title: Postero-lateral disc prosthesis combined with a unilateral facet replacement device maintains quantity and quality of motion at a single lumbar level.
abstract: BACKGROUND
  Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent.
  
  
  OBJECTIVE
  The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels.
  
  
  METHODS
  In-vitro study using human cadaveric lumbar spines.
  
  
  METHODS
  Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions.
  
  
  RESULTS
  Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space.
  
  
  CONCLUSIONS
  Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level.
authors.affiliation: Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL, USA.
authors.forename: Aniruddh N
authors.initials: AN
authors.lastname: Nayak
authors.affiliation: Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Doarn
authors.affiliation: Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Gaskins
authors.affiliation: Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA.
authors.forename: Chris R
authors.initials: CR
authors.lastname: James
authors.affiliation: Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL, USA.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Cabezas
authors.affiliation: Center for Spinal Disorders, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Castellvi
authors.affiliation: Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL, USA ; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Santoni
keywords: biomechanics; facet replacement; instantaneous center of rotation; interpedicular travel; lumbar spine arthroplasty; total disc replacement