In vitro analysis of circumferential joint replacement, including bilateral facet joint replacement with lateral lumber disc prosthesis: a parametric investigation of disc sizing.
Lateral lumbar disc prosthesis (LLDP) is an innovative device used to restore motion in select patients through a lateral retroperitoneal approach. No in vitro biomechanical studies have been published. Further, the potential for in toto circumferential joint restoration when use of this anterior disc is combined with facet replacement remains unqualified but signifies a potentially interesting clinical direction.



Researchers conducted a biomechanical feasibility study of an LLDP designed to investigate parameters of disc sizing used with bilateral facet joint replacement in a cadaveric model. Tested constructs at L4-L5 included (1) intact, (2) LLDP, (3) LLDP + wide discectomy, (4) LLDP + bilateral facetectomy, and (5) LLDP + bilateral facet joint replacement (BFJR). Investigators tested instrumented constructs (2-5) with an LLDP at compact-fit and lax-fit heights and used raw data to perform statistical analysis by repeated measures analysis of variance (ANOVA), along with Student-Newman-Keuls post hoc analysis (p ≤ 0.05).



Increased height of the LLDP resulted in significantly less motion compared with intact. Widening the discectomy while using lax-fit sizing led to motion similar to intact in flexion-extension. As expected, motion was greater with lax-fit height than with compact-fit height in all loading modes and constructs, as is noted with a widened discectomy. The L4-L5 center of rotation was maintained regardless of placement of the LLDP.



After bilateral facetectomy, reconstruction of the three-joint complex achieved by combining the LLDP with BFJR may provide a viable alternative to current clinical treatment regimens.
Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA. mmoldavsky@globusmedical.com.
Mark
M
Moldavsky
Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
Pavel
P
Neumann
Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA.
Noelle
N
Klocke
Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA.
Mir
M
Hussain
Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA.
Brandon S
BS
Bucklen
D017586:Diskectomy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D059145:Total Disc Replacement / Q000379:methods*; D021801:Zygapophyseal Joint / Q000601:surgery*
Center of rotation; Circumferential arthroplasty; Lateral disc prosthesis; Range of motion; Six degrees of freedom
Eur Spine J. 2012 Jun;21 Suppl 5:S577-84
20830492
J Neurosurg. 1999 Apr;90(2 Suppl):163-9
10199244
Spine (Phila Pa 1976). 2014 May 20;39(12 ):925-31
24718066
Eur Spine J. 2014 Nov;23(11):2330-9
24722881
Eur Spine J. 2009 Nov;18(11):1695-1705
19763638
J Neurol Surg A Cent Eur Neurosurg. 2015 Mar;76(2):133-8
25545808
Spine (Phila Pa 1976). 1988 Sep;13(9):1033-41
3206297
J Spinal Disord. 1998 Oct;11(5):416-29
9811103
Spine (Phila Pa 1976). 2004 Sep 1;29(17 ):1938-44
15534420
Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S302-11
21160394
J Spinal Disord Tech. 2014 May;27(3):148-53
22525508
Eur Spine J. 2008 Dec;17(12):1635-50
18946684
J Neurosurg Spine. 2011 Jan;14(1):38-45
21166491
Orthop Clin North Am. 1983 Jul;14 (3):491-504
6346204
Spine (Phila Pa 1976). 2005 Jul 15;30(14 ):1576-83; discussion E388-90
16025025
Clin Biomech (Bristol, Avon). 2007 Mar;22(3):257-65
17196720
Spine (Phila Pa 1976). 1994 Jun 15;19(12 ):1371-80
8066518
Clin Biomech (Bristol, Avon). 2012 Jan;27(1):64-70
21849224
Eur Spine J. 2015 Apr;24 Suppl 3:331-8
25794698
J Neurosurg Spine. 2010 Aug;13(2):260-6
20672964
Spine (Phila Pa 1976). 2003 Oct 15;28(20):S110-7
14560182
Spine (Phila Pa 1976). 2011 Jun;36(13):1017-21
21224772
J Neurosurg. 1999 Jul;91(1 Suppl):60-4
10419370
Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S361-7
21160401
Spine (Phila Pa 1976). 2001 Mar 15;26(6):E122-9
11246394
Spine (Phila Pa 1976). 2013 Oct 15;38(22):1913-9
23921330
J Neurosurg Spine. 2012 Apr;16(4):329-33
22284229
Eur Spine J. 1995;4(6):339-42
8983652
J Spinal Disord. 1992 Dec;5(4):390-6; discussion 397
1490035
Int J Spine Surg. 2012 Dec 01;6:18-23
25694866