title: The effect of posterior decompressive procedures on segmental range of motion after cervical total disc arthroplasty.
abstract: METHODS
  We quantified the segmental biomechanics of a cervical total disc replacement (TDR) before and after progressive posterior decompression. We hypothesized that posterior decompressive procedures would not significantly increase range of motion (ROM) at the index TDR level.
  
  
  OBJECTIVE
  To quantify the kinematics of a cervical total disc replacement (TDR) before and after posterior cervical decompression.
  
  
  BACKGROUND
  A reported yet unaddressed issue is the potential for the development of same-segment disease after implantation of a cervical TDR and the implications of same-segment posterior decompression on TDR mechanics.
  
  
  METHODS
  Eight human cadaveric cervical spines C3-C7 were tested in flexion-extension, lateral bending, and axial rotation while intact, after C5-C6 TDR, C5-C6 unilateral foraminotomy, C5-C6 bilateral foraminotomies, and after C5 laminectomy in combination with the bilateral foraminotomies. Moment versus angular motion curves were obtained for each testing step, and the load-displacement data were analyzed to determine the range of angular motion for each step.
  
  
  RESULTS
  Unilateral foraminotomy did not result in a statistically significant increase in flexion-extension ROM, and did not increase the ROM to a degree greater than normal. Although bilateral foraminotomies did increase flexion-extension ROM, motion remained within a physiological range. A full laminectomy added to the bilateral foraminotomies significantly increased ROM and was also associated with distortion of the load-displacement curves.
  
  
  CONCLUSIONS
  With respect to segmental biomechanics as demonstrated, we think that for same-segment disease, a unilateral foraminotomy can be performed safely. However, the impact of in vivo conditions was not accounted for in this model, and it is possible that cyclical loading and other physiological stresses on such a construct may affect the behavior and lifespan of the implant in a way that cannot be predicted by a biomechanical study. Bilateral foraminotomies would require close observation and additional clinical follow-up, whereas complete laminectomy combined with bilateral foraminotomies should be avoided after TDR given the significant changes in kinematics. In addition, future disc replacement designs may need to account for changes after posterior decompression for same-segment disease.
  
  
  METHODS
  N/A.
authors: *Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL †Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL; and ‡Department of Orthopaedic Surgery, Northwestern University School of Medicine, Chicago, IL.
authors: Michael J
authors: MJ
authors: Brody
authors: Alpesh A
authors: AA
authors: Patel
authors: Alexander J
authors: AJ
authors: Ghanayem
authors: Bartosz
authors: B
authors: Wojewnik
authors: Gerard
authors: G
authors: Carandang
authors: Robert M
authors: RM
authors: Havey
authors: Leonard I
authors: LI
authors: Voronov
authors: Georgios
authors: G
authors: Vastardis
authors: Tejaswy
authors: T
authors: Potluri
authors: Avinash G
authors: AG
authors: Patwardhan
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002102:Cadaver; D002574:Cervical Vertebrae / Q000601:surgery*; D019245:Compressive Strength; D000075202:Contraindications; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D059526:Foraminotomy / Q000379:methods*; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009038:Motion; D016059:Range of Motion, Articular; D059145:Total Disc Replacement; D016474:Weight-Bearing