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Foroutan P, Quarrington RD, Russo MP, Ding B, Cripton PA, Costi JJ, Jones CF. Facet deflection and strain are dependent on axial compression and distraction in C5-C7 spinal segments under constrained flexion. JOR Spine 2024; 7:e1360. [PMID: 39071861 PMCID: PMC11272947 DOI: 10.1002/jsp2.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Background Facet fractures are frequently associated with clinically observed cervical facet dislocations (CFDs); however, to date there has only been one experimental study, using functional spinal units (FSUs), which has systematically produced CFD with concomitant facet fracture. The role of axial compression and distraction on the mechanical response of the cervical facets under intervertebral motions associated with CFD in FSUs has previously been shown. The same has not been demonstrated in multi-segment lower cervical spine specimens under flexion loading (postulated to be the local injury vector associated with CFD). Methods This study investigated the mechanical response of the bilateral inferior C6 facets of thirteen C5-C7 specimens (67±13 yr, 6 male) during non-destructive constrained flexion, superimposed with each of five axial conditions: (1) 50 N compression (simulating weight of the head); (2-4) 300, 500, and 1000 N compression (simulating the spectrum of intervertebral compression resulting from neck muscle bracing prior to head-first impact and/or externally applied compressive forces); and, (5) 2 mm of C6/C7 distraction (simulating the intervertebral distraction present during inertial loading of the cervical spine by the weight of the head). Linear mixed-effects models (α = 0.05) assessed the effect of axial condition. Results Increasing amounts of intervertebral compression superimposed on flexion rotations, resulted in increased facet surface strains (range of estimated mean difference relative to Neutral: maximum principal = 77 to 110 με, minimum principal = 126 to 293 με, maximum shear = 203 to 375 με) and angular deflection of the bilateral inferior C6 facets relative to the C6 vertebral body (range of estimated mean difference relative to Neutral = 0.59° to 1.47°). Conclusions These findings suggest increased facet engagement and higher load transfer through the facet joint, and potentially a higher likelihood of facet fracture under the compressed axial conditions.
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Affiliation(s)
- Parham Foroutan
- School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Ryan D. Quarrington
- School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Pyrros Russo
- Biomechanics and Implants Research Group, Medical Device Research Institute, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Boyin Ding
- School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Peter A. Cripton
- Orthopaedic and Injury Biomechanics Group, School of Biomedical Engineering and Departments of Mechanical Engineering and OrthopaedicsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - John J. Costi
- Biomechanics and Implants Research Group, Medical Device Research Institute, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Claire F. Jones
- School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Department of Orthopaedics & TraumaRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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Liu M, Quarrington RD, Sandoz B, Robertson WSP, Jones CF. Evaluation of Apparatus and Protocols to Measure Human Passive Neck Stiffness and Range of Motion. Ann Biomed Eng 2024; 52:2178-2192. [PMID: 38658477 PMCID: PMC11247060 DOI: 10.1007/s10439-024-03517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Understanding of human neck stiffness and range of motion (ROM) with minimal neck muscle activation ("passive") is important for clinical and bioengineering applications. The aim of this study was to develop, implement, and evaluate the reliability of methods for assessing passive-lying stiffness and ROM, in six head-neck rotation directions. Six participants completed two assessment sessions. To perform passive-lying tests, the participant's head and torso were strapped to a bending (flexion, extension, lateral bending) or a rotation (axial rotation) apparatus, and clinical bed, respectively. The head and neck were manually rotated by the researcher to the participant's maximum ROM, to assess passive-lying stiffness. Participant-initiated ("active") head ROM was also assessed in the apparatus, and seated. Various measures of apparatus functionality were assessed. ROM was similar for all assessment configurations in each motion direction except flexion. In each direction, passive stiffness generally increased throughout neck rotation. Within-session reliability for stiffness (ICC > 0.656) and ROM (ICC > 0.872) was acceptable, but between-session reliability was low for some motion directions, probably due to intrinsic participant factors, participant-apparatus interaction, and the relatively low participant number. Moment-angle corridors from both assessment sessions were similar, suggesting that with greater sample size, these methods may be suitable for estimating population-level corridors.
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Affiliation(s)
- Mingyue Liu
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Ryan D Quarrington
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Baptiste Sandoz
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, France
| | - William S P Robertson
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Claire F Jones
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia.
- Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Como CJ, LeVasseur CM, Oyekan A, Padmanabhan A, Makowicz N, Chen S, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. Dynamic in vivo 3D atlantooccipital kinematics during multiplanar physiologic motions. J Biomech 2024; 173:112236. [PMID: 39084063 DOI: 10.1016/j.jbiomech.2024.112236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
Normal biomechanics of the upper cervical spine, particularly at the atlantooccipital joint, remain poorly characterized. The purpose of this study was to determine the intervertebral kinematics of the atlantooccipital joint (occiput-C1) during three-dimensional in vivo physiologic movements. Twenty healthy young adults performed dynamic flexion/extension, axial rotation, and lateral bending while biplane radiographs were collected at 30 images per second. Motion at occiput-C1 was tracked using a validated volumetric model-based tracking process that matched subject-specific CT-based bone models to the radiographs. The occiput-C1 total range of motion (ROM) and helical axis of motion (HAM) was calculated for each movement. During flexion/extension, the occiput-C1 moved almost exclusively in-plane (ROM: 17.9 ± 6.9°) with high variability in kinematic waveforms (6.3°) compared to the in-plane variability during axial rotation (1.4°) and lateral bending (0.9°) movements. During axial rotation, there was small in-plane motion (ROM: 4.2 ± 2.5°) compared to out-of-plane flexion/extension (ROM: 12.7 ± 5.4°). During lateral bending, motion occurred in-plane (ROM: 9.0 ± 3.1°) and in the plane of flexion/extension (ROM: 7.3 ± 2.7°). The average occiput-C1 axis of rotation intersected the sagittal and coronal planes 7 mm to 18 mm superior to the occipital condyles. The occiput-C1 axis of rotation pointed 60° from the sagittal plane during axial rotation but only 10° from the sagittal plane during head lateral bending. These novel results are foundational for future work on upper cervical spine kinematics.
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Affiliation(s)
- Christopher J Como
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States.
| | - Clarissa M LeVasseur
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Anthony Oyekan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Aditya Padmanabhan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Noah Makowicz
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Stephen Chen
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William F Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Joon Y Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Jeremy D Shaw
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William J Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
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Luo Y, Huang X, Yue Y, Lin X, Chen G, Wang K, Luo Y. In vivo cervical vertebrae kinematic studies based on dual fluoroscopic imaging system measurement: A narrative review. Heliyon 2024; 10:e30904. [PMID: 38765031 PMCID: PMC11097065 DOI: 10.1016/j.heliyon.2024.e30904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024] Open
Abstract
Understanding the motion characteristics of cervical spine through biomechanical analysis aids in the identification of abnormal joint movements. This knowledge is essential for the prevention, diagnosis, and treatment of related disorders. However, the anatomical structure of the cervical spine is complex, and traditional medical imaging techniques have certain limitations. Capturing the movement characteristics of various parts of the cervical spine in vivo during motion is challenging. The dual fluoroscopic imaging system (DFIS) is able to quantify the motion and motion patterns of individual segments. In recent years, DFIS has achieved accurate non-invasive measurements of dynamic joint movements in humans. This review assesses the research findings of DFIS about the cervical spine in healthy and pathological individuals. Relevant study search was conducted up to October 2023 in Web of Science, PubMed, and EBSCO databases. After the search, a total of 30 studies were ultimately included. Among them, 13 studies focused on healthy cervical spines, while 17 studies focused on pathological cervical spines. These studies mainly centered on exploring the vertebral bodies and associated structures of the cervical spine, including intervertebral discs, intervertebral foramina, and zygapophyseal joints. Further research could utilize DFIS to investigate cervical spine motion in different populations and under pathological conditions.
