The impact of total lumbar disc replacement on segmental and total lumbar lordosis

Cakir, Balkan; Richter, Marcus; Käfer, Wolfram; Puhl, W.; Schmidt, René

doi:10.1016/j.clinbiomech.2004.11.019

Cited by 61 publications

(43 citation statements)

References 28 publications

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“…One of the primary aims of TDR is to preserve motion and thereby ultimately avoid stress and degeneration of the adjacent segment. Radiographic studies have demonstrated maintained physiological sagittal and spinopelvic alignment following TDR [5,10,33,61]. It has therefore been hypothesized that the above-mentioned fusion-related negative side effects and post-fusion pain patterns could be avoided with TDR.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, implant positioning and disc-/implant-height have been shown to influence and increase post-operative segmental lordosis which may ultimately lead to a subluxation of the facet joints (Fig. 3) [5,41,53].…”

Section: Radiological Studiesmentioning

confidence: 99%

“…Hypothetically, lumbar disc arthroplasty should serve to avoid stress to the adjacent segments by maintaining motion. Furthermore, it has been shown that physiological sagittal alignment is maintained following TDR [5,6,10,33,61].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Radiological Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…Only a few in vivo studies already described an increase of segmental lordosis after implantation of TDR. An increase was observed after implantation of the Prodisc [2,12], the Charité [9] and the semi-constrained Maverick-prosthesis, which has a more posterior and cranial centre of rotation, compared with the Prodisc [16]. But there is still no agreement if this increase can be considered as a segmental realignment to physiologic values, as proposed by Hopf et al [9] or as an unphysiological increase towards hyperlordosis, as proposed by Cakir et al [2].…”

Section: Discussionmentioning

confidence: 99%

“…Although some TDRs are in use for several years and are clinically established, such as the Charité-Prosthesis with its unconstrained and the Prodisc-Prosthesis with its semi-constrained disc kinematic, little is known about the impact of different disc kinematics on biomechanical behaviour of the lumbar spinal unit. Also the variable centre of rotation in case of semi-constrained prosthesis is supposed to be of crucial importance for segmental biomechanics [2,7]. Further insight into the biomechanical behaviour of TDR could help to assess clinical outcome better.…”

Section: Introductionmentioning

confidence: 99%

The role of prosthesis design on segmental biomechanics

et al. 2010

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The purpose of this study was to evaluate the influence of different implant designs of total lumbar disc replacements on the segmental biomechanics of the lumbar spine. The unconstrained Charité, the semi-constrained Prodisc and a semi-constrained Prototype with more posterior centre of rotation than the Prodisc were tested in vitro using six human, lumbar spines L2-L5. The segmental lordosis was measured on plain radiographs and the range of motion (ROM) for all six degrees of freedom with a previously described spine tester. All prostheses were implanted at level L3-

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Biomechanical function of a balloon nucleus pulposus replacement system: A human cadaveric spine study

Lee

Lim

Lee

et al. 2017

Journal Orthopaedic Research

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With recent advances in motion-sparing techniques in spine surgery, disc nucleus replacement (DNR) has been introduced as a viable method to restore the biomechanical functions of the spine. Several methods of DNR have been proposed in the literature. However, the risk of device migration or extrusion is a major issue that should be addressed for a successful DNR. DNR using a balloon nucleus (BN) filled with pressurized fluid may be capable of reducing such risks while preserving the advantages of DNR. The objective of this study was to investigate the biomechanical functionalities of the human cadaveric lumbar motion segments with a custom made BN filled with saline at internal fluid pressure of 0.3 or 0.6 MPa in terms of axial and rotational flexibilities of the L4-L5 motion segment. Axial flexibility was quantified by the axial displacement resulting from an axial compressive force of 400 N while the rotational flexibility by the range of motions determined as the rotational angles in response to a pure moment of 6.0 Nm in flexion, extension, and right- and left-lateral bending directions. These tests were performed successively on the motion segment in the following conditions: intact, post nucleotomy, implanting BN with 0.3 MPa, and BN with 0.6 MPa. The nucleotomy was found to significantly increase both the axial and rotational flexibilities while the implantation of the BN reduced the axial and rotational flexibilities to those of the intact segment. The axial and rotational flexibilities of the segment with the BN with 0.3 MPa were greater than those of the segment with the BN with 0.6 MPa. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:167-173, 2018.

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The impact of total lumbar disc replacement on segmental and total lumbar lordosis

Cited by 61 publications

References 28 publications

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

The role of prosthesis design on segmental biomechanics

Biomechanical function of a balloon nucleus pulposus replacement system: A human cadaveric spine study

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