title: Motion analysis of total cervical disc replacements using computed tomography: preliminary experience with nine patients and a model.
abstract: BACKGROUND
  Cervical total disc replacement (CTDR) is an alternative to anterior fusion. Therefore, it is desirable to have an accurate in vivo measurement of prosthetic kinematics and assessment of implant stability relative to the adjacent vertebrae.
  
  
  OBJECTIVE
  To devise an in vivo CT-based method to analyze the kinematics of cervical total disc replacements (CTDR), specifically of two prosthetic components between two CT scans obtained under different conditions.
  
  
  METHODS
  Nine patients with CTDR were scanned in flexion and extension of the cervical spine using a clinical CT scanner with a routine low-dose protocol. The flexion and extension CT volume data were spatially registered, and the prosthetic kinematics of two prosthetic components, an upper and a lower, was calculated and expressed in Euler angles and orthogonal linear translations relative to the upper component. For accuracy analysis, a cervical spine model incorporating the same disc replacement as used in the patients was also scanned and processed in the same manner.
  
  
  RESULTS
  Analysis of both the model and patients showed good repeatability, i.e. within 2 standard deviations of the mean using the 95% limits of agreement with no overlapping confidence intervals. The accuracy analysis showed that the median error was close to zero.
  
  
  CONCLUSIONS
  The mobility of the cervical spine after total disc replacement can be effectively measured in vivo using CT. This method requires an appropriate patient positioning and scan parameters to achieve suitable image quality.
authors: Division of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors: Per
authors: P
authors: Svedmark
authors: Fredrik
authors: F
authors: Lundh
authors: Gunnar
authors: G
authors: Németh
authors: Marilyn E
authors: ME
authors: Noz
authors: Gerald Q
authors: GQ
authors: Maguire
authors: Michael P
authors: MP
authors: Zeleznik
authors: Henrik
authors: H
authors: Olivecrona
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D019919:Prosthesis Implantation; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D059145:Total Disc Replacement