Kinematics of Progressive Circumferential Ligament Resection (Decompression) in Conjunction With Cervical Disc Arthroplasty in a Spondylotic Spine Model

Roberto, Rolando Figueroa; McDonald, Thomas; Curtiss, Shane; Neu, Corey P.; Kim, Kee D.; Pennings, Fritz

doi:10.1097/brs.0b013e3181c55bcd

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…The difference between previous studies investigating TDA ROM and stiffness 12,35 and the current results may be related to the difference in the design of artificial discs used. The literature shows that 2level TDA with PLL resection can show additive rotational instability, 16,19 suggesting the importance of retaining critical support structures such as PLL or compensation through prosthetic devices. In contrast, ROM over the C5-C7 segments in our study decreased for both the 1-and the 2-level TDAs with respect to intact, supporting the notion that the choice of implant design may have a significant impact on motion segmental stability.…”

Section: Surgical Stepsmentioning

confidence: 99%

“…13 Others suggested that PLL is thinner and weaker than the anterior longitudinal ligament 12,[14][15][16] with proponents of its resection suggesting that it plays only a minor role in motion segment stability compared to the remaining ligamentous structures. [17][18][19] During TDA, PLL resection is suggested to facilitate a more parallel distraction, better decompression, and disc height restoration and ensures segment mobility. 5,[20][21][22] On the contrary, it has been postulated that PLL should not be excised in order to maintain its stabilizing effect.…”

Section: Introductionmentioning

confidence: 99%

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Does Resection of the Posterior Longitudinal Ligament Affect the Stability of Cervical Disc Arthroplasty?

et al. 2018

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Background: The need for posterior longitudinal ligament (PLL) resection during cervical total disc arthroplasty (TDA) has been debated. The purpose of this laboratory study was to investigate the effect of PLL resection on cervical kinematics after TDA. Methods: Eight cadaveric cervical spine specimens were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) to moments of 61.5 Nm. After testing the intact condition, anterior C5-C6 cervical discectomy was performed followed by PLL resection and implantation of a compressible, 6-degrees-of-freedom disc prosthesis (M6-C, Spinal Kinetics Inc, Sunnyvale, California). Next, a second prosthesis was implanted at C6-C7 with PLL intact. Finally, the C6-C7 PLL was resected while the disc prosthesis remained in place. Segmental range of motion (ROM) and stiffness in the high flexibility zone around the neutral posture were analyzed using repeated measures ANOVA. Results: At C5-C6, following TDA and PLL resection, FE, LB, and AR ROMs decreased significantly. Anterior and posterior disc height, segmental lordosis, and flexion stiffness increased significantly. At C6-C7, TDA with the PLL intact resulted in a significant increase in anterior disc height and segmental lordosis with no change in posterior disc height. FE, LB, and AR ROMs all decreased significantly, while flexion stiffness increased significantly compared to intact. PLL resection at C6-C7 did not result in a notable change compared to TDA with PLL intact. At the same level, flexion stiffness decreased following PLL resection compared to TDA with a value closer to intact. Two-level TDA (C5-C7) with PLL resection did not result in a loss of segmental stability. Conclusion: PLL resection did not significantly affect motion segment kinematics following cervical TDA using a prosthesis with inherent stiffness. Motion segment stiffness loss after PLL resection can be compensated for by a TDA design that can provide resistance to angular motion.

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Section: Surgical Stepsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Resection of the Posterior Longitudinal Ligament Affect the Stability of Cervical Disc Arthroplasty?

et al. 2018

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“…The number of specimens used was chosen to be consistent with the numbers in similar studies. 2,3,18,25,28 The condition of each specimen when received, especially the index level, dictated whether C3-T1 (index level C5-6) or C2-7 (index level C4-5) was used. That is, if manual palpation indicated equivalent flexibility at C4-5 and C5-6 or greater flexibility at C5-6, then C3-T1 was harvested; if C4-5 appeared substantially more flexible than C5-6, then C2-7 was harvested.…”

Section: Specimen Selectionmentioning

confidence: 99%

“…18 Bevevino et al demonstrated that bilateral foraminotomy in cervical spine specimens implanted with a metal-on-metal, ball-in-trough CA device did not significantly increase segmental ROM. 2 Roberto et al evaluated the effects of PLL resection, unilateral and bilateral foraminotomy (50% facet joint re-section), and laminectomy on cervical stability in a spondylotic model utilizing the ProDisc-C. 25 Progressive resections led to minor increases in sagittal rotation ROM, with a substantial 57% increase following laminectomy. However, these values were within normative physiological limits; thus, the authors concluded that sequential posterior resection did not result in clinically relevant spinal instability.…”

