title: Multidirectional flexibility analysis of cervical artificial disc reconstruction: in vitro human cadaveric spine model.
abstract: OBJECTIVE
  This in vitro experimental study was conducted to investigate the initial biomechanical effect of artificial intervertebral disc replacement in the cervical spine. The multidirectional flexibility of replaced and adjacent spinal segments were analyzed using a cadaveric cervical spine model.
  
  
  METHODS
  The following three cervical reconstructions were sequentially performed at the C5-6 level after anterior discectomy in seven human cadaveric occipitocervical spines: anterior artificial disc replacement with a bioactive three-dimensional (3D) fabric disc (FD); anterior iliac bone graft; and anterior plate fixation with iliac bone graft. Six unconstrained pure moments were applied with a 6-df spine simulator, and 3D segmental motions at the operative and adjacent segments were measured with an optoelectronic motion measurement system. The 3D FD group demonstrated statistically equivalent ranges of motion (ROMs) when compared with intact values in axial rotation and lateral bending. The 45% increase in flexion-extension ROM was demonstrated in 3D FD group; however, neutral zone analysis did not reach statistical significance between the intact spine and 3D FD. The anterior iliac bone graft and iliac bone graft reconstructions demonstrated statistically lower ROMs when compared with 3D FD in all loading modes (p < 0.05). The adjacent-level ROMs of the 3D FD group demonstrated nearly physiological characteristics at upper and lower adjacent levels. Excellent stability at the interface was maintained during the whole testing without any device displacement and dislodgment.
  
  
  CONCLUSIONS
  The stand-alone cervical 3D FD demonstrated nearly physiological biomechanical characteristics at both operative and adjacent spinal segments in vitro, indicating an excellent clinical potential for cervical artificial disc replacement.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. y-kotani@med.hokudai.ac.jp
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Cunningham
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Anton E
authors.initials: AE
authors.lastname: Dmitriev
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Niabin
authors.initials: N
authors.lastname: Hu
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shikinami
authors.forename: Paul C
authors.initials: PC
authors.lastname: McAfee
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D001860:Bone Plates; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery*; D019245:Compressive Strength / Q000502:physiology; D017586:Diskectomy; D019544:Equipment Failure Analysis; D006801:Humans; D066298:In Vitro Techniques; D007403:Intervertebral Disc / Q000601:surgery*; D018583:Pliability; D011095:Polyethylenes; D019736:Prostheses and Implants; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D013718:Tensile Strength / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology
chemical_list: D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene