Abstract
An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4–C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI™,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2–C7) were tested in flexion/extension, lateral bending, and axial rotation under a ± 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4–C5 and tested. Then, a fusion using lateral mass fixation and an anterior plate was simulated and tested. Stiffness and range of motion (ROM) data were calculated. The ROM of the C4–C5 motion segment with the arthroplasty device was similar to that of the intact spine in flexion/extension and slightly less in lateral bending and rotation, while the fusion construct allowed significantly less motion in all directions. The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting.
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Aunoble S, Donkersloot P, Le Huec JC (2004) Dislocations with intervertebral disc prosthesis: two case reports. Eur Spine J 13:464–467. doi:10.1007/s00586-004-0687-3
Azmi H, Schlenk RP (2003) Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus 15(3):E6. doi:10.3171/foc.2003.15.3.6
Baba H, Furusawa N, Imura S, Kawahara N, Tsuchiya H, Tomita K (1993) Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine 18:2167–2173
Bertagnoli R, Yue JJ, Pfeiffer F, Fenk-Mayer A, Lawrence JP, Kershaw T, Nanieva R (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410
Buttner-Janz K, Schellnack K, Zippel H (1989) Biomechanics of the SB Charite lumbar intervertebral disc endoprosthesis. Int Orthop 13:173–176. doi:10.1007/BF00268042
Cherubino P, Benazzo F, Borromeo U, Perle S (1990) Degenerative arthritis of the adjacent spinal joints following anterior cervical spinal fusion: clinicoradiologic and statistical correlations. Ital J Orthop Traumatol 16:533–543
Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617
Coric D, Finger F, Boltes P (2006) Prospective randomized controlled study of the Bryan cervical disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31–35. doi:10.3171/spi.2006.4.1.31
Cummins BH, Robertson JT, Gill SS (1998) Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943–948
David T (2005) Revision of a Charite artificial disc 9.5 years in vivo to a new Charite artificial disc: case report and explant analysis. Eur Spine J 14:507–511. doi:10.1007/s00586-004-0842-x
DiAngelo DJ, Foley KT, Morrow BR, Schwab JS, Song J, German JW, Blair E (2004) In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant. Neurosurg Focus 17(3):E7
Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC (2005) Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine 30:1165–1172. doi:10.1097/01.brs.0000162441.23824.95
Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, An HS (2002) Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 27:2431–2434. doi:10.1097/00007632-200211150-00003
Fernstrom U (1966) Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acta Chir Scand Suppl 357:154–159
Geisler FH, Caspar W, Pitzen T, Johnson TA (1998) Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine 23:911–920. doi:10.1097/00007632-199804150-00013
Goffin J, Van Calenbergh F, van Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single-level and bi-level. Spine 28:2673–2678. doi:10.1097/01.BRS.0000099392.90849.AA
Gore DR, Sepic SB (1998) Anterior discectomy and fusion for painful cervical disc disease: a report of 50 patients with an average follow-up of 21 years. Spine 23:2047–2051. doi:10.1097/00007632-199810010-00002
Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528
Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194S. doi:10.1016/j.spinee.2004.07.007
Katsuura A, Hukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324. doi:10.1007/s005860000243
McAfee PC (2006) The advantages of cervical disc replacement for the treatment of degenerative disc disease. Curr Opin Orthop 17:233–239. doi:10.1097/01.bco.0000223531.42148.c6
McAfee PC, Cunningham B, Dmitriev A, Hu N, Woo Kim S, Cappuccino A, Pimenta L (2003) Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 28:S176–S185. doi:10.1097/01.BRS.0000092219.28382.0C
McAfee PC, Cunningham BW, Hayes V, Sidiqi F, Dabbah M, Sefter JC, Hu N, Beatson H (2006) Biomechanical analysis of rotational motions after disc arthroplasty: implications for patients with adult deformities. Spine 31:S152–S160. doi:10.1097/01.brs.0000234782.89031.03
McAfee PC, Cunningham BW, Lee GA, Orbegoso CM, Haggerty CJ, Fedder IL, Griffith SL (1999) Revision strategies for salvaging or improving failed cylindrical cages. Spine 24:2147–2153. doi:10.1097/00007632-199910150-00015
Miura T, Panjabi MM, Cripton PA (2002) A method to simulate in vivo cervical spine kinematics using in vitro compressive preload. Spine 27:43–48. doi:10.1097/00007632-200201010-00011
Pimenta L, McAfee PC, Cappuccino A, Bellera FP, Link HD (2004) Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J 4:315S–321S. doi:10.1016/j.spinee.2004.07.024
Porchet F, Metcalf NH (2004) Clinical outcomes with the Prestige II cervical disc: preliminary results from a prospective randomized clinical trial. Neurosurg Focus 17(3):E6. doi:10.3171/foc.2004.17.3.6
Rhyne AL, Siddiqui F, Darden BV (2005) Incidence of post-operative dysphagia following total cervical disc replacement versus anterior cervical discectomy and fusion with instrumentation (abstract). In: 33rd Annual Cervical Spine Research Society, San Diego
Smith GW, Robinson RA (1958) The treatment of certain cervical–spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:607–624
Swank ML, Lowery GL, Bhat AL, McDonough RF (1997) Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction. Eur Spine J 6:138–143. doi:10.1007/BF01358747
Urban JP, Holm S, Maroudas A, Nachemson A (1982) Nutrition of the intervertebral disc: effect of fluid flow on solute transport. Clin Orthop Relat Res (170):296–302
Urban JP, Holm S, Maroudas A, Nachemson A (1977) Nutrition of the intervertebral disk: an in vivo study of solute transport. Clin Orthop Relat Res (129):101–114
Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J (2002) Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96:17–21
Wigfield CC, Gill SS, Nelson RJ, Metcalf NH, Robertson JT (2002) The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 27:2446–2452. doi:10.1097/00007632-200211150-00006
Wigfield CC, Skrzypiec D, Jackowski A, Adams MA (2003) Internal stress distribution in cervical intervertebral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech 16:441–449. doi:10.1097/00024720-200310000-00002
Xu R, Ebraheim NA, Klausner T, Yeasting RA (1998) Modified Magerl technique of lateral mass screw placement in the lower cervical spine: an anatomic study. J Spinal Disord 11:237–240. doi:10.1097/00002517-199806000-00011
Acknowledgments
We thank Kristin Kraus, M.Sc., for her editorial assistance in preparing this paper. The experiments described in this paper comply with the current laws of the United States.
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Finn, M.A., Brodke, D.S., Daubs, M. et al. Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty. Eur Spine J 18, 1520–1527 (2009). https://doi.org/10.1007/s00586-009-1085-7
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DOI: https://doi.org/10.1007/s00586-009-1085-7