title: Does total disc arthroplasty in C3/C4-segments change the kinematic features of axial rotation?
abstract: We analyze how kinematic properties of C3/C4-segments are modified after total disc arthroplasty (TDA) with PRESTIGE(®) and BRYAN(®) Cervical Discs. The measurements were focused on small ranges of axial rotation (<0.8°) in order to investigate physiologic rotations, which frequently occur in vivo. Eight human segments were stimulated by triangularly varying, axially directed torque. By using a 6D-measuring device with high resolution the response of segmental motion was characterised by the instantaneous helical axis (IHA). Position, direction, and migration rate of the IHA were measured before and after TDA. External parameters: constant axially directed pre-load, constant flexional/extensional and lateral-flexional pre-torque. The applied axial torque and IHA-direction did not run parallel. The IHA-direction was found to be rotated backwards and largely independent of the rotational angle, amount of axial pre-load, size of pre-torque, and TDA. In the intact segments pre-flexion/extension hardly influenced IHA-positions. After TDA, IHA-position was shifted backwards significantly (BRYAN-TDA: ≈8mm; PRESTIGE-TDA: ≈6mm) and in some segments laterally as well. Furthermore it was significantly shifted ventrally by pre-flexion and dorsally by pre-extension. The rate of lateral IHA-migration increased significantly after BRYAN-TDA during rightward or leftward rotations. In conclusion after the TDA the IHA-positions shifted backwards with significant increase in variability of the IHA-positions after the BRYAN-TDA more than in PRESTIGE-TDA. The TDA-procedure altered the segment kinematics considerably. TDA causes additional translations of the vertebrae, which superimpose the kinematics of the adjacent levels. The occurrence of adjacent level disease (ALD) is not excluded after the TDA for kinematical reasons.
authors: Department of Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Germany. martin.wachowski@web.de
authors: Martin Michael
authors: MM
authors: Wachowski
authors: Markus
authors: M
authors: Wagner
authors: Jan
authors: J
authors: Weiland
authors: Jochen
authors: J
authors: Dörner
authors: Björn Werner
authors: BW
authors: Raab
authors: Henning
authors: H
authors: Dathe
authors: Riccardo
authors: R
authors: Gezzi
authors: Dietmar
authors: D
authors: Kubein-Meesenburg
authors: Hans
authors: H
authors: Nägerl
mesh_terms: D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000502:physiology*; D006801:Humans; D007403:Intervertebral Disc / Q000502:physiology*; D012399:Rotation; D019415:Torque; D059145:Total Disc Replacement