title: In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement.
abstract: BACKGROUND
  To better understand cervical kinematics following cervical disc replacement (CDR), the in vivo behavior of a minimally constrained CDR was assessed.
  
  
  METHODS
  Radiographic analysis of 19 patients undergoing a 1-level CDR from C4-5 to C6-7 (DISCOVER, Depuy-Spine, USA) was performed. Neutral-lateral and flexion-extension radiographs obtained at preop, postop and late follow-up were analyzed for segmental angle and global angle (GA C2-7). Flexion-extension range of motion was analyzed using validated quantitative motion analysis software (QMA®, Medical Metrics, USA). The FSU motion parameters measured at the index and adjacent levels were angular range of motion (ROM), translation and center of rotation (COR). Translation and COR were normalized to the AP dimension of the inferior endplate of the caudal vertebra. All motion parameters, including COR, were compared with normative reference data.
  
  
  RESULTS
  The average patient age was 43.5 ± 7.3 years. The mean follow-up was 15.3 ± 7.2 months. C2-7 ROM was 35.9° ± 15.7° at preop and 45.4° ± 13.6° at follow-up (∆p < .01). Based on the QMA at follow-up, angular ROM at the CDR level measured 9.8° ± 5.9° and translation was 10.1 ± 7.8 %. Individuals with higher ROM at the CDR level had increased translation at that level (p < .001, r = 0.97), increased translation and ROM at the supra-adjacent level (p < .001, r = .8; p = .005, r = .6). There was a strong interrelation between angular ROM and translation at the supra-adjacent level (p < .001, r = .9) and caudal-adjacent level (p < .001, r = .9). The location of the COR at the CDR- and supra-adjacent levels was significantly different for the COR-X (p < .001). Notably, the COR-Y at the CDR level was significantly correlated with the extent of CDR-level translation (p = .02, r = .6). Shell angle, which may be influenced by implant size and positioning had no impact on angular ROM but was correlated with COR-X (p = .05, r = -.6) and COR-Y (p = .04, r = -.5).
  
  
  CONCLUSIONS
  The COR is an important parameter for assessing the ability of non-constrained CDRs to replicate the normal kinematics of a FSU. CDR size and location, both of which can impact shell angle, may influence the amount of translation by affecting the location of the COR. Future research is needed to show how much translation is beneficial concerning clinical outcomes and facet loading.
authors.affiliation: Werner Wicker Clinic, German Scoliosis Center Bad Wildungen, Im Kreuzfeld 4, 34537 Bad Wildungen, Germany. heiko.koller@t-online.de
authors.forename: Heiko
authors.initials: H
authors.lastname: Koller
authors.forename: Oliver
authors.initials: O
authors.lastname: Meier
authors.forename: Juliane
authors.initials: J
authors.lastname: Zenner
authors.forename: Michael
authors.initials: M
authors.lastname: Mayer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D059145:Total Disc Replacement / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome