The Effect of Posterior Decompressive Procedures on Segmental Range of Motion After Cervical Total Disc Arthroplasty

Brody, Michael J.; Patel, Alpesh A.; Ghanayem, Alexander J.; Wojewnik, Bartosz; Carandang, Gerard; Havey, Robert M.; Voronov, Leonard I.; Vastardis, Georgios; Potluri, Tejaswy; Patwardhan, Avinash G.

doi:10.1097/brs.0000000000000481

Cited by 7 publications

(10 citation statements)

References 5 publications

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“…During flexion and extension, mean angular ROM, LZ, and SZ after arthroplasty were maintained and were not significantly different from those of controls (Figs. [3][4][5]. During left axial rotation, ROM was reduced by 13% compared to controls, and LZ was reduced by 33% in overall axial rotation.…”

Section: Range Of Motion Lax Zone and Stiff Zonementioning

confidence: 84%

“…In another biomechanical model utilizing the ProDisc-C, Brody et al demonstrated that a unilateral foraminotomy did not result in a significantly increased ROM. 3 Bilateral foraminotomies increased ROM, but within physiological ranges. However, bilateral foraminotomies in the presence of a full laminectomy were associated with segmental ROM at the upper limits of published normative data, suggesting nonphysiological motion.…”

Section: Clinical Relevancementioning

confidence: 94%

“…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%

“…Although laminectomy was the final endpoint in these studies, both Roberto et al 25 and Brody et al 3 performed a bilateral foraminotomy, whereas our protocol involved a laminoplasty as the penultimate procedure, which may affect the biomechanics and thus data interpretation. Interestingly, we reported a 90% increase in flexion-extension in the arthroplasty group from laminoplasty to laminectomy (compared to 16% in the control group), which is of greater magnitude than rates in previously published studies.…”

Section: Clinical Relevancementioning

confidence: 99%

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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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Section: Range Of Motion Lax Zone and Stiff Zonementioning

confidence: 84%

Section: Clinical Relevancementioning

confidence: 94%

Section: Specimen Selectionmentioning

confidence: 99%

Section: Clinical Relevancementioning

confidence: 99%

See 2 more Smart Citations

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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“…Each specimen was fixed to a kinematic testing apparatus at the caudal end only; the cephalad end was left unconstrained. 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Bilateral posterior cervical cages provide biomechanical stability: assessment of stand-alone and supplemental fixation for anterior cervical discectomy and fusion

Voronov

Siemionow

Havey

et al. 2016

MDER

Self Cite

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IntroductionSupplemental posterior instrumentation has been widely used to enhance stability and improve fusion rates in higher risk patients undergoing anterior cervical discectomy and fusion (ACDF). These typically involve posterior lateral mass or pedicle screw fixation with significant inherent risks and morbidities. More recently, cervical cages placed bilaterally between the facet joints (posterior cervical cages) have been used as a less disruptive alternative for posterior fixation. The purpose of this study was to compare the stability achieved by both posterior cages and ACDF at a single motion segment and determine the stability achieved with posterior cervical cages used as an adjunct to single- and multilevel ACDF.MethodsSeven cadaveric cervical spine (C2–T1) specimens were tested in the following sequence: intact, C5–C6 bilateral posterior cages, C6–C7 plated ACDF with and without posterior cages, and C3–C5 plated ACDF with and without posterior cages. Range of motion in flexion–extension, lateral bending, and axial rotation was measured for each condition under moment loading up to ±1.5 Nm.ResultsAll fusion constructs significantly reduced the range of motion compared to intact in flexion–extension, lateral bending, and axial rotation (P<0.05). Similar stability was achieved with bilateral posterior cages and plated ACDF at a single level. Posterior cages, when placed as an adjunct to ACDF, further reduced range of motion in both single- and multilevel constructs (P<0.05).ConclusionThe biomechanical effectiveness of bilateral posterior cages in limiting cervical segmental motion is comparable to single-level plated ACDF. Furthermore, supplementation of single- and multilevel ACDF with posterior cervical cages provided a significant increase in stability and therefore may be a potential, minimally disruptive option for supplemental fixation for improving ACDF fusion rates.

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Motion response of a polycrystalline diamond adaptive axis of rotation cervical total disc arthroplasty

Havey

Khayatzadeh

Voronov

et al. 2019

Clinical Biomechanics

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The Effect of Posterior Decompressive Procedures on Segmental Range of Motion After Cervical Total Disc Arthroplasty

Abstract: N/A.

Cited by 7 publications

References 5 publications

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

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

Bilateral posterior cervical cages provide biomechanical stability: assessment of stand-alone and supplemental fixation for anterior cervical discectomy and fusion

Motion response of a polycrystalline diamond adaptive axis of rotation cervical total disc arthroplasty

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