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Postero-lateral disc prosthesis combined with a unilateral facet replacement device maintains quantity and quality of motion at a single lumbar level.

Nayak AN, Doarn MC, Gaskins RB, James CR, Cabezas AF, Castellvi AE, Santoni BG - Int J Spine Surg (2014)

Bottom Line: ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions.Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR.No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode.

View Article: PubMed Central - PubMed

Affiliation: Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL, USA.

ABSTRACT

Background: Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent.

Purpose: The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels.

Study design: In-vitro study using human cadaveric lumbar spines.

Methods: Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions.

Results: Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space.

Conclusion: Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level.

No MeSH data available.


Related in: MedlinePlus

Range of motion (ROM) histogram showing index level ROM (y-axis) as a function of instrumentation for various loading modes (x-axis).
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Figure 0005: Range of motion (ROM) histogram showing index level ROM (y-axis) as a function of instrumentation for various loading modes (x-axis).

Mentions: Baseline total flexion-extension ROM for the intact L4-L5 segment was 11.3 ± 4.3° (Figure 5). Subsequent spinal reconstruction with the Uni-FR (12.3° ± 4.3°) and Uni-FR + PDR (10.3° ± 3.1°) did not significantly affect flexion-extension ROM (p = 0.081). Range of motion findings were similar under 400 N applied compressive follower load, with no significant differences in flexion-extension between instrumentation conditions (p = 0.747). Baseline flexion-extension IPT was 13.0 ± 3.9 mm without the follower load and 10.2 ± 3.5 mm with the follower load (Table 1). Without the follower load, IPT in the Uni-FR and Uni-FR + PDR conditions increased to 14.6 ± 4.1 mm (p = 0.008) and 14.3 ± 4.1 mm (p = 0.043). No changes in IPT during flexion-extension loading were noted with the follower load for either reconstruction condition (p = 0.294).


Postero-lateral disc prosthesis combined with a unilateral facet replacement device maintains quantity and quality of motion at a single lumbar level.

Nayak AN, Doarn MC, Gaskins RB, James CR, Cabezas AF, Castellvi AE, Santoni BG - Int J Spine Surg (2014)

Range of motion (ROM) histogram showing index level ROM (y-axis) as a function of instrumentation for various loading modes (x-axis).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325497&req=5

Figure 0005: Range of motion (ROM) histogram showing index level ROM (y-axis) as a function of instrumentation for various loading modes (x-axis).
Mentions: Baseline total flexion-extension ROM for the intact L4-L5 segment was 11.3 ± 4.3° (Figure 5). Subsequent spinal reconstruction with the Uni-FR (12.3° ± 4.3°) and Uni-FR + PDR (10.3° ± 3.1°) did not significantly affect flexion-extension ROM (p = 0.081). Range of motion findings were similar under 400 N applied compressive follower load, with no significant differences in flexion-extension between instrumentation conditions (p = 0.747). Baseline flexion-extension IPT was 13.0 ± 3.9 mm without the follower load and 10.2 ± 3.5 mm with the follower load (Table 1). Without the follower load, IPT in the Uni-FR and Uni-FR + PDR conditions increased to 14.6 ± 4.1 mm (p = 0.008) and 14.3 ± 4.1 mm (p = 0.043). No changes in IPT during flexion-extension loading were noted with the follower load for either reconstruction condition (p = 0.294).

Bottom Line: ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions.Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR.No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode.

View Article: PubMed Central - PubMed

Affiliation: Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL, USA.

ABSTRACT

Background: Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent.

Purpose: The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels.

Study design: In-vitro study using human cadaveric lumbar spines.

Methods: Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions.

Results: Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space.

Conclusion: Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level.

No MeSH data available.


Related in: MedlinePlus