We Need to Talk about Lumbar Total Disc Replacement

Beatty, Stephen

doi:10.14444/5029

Cited by 27 publications

(17 citation statements)

References 623 publications

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“…To minimize the incidence of ASD, several dynamic systems such as artificial discs and dynamic stabilization implants have therefore been introduced ( Beatty, 2018 ) which can preserve intervertebral disc (IVD) motion and unload the stress on adjacent levels ( Huang et al, 2016 ). However, the indications of these treatments are limited and they are not applicable to patients who still require fusion surgery.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation Between Rigid and Semirigid Posterolateral Fixation During Daily Activities: Geometrically Parametric Poroelastic Finite Element Analyses

Nikkhoo

Chen

et al. 2021

Front. Bioeng. Biotechnol.

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While spinal fusion using rigid rods remains the gold standard treatment modality for various lumbar degenerative conditions, its adverse effects, including accelerated adjacent segment disease (ASD), are well known. In order to better understand the performance of semirigid constructs using polyetheretherketone (PEEK) in fixation surgeries, the objective of this study was to analyze the biomechanical performance of PEEK versus Ti rods using a geometrically patient-specific poroelastic finite element (FE) analyses. Ten subject-specific preoperative models were developed, and the validity of the models was evaluated with previous studies. Furthermore, FE models of those lumbar spines were regenerated based on postoperation images for posterolateral fixation at the L4–L5 level. Biomechanical responses for instrumented and adjacent intervertebral discs (IVDs) were analyzed and compared subjected to static and cyclic loading. The preoperative model results were well comparable with previous FE studies. The PEEK construct demonstrated a slightly increased range of motion (ROM) at the instrumented level, but decreased ROM at adjacent levels, as compared with the Ti. However, no significant changes were detected during axial rotation. During cyclic loading, disc height loss, fluid loss, axial stress, and collagen fiber strain in the adjacent IVDs were higher for the Ti construct when compared with the intact and PEEK models. Increased ROM, experienced stress in AF, and fiber strain at adjacent levels were observed for the Ti rod group compared with the intact and PEEK rod group, which can indicate the risk of ASD for rigid fixation. Similar to the aforementioned pattern, disc height loss and fluid loss were significantly higher at adjacent levels in the Ti rod group after cycling loading which alter the fluid–solid interaction of the adjacent IVDs. This phenomenon debilitates the damping quality, which results in disc disability in absorbing stress. Such finding may suggest the advantage of using a semirigid fixation system to decrease the chance of ASD.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation Between Rigid and Semirigid Posterolateral Fixation During Daily Activities: Geometrically Parametric Poroelastic Finite Element Analyses

Nikkhoo

Chen

et al. 2021

Front. Bioeng. Biotechnol.

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“…In chronic stages, generally, surgery is required because the IVD is unable to cure itself [28]. Existing surgical interventions include discectomy and spinal fusion, or-occasionally in the cervical spine-a total disc replacement is indicated [29]. Patients who had discectomy show improvement when compared to nonsurgical therapy in short-term follow-ups; however, long term follow-ups (beyond two years) indicate no significant difference in the outcomes [30].…”

Section: Introductionmentioning

confidence: 99%

The Role of Hyaluronic Acid in Intervertebral Disc Regeneration

2020

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Intervertebral disc (IVD) degeneration is a leading cause of low back pain worldwide, incurring a significant burden on the healthcare system and society. IVD degeneration is characterized by an abnormal cell-mediated response leading to the stimulation of different catabolic biomarkers and activation of signalling pathways. In the last few decades, hyaluronic acid (HA), which has been broadly used in tissue-engineering, has popularised due to its anti-inflammatory, analgesic and extracellular matrix enhancing properties. Hence, there is expressed interest in treating the IVD using different HA compositions. An ideal HA-based biomaterial needs to be compatible and supportive of the disc microenvironment in general and inhibit inflammation and downstream cascades leading to the innervation, vascularisation and pain sensation in particular. High molecular weight hyaluronic acid (HMW HA) and HA-based biomaterials used as therapeutic delivery platforms have been trialled in preclinical models and clinical trials. In this paper, we reviewed a series of studies focused on assessing the effect of different compositions of HA as a therapeutic, targeting IVD degeneration. Overall, tremendous advances have been made towards an optimal form of a HA biomaterial to target specific biomarkers associated with IVD degeneration, but further optimization is necessary to address regeneration.

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“…Several artificial discs were developed through the years for this purpose, including the ProDisc (Synthes Spine, Inc., West Chester, PA), SB Charit e (DePuy Spine, Inc., Raynham, MA), and AcroFlex (AcroMed Corp, Cleveland, OHdiscontinued). Although its long-term effect remains to be determined, in follow-up periods of 2-5 years, TDR was proven to have a lower likelihood of adjacent level disease [2], complications, and reoperation rates [3][4][5][6][7] in comparison to lumbar fusion. Yet, TDR has been associated with some postoperative complications, such as disc height loss, damaged facet joints, spontaneous fusion of the adjacent vertebrae, inflammations, mechanical wear, enlarged lordosis angle due to harming of ligaments during the surgery, and other surgery-related problems [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Compliant Mechanism as a Motion-Preserving Artificial Spinal Disc: A Novel Concept

David

Shoham

2020

Journal of Engineering and Science in Medical Diagnostics and Therapy

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Investigations of spinal disc replacement options have been conducted for several decades but, as yet, the suggested solutions have not been proven to correctly preserve the natural joint motion. This paper focuses on a new structure of an artificial intervertebral disc joint that closely supports a close-to-natural three-dimensional motion of two adjacent vertebrae. The disc design is based on a passive parallel mechanism, with different stiffnesses for each link. Optimization of the artificial disc dimensions and link stiffnesses enabled convergence of the finite screw axis (FSA) of the artificial disc joint with that of a natural disc. As a result, the natural motion of the spine vertebrae was maintained and the loads on the facet joints minimized. The mechanism design was optimized, built, tested, and proven to be a feasible artificial disc with natural motion preservation characteristics.

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We Need to Talk about Lumbar Total Disc Replacement

Cited by 27 publications

References 623 publications

Biomechanical Investigation Between Rigid and Semirigid Posterolateral Fixation During Daily Activities: Geometrically Parametric Poroelastic Finite Element Analyses

Biomechanical Investigation Between Rigid and Semirigid Posterolateral Fixation During Daily Activities: Geometrically Parametric Poroelastic Finite Element Analyses

The Role of Hyaluronic Acid in Intervertebral Disc Regeneration

Compliant Mechanism as a Motion-Preserving Artificial Spinal Disc: A Novel Concept

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