Does total disc arthroplasty in C3/C4-segments change the kinematic features of axial rotation?

Wachowski, Martin Michael; Wagner, Markus; Weiland, Jan; Dorner, Joe W.; Raab, Björn; Dathe, Henning; Gezzi, Riccardo; Kubein-Meesenburg, Dietmar; Nägerl, Hans

doi:10.1016/j.jbiomech.2013.03.027

Cited by 14 publications

(26 citation statements)

References 31 publications

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“…38 Considering the biomechanics, the instant center of rotation can change significantly for each successive motion segment from C2-3 to C6-7, and the kinematics of axial rotation are also altered after CDA in the C3-4 segment. 1,32 The higher prevalence and severity of HO at the level of C3-4, as shown here, implies that the currently available, universal (i.e., 1 kind for all levels) design of artificial discs may not be ideal. A tailor-made device that can obtain better carpentry or natural ROM specifically for C3-4 may reduce unintended HO.…”

Section: Discussionmentioning

confidence: 96%

Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Chang

et al. 2016

SPI

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OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

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Section: Discussionmentioning

confidence: 96%

Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Chang

et al. 2016

SPI

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“…To summarize, evidence on whether CTDR can restore cervical kinematics back to normal is lacking. While CTDR with Prestige prosthesis was found more compatible to physiological kinematics of spine than the Bryan disc, both types of prosthesis simulated significantly different spinal kinematics from the healthy population [40]. Incompatibility of spinal kinematics after CTDR with physiological kinematics may, therefore, be an inducing agent of HO [41].…”

Section: Center Of Rotationmentioning

confidence: 89%

Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics

Hui¹,

Phan²,

Kerferd³

et al. 2021

Asian Spine J

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Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.

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“…A well-established 6D measuring apparatus was used for the experiments (Mansour et al 2004 ; Wachowski et al 2013 , 2017 ; Roch et al 2020a , 2020b ). A water pump system was used to apply an axial rotation with a cyclically varying torque-time function Tz(t) (frequency ≈ ).…”

Section: Methodsmentioning

confidence: 99%

The impact of bilateral facetectomy on the instantaneous helical axis of the functional thoracic spinal unit T4-5 during axial rotation

Roch

Saul

Wüstefeld³

et al. 2021

International Biomechanics

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The location of the instantaneous helical axis (IHA) and the impact of the facet joints (FJ) on the kinematics in the thoracic spine remain inconclusive. This study aimed to examine the IHA in the functional spinal unit (FSU) T4-5 during axial rotation in intact conditions and after bilateral facetectomy. Four human T4-5 FSUs were examined with an established 6D measuring apparatus in intact conditions and after bilateral facetectomy. The IHA’s parameters migration, location, and direction in the horizontal plane were calculated. Defined preloads in different positions were applied. Under the intact conditions, the IHA migrated about 4 mm and from one to the contralateral side according to the applied preload. The location of the IHA was observed in the anterior part of the spinal canal. After bilateral facetectomy, the location of the IHA shifted ventrally about 10 mm compared to the intact conditions. Under intact conditions, the direction of the IHA was minimally dorsally reclined. After bilateral facetectomy, the IHA was significantly more ventrally inclined. The study determined the location of the IHA under intact conditions at the anterior part of the spinal canal. The IHA of the FSU T4-5 is substantially influenced by the guidance of the FJs.

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Does total disc arthroplasty in C3/C4-segments change the kinematic features of axial rotation?

Cited by 14 publications

References 31 publications

Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics

The impact of bilateral facetectomy on the instantaneous helical axis of the functional thoracic spinal unit T4-5 during axial rotation

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