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Affiliation(s)
- Yuanbiao Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xinwei Huang
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Yongda Yue
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xiande Lin
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Guoxian Chen
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Kun Wang
- Department of Rehabilitation Therapy, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Ye Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Zhang Z, Cao K, Zhong Y, Yang J, Chen S, Li G, Wang S, Wan Z. An in Vivo, Three-Dimensional (3D), Functional Centers of Rotation of the Healthy Cervical Spine. World Neurosurg 2024; 184:e203-e210. [PMID: 38266986 DOI: 10.1016/j.wneu.2024.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study examined cervical center of rotation (COR) positions in 7 postures using validated cone beam computed tomography (CBCT) combined with 3D-3D registration in healthy volunteers. METHODS CBCT scans were performed on 20 healthy volunteers in 7 functional positions, constructing a three-dimensional (3D) model. Images were registered to the neutral position using 3D-3D registration, allowing analysis of kinematic differences and rotational axes. COR measurements were obtained for each segment (C2/3 to C6/7) in each posture. RESULTS The CORs of C2/3 to C6/7 were predominantly posterior (-5.3 ± 3.8 ∼ -0.6 ± 1.2 mm) and superior (16.5 ± 6.0 ∼ 23.6 ± 3.2 mm) to the intervertebral disc's geometric center (GC) in flexion and extension. However, the C4/5 segment's COR was anterior to the GC (2.0 ± 9.8 mm) during flexion and close to it in the right-left direction. During left-right twisting, the CORs of C2/3-C6/7 were posterior (-21.8 ± 10.5 ∼-0.9 ± 0.8 mm) and superior (3.1 ± 7.5 ∼23.2 ± 3.6 mm) to the GCs in anterior-posterior and superior-inferior directions, without consistent right-left directionality. During left-right bending, each segment's COR was predominantly posterior (-25.2 ± 13.1 ∼-6.5 ± 9.9 mm) and superior (0.3 ± 12.5 ∼12.1 ± 5.1 mm) to the GC in anterior-posterior and superior-inferior directions, except for the C2/3 segment, located inferiorly (-5.9 ± 4.1 mm) in left bending. The right-left COR position varied across segments. CONCLUSIONS Our findings reveal segment-specific and posture-dependent COR variations. Notably, the CORs of C3/4, C4/5, and C5/6 consistently align near the intervertebral disc's GC at different postures, supporting their suitability for total disc replacement surgery within the C3/4 to C5/6 segments.
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Affiliation(s)
- Zizhen Zhang
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Kai Cao
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yanlong Zhong
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jie Yang
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Shaofeng Chen
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Guoan Li
- Department of Orthopaedic Surgery, Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts, USA
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Zongmiao Wan
- The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
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Fleck S, Lang A, Lehmberg J, Landscheidt JF, Gerlach R, Rathert J, Ulrich C, Schär RT, Hartmann S, Mueller JU, Thome C. Prospective Multicenter Trial of Cervical Arthroplasty with the ROTAIO® Cervical Disc Prosthesis. Global Spine J 2024; 14:429-437. [PMID: 35929409 PMCID: PMC10802525 DOI: 10.1177/21925682221109563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Clinical observational study. OBJECTIVE The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. MATERIAL AND METHODS 120 patients (72 females and 48 males with median age of 43.0 years [23-60 yrs] underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n = 104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months in 100%, 96% and 77% of the cohort by VAS, NDI, WL-26, Patient`s Satisfaction Index (PSI), SF-36, Nurick Score, mJOA, Composite Success Rate, complications, patient`s overall satisfaction and analgesics use. RESULTS Highly significant clinical improvements were observed according to NDI and VAS (P < .0001 (arm); P < .001 (neck); P = .002 (head)) at all time points. Analgetic use could be reduced in 87.1 to 95.2%. Doctor`s visits have been reduced in 93.8% after 24 months. Patient`s overall satisfaction was high with 78.4 to 83.5% of patients. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed resulting in a revision rate of 1.7% in 2 years. CONCLUSION The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating highly significant clinical improvement and high patient`s overall satisfaction with very low revision rates at 2 years.
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Affiliation(s)
- Steffen Fleck
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Anna Lang
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jens Lehmberg
- Department of Neurosurgery, Klinikum Bogenhausen, Munich, Germany
| | | | - Ruediger Gerlach
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | - Julian Rathert
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | | | - Ralph T. Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Claudius Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Lanman TH, Cuellar JM, Mottole N, Wernke M, Carruthers E, Valdevit A. Range of motion after 1, 2, and 3 level cervical disc arthroplasty. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100294. [PMID: 38162168 PMCID: PMC10755821 DOI: 10.1016/j.xnsj.2023.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background Motion of a solid body involves translation and rotation. Few investigations examine the isolated translational and rotational components associated with disc arthroplasty devices. This study investigates single- and multi-level cervical disc arthroplasty with respect to index and adjacent level range of motion. The investigators hypothesized that single- and multilevel cervical disc replacement will lead to comparable or improved motion at implanted and adjacent levels. Methods Seven human cervical spines from C2 to C7 were subjected to displacement-controlled loading in flexion, extension, and lateral bending under intact, 1-Level (C5-C6), 2-Level (C5-C6, C6-C7) and 3-Level (C5-C6, C6-C7, C4-C5) conditions. 3D motions sensors were mounted at C4, C5, and C6. Motion data for translations and rotations at each level for each surgical condition and loading mode were compared to intact conditions. Results 1-Level: The index surgery resulted in statistically increased translations in extension and lateral bending at all levels with statistically increased translation observed in flexion in the superior and inferior levels. In rotation, the index surgeries decreased rotation under flexion, with remaining levels not statistically different to intact conditions. 2-Level A device placed inferiorly resulted in statistically increased translations at all levels in extension with statistically increased translations superior and inferior to the index level in flexion. Lateral bending resulted in increased nonsignificant translations. Rotations were elevated or comparable to the intact level for all loading. 3-Level Translations were statistically increased for all levels in all loading modes while rotations were elevated or were comparable to the intact level for all loading modes and levels. Conclusions Micromotion sensors permitted monitoring and recording of small magnitude angulations and translations using a loading mechanism that did not over constrain cervical segmental motion. Multilevel cervical disc arthroplasty yielded comparable or increased overall motion at the index and adjacent levels compared to intact conditions.