Section: Clinical Relevancementioning

confidence: 99%

Biomechanical evaluation of the ProDisc-C stability following graded posterior cervical injury

Staudt

Rabin

Baaj

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEThere are limited data regarding the implications of revision posterior surgery in the setting of previous cervical arthroplasty (CA). The purpose of this study was to analyze segmental biomechanics in human cadaveric specimens with and without CA, in the context of graded posterior resection.METHODSFourteen human cadaveric cervical spines (C3–T1 or C2–7) were divided into arthroplasty (ProDisc-C, n = 7) and control (intact disc, n = 7) groups. Both groups underwent sequential posterior element resections: unilateral foraminotomy, laminoplasty, and finally laminectomy. Specimens were studied sequentially in two different loading apparatuses during the induction of flexion-extension, lateral bending, and axial rotation.RESULTSRange of motion (ROM) after artificial disc insertion was reduced relative to that in the control group during axial rotation and lateral bending (13% and 28%, respectively; p < 0.05) but was similar during flexion and extension. With sequential resections, ROM increased by a similar magnitude following foraminotomy and laminoplasty in both groups. Laminectomy had a much greater effect: mean (aggregate) ROM during flexion-extension, lateral bending, and axial rotation was increased by a magnitude of 52% following laminectomy in the setting of CA, compared to an 8% increase without arthroplasty. In particular, laminectomy in the setting of CA introduced significant instability in flexion-extension, characterized by a 90% increase in ROM from laminoplasty to laminectomy, compared to a 16% increase in ROM from laminoplasty to laminectomy without arthroplasty (p < 0.05).CONCLUSIONSForaminotomy and laminoplasty did not result in significant instability in the setting of CA, compared to controls. Laminectomy alone, however, resulted in a significant change in biomechanics, allowing for significantly increased flexion and extension. Laminectomy alone should be used with caution in the setting of previous CA.

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“…However, some surgeons opposed to TDR-C in spondylosis have suggested that even TDR insertion could not be expected to achieve motion preservation when hard spurs or uncinate process-to-facet fusion is present. 53,54 Thus, others have recommended some techniques to overcome increased motion even in spondylosis, such as posterior longitudinal ligament resection with ventral foraminotomy 53 and/or bilateral uncinatectomy. 54…”

Section: Hybrid Technique For Multilevel Surgery and Tdr-c In Cervicamentioning

confidence: 99%

Past, Present, and Future of Cervical Arthroplasty

Oh¹,

Yoon

2013

Keio J. Med.

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Cervical arthroplasty was developed in an attempt to maintain cervical motion and potentially to avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease should improve. However, problems associated with cervical arthroplasty have been reported: these include kyphosis, heterotopic ossification-induced motion limitation, no motion preservation even at the index level, and a higher revision rate in a limited number of cases compared with anterior cervical discectomy and fusion (ACDF). In addition, for degenerative cervical disc disorders, the risk of developing adjacent segment degeneration more than 2 years after surgery is reportedly similar for ACDF and cervical arthroplasty. Cervical disc arthroplasty is an emerging motion-sparing technology and is currently undergoing evaluation in many countries as an alternative to arthrodesis for the treatment of cervical radiculopathy and myelopathy. The decision whether to use arthrodesis or arthroplasty is a difficult one. The achievement of good prosthetic performance demands exacting implantation techniques to ensure correct placement. This fact underlines the increasing importance of special instrumentation and surgical skills that involve an understanding of prosthetic lubrication, wear, and biologic effects and familiarity with currently available information regarding kinematics, basic science, testing, and early clinical results. Fortunately, a number of devices are at the late preclinical study stage or at the early clinical trial stage, and results in many cases are promising. In the near future, it is likely that new designs will be produced to replace spinal discs totally or partially in a pathologic entity-specific manner.

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Kinematics of Progressive Circumferential Ligament Resection (Decompression) in Conjunction With Cervical Disc Arthroplasty in a Spondylotic Spine Model

Cited by 8 publications

References 23 publications

Does Resection of the Posterior Longitudinal Ligament Affect the Stability of Cervical Disc Arthroplasty?

Does Resection of the Posterior Longitudinal Ligament Affect the Stability of Cervical Disc Arthroplasty?

Biomechanical evaluation of the ProDisc-C stability following graded posterior cervical injury

Past, Present, and Future of Cervical Arthroplasty

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