prosthetic position and degree of facet tropism. Multiple logistic regression analysis was also performed to analyze the effect of facet tropism on the progression of facet arthrosis. Results The mean age at the surgery was 44.43 ± 11.09 years and there were 16 males and 26 females. The mean follow-up period was 53.18 ± 15.79 months. Non-PFA group was composed of 19 levels and PFA group was composed of 32 levels. Age at surgery, sex proportion, mean follow-up period, level of implant, grade of preoperative facet arthrosis and coronal and sagittal prosthetic position were not significantly different between two groups (p = 0. 264, 0.433, 0.527, 0.232, 0.926, 0.849 and 0.369, respectively). However, PFA group showed significantly higher degree of facet tropism (7.37 ± 6.46°) than that of non-PFA group (3.51 ± 3.53°) and p value was 0.008. After adjustment for age, sex and coronal and sagittal prosthetic position, multiple logistic regression analysis revealed that facet tropism of more than 5°was the only significant independent predictor of progression of facet arthrosis (odds ratio 5.39, 95 % confidence interval 1.251-19.343, p = 0.023). Conclusions The data demonstrate that significant higher degree of facet tropism was seen in PFA group compared with non-PFA group and facet tropism of more than 5°had a significant association with PFA after TDR using ProDisc-L Ò .

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“…The design of the TDR also appears to influence the loading that occurs at the facets [23]. Finally, placement and the height of the TDR appear to be important considerations for biomechanical function [27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Use of a personalized hybrid biomechanical model to assess change in lumbar spine function with a TDR compared to an intact spine

2011

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Total disc replacements (TDRs) have been employed with increasing frequency in recent years with the intention of restoring natural motion to the spine and reducing adjacent level trauma. Previous assessments of the TDRs have subjectively measured patient satisfaction, evaluated sagittal range of motion via static imaging, or examined biomechanical loading in vitro. This study examined the kinematics and biomechanical loading of the lumbar spine with an intact spine compared to a TDR inserted at L5/S1 in the same spine. A validated biologically driven personalized dynamic biomechanical model was used to assess range of motion (ROM) and lumbar spine tissue forces while a subject performed a series of bending and lifting exertions representative of normal life activities. This analysis concluded that with the insertion of a TDR, forces are of much greater magnitude in all three directions of loading and are concentrated at both the endplates and the posterior element structures compared to an intact spine. A significant difference is seen between the intact spine and the TDR spine at levels above the TDR insertion level as a function of supporting an external load (lifting). While ROM within the TDR joint was larger than in the intact spine (yet within the normal ranges under the unloaded bending conditions), the differences between spines were far greater in all three planes of motion under loaded lifting conditions. At levels above the TDR insertion, larger ROM was present during the lifting conditions. Sagittal motions were often greater at the higher lumbar levels, but there appeared to be less lateral and twisting motion. Collectively, this analysis indicates that the insertion of a TDR significantly alters the function of the spine.

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Total Disc Replacement Positioning Affects Facet Contact Forces and Vertebral Body Strains

Cited by 78 publications

References 61 publications

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

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

Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L®

Use of a personalized hybrid biomechanical model to assess change in lumbar spine function with a TDR compared to an intact spine

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