Yoganandan Narayan, Purushothaman Yuvaraj, Choi Hoon, Baisden Jamie, Rajasekaran Deepak, Banerjee Anjishnu, Jebaseelan Davidson, Kurpad Shekar
Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226; VA Medical Center, Medical College of Wisconsin, Milwaukee, WI 53226; Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.
Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226.
J Eng Sci Med Diagn Ther. 2021 May 1;4(2):021004. doi: 10.1115/1.4049907. Epub 2021 Feb 22.
Many artificial discs for have been introduced to overcome the disadvantages of conventional anterior discectomy and fusion. The purpose of this study was to evaluate the performance of different U.S. Food and Drug Administration (FDA)-approved cervical disc arthroplasty (CDA) on the range of motion (ROM), intradiscal pressure, and facet force variables under physiological loading. A validated three-dimensional finite element model of the human intact cervical spine (C2-T1) was used. The intact spine was modified to simulate CDAs at C5-C6. Hybrid loading with a follower load of 75 N and moments under flexion, extension, and lateral bending of 2 N·m each were applied to intact and CDA spines. From this work, it was found that at the index level, all CDAs except the Bryan disc increased ROM, and at the adjacent levels, motion decreased in all modes. The largest increase occurred under the lateral bending mode. The Bryan disc had compensatory motion increases at the adjacent levels. Intradiscal pressure reduced at the adjacent levels with Mobi-C and Secure-C. Facet force increased at the index level in all CDAs, with the highest force with the Mobi-C. The force generally decreased at the adjacent levels, except for the Bryan disc and Prestige LP in lateral bending. This study demonstrates the influence of different CDA designs on the anterior and posterior loading patterns at the index and adjacent levels with head supported mass type loadings. The study validates key clinical observations: CDA procedure is contraindicated in cases of facet arthroplasty and may be protective against adjacent segment degeneration.
为克服传统前路椎间盘切除术和融合术的缺点,人们已推出多种人工椎间盘。本研究的目的是评估美国食品药品监督管理局(FDA)批准的不同颈椎间盘置换术(CDA)在生理负荷下对活动范围(ROM)、椎间盘内压力和小关节力变量的影响。使用了经过验证的人体完整颈椎(C2-T1)三维有限元模型。对完整脊柱进行修改,以模拟C5-C6节段的CDA。分别对完整脊柱和CDA脊柱施加75 N的跟随载荷以及屈曲、伸展和侧弯时各2 N·m的力矩的混合载荷。通过这项研究发现,在索引节段,除Bryan椎间盘外,所有CDA均增加了ROM,而在相邻节段,所有模式下的活动均减少。最大的增加发生在侧弯模式下。Bryan椎间盘在相邻节段有代偿性活动增加。Mobi-C和Secure-C使相邻节段的椎间盘内压力降低。所有CDA在索引节段的小关节力均增加,Mobi-C的力最高。除Bryan椎间盘和Prestige LP在侧弯时外,相邻节段的力通常降低。本研究证明了不同CDA设计在头部支撑质量型载荷下对索引节段和相邻节段前后负荷模式的影响。该研究验证了关键的临床观察结果:小关节置换术病例禁忌CDA手术,且CDA可能预防相邻节段退变。
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