The effect of posterior decompressive procedures on segmental range of motion after cervical total disc arthroplasty

Michael J. Brody, Alpesh A. Patel, Alexander J. Ghanayem, Bartosz Wojewnik, Gerard Carandang, Robert M. Havey, Leonard I. Voronov, Georgios Vastardis, Tejaswy Potluri, Avinash G. Patwardhan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Study Design. 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. Summary of Background Data. 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 fo 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)1558-1563
Number of pages6
JournalSpine
Volume39
Issue number19
DOIs
StatePublished - Sep 1 2014

Keywords

  • biomechanics
  • cervical disc arthroplasty
  • cervical spine
  • foraminotomy
  • laminectomy
  • posterior decompression

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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