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Affiliation(s)
- Todd H. Lanman
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd #800 #901, Los Angeles, CA 90048
| | - Jason M. Cuellar
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd #800 #901, Los Angeles, CA 90048
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Hsieh MK, Tai CL, Li YD, Lee DM, Lin CY, Tsai TT, Lai PL, Chen WP. Finite element analysis of optimized novel additively manufactured non-articulating prostheses for cervical total disc replacement. Front Bioeng Biotechnol 2023; 11:1182265. [PMID: 37324423 PMCID: PMC10267663 DOI: 10.3389/fbioe.2023.1182265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Ball-and-socket designs of cervical total disc replacement (TDR) have been popular in recent years despite the disadvantages of polyethylene wear, heterotrophic ossification, increased facet contact force, and implant subsidence. In this study, a non-articulating, additively manufactured hybrid TDR with an ultra-high molecular weight polyethylene core and polycarbonate urethane (PCU) fiber jacket, was designed to mimic the motion of normal discs. A finite element (FE) study was conducted to optimize the lattice structure and assess the biomechanical performance of this new generation TDR with an intact disc and a commercial ball-and-socket Baguera®C TDR (Spineart SA, Geneva, Switzerland) on an intact C5-6 cervical spinal model. The lattice structure of the PCU fiber was constructed using the Tesseract or the Cross structures from the IntraLattice model in the Rhino software (McNeel North America, Seattle, WA) to create the hybrid I and hybrid II groups, respectively. The circumferential area of the PCU fiber was divided into three regions (anterior, lateral and posterior), and the cellular structures were adjusted. Optimal cellular distributions and structures were A2L5P2 in the hybrid I and A2L7P3 in the hybrid II groups. All but one of the maximum von Mises stresses were within the yield strength of the PCU material. The range of motions, facet joint stress, C6 vertebral superior endplate stress and path of instantaneous center of rotation of the hybrid I and II groups were closer to those of the intact group than those of the Baguera®C group under 100 N follower load and pure moment of 1.5 Nm in four different planar motions. Restoration of normal cervical spinal kinematics and prevention of implant subsidence could be observed from the FE analysis results. Superior stress distribution in the PCU fiber and core in the hybrid II group revealed that the Cross lattice structure of a PCU fiber jacket could be a choice for a next-generation TDR. This promising outcome suggests the feasibility of implanting an additively manufactured multi-material artificial disc that allows for better physiological motion than the current ball-and-socket design.
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Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - De-Mei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yi Lin
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Weng-Pin Chen
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
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Zhang H, Sang D, Zhang B, Ren YN, Wang X, Feng JJ, Du CF, Liu B, Zhu R. Parameter Study on How the Cervical Disc Degeneration Affects the Segmental Instantaneous Centre of Rotation. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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10
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Takami T, Hara T, Hara M, Inui T, Ito K, Koyanagi I, Mizuno J, Mizuno M, Nakase H, Shimokawa N, Sugawara T, Suzuki S, Takahashi T, Takayasu M, Tani S, Hida K, Kim P, Arai H. Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients. Neurol Med Chir (Tokyo) 2022; 62:489-501. [PMID: 36223947 PMCID: PMC9726179 DOI: 10.2176/jns-nmc.2022-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2023] Open
Abstract
Anterior cervical disc replacement (ACDR) using cervical artificial disc (CAD) has the advantage of maintaining the range of motion (ROM) at the surgical level, subsequently reducing the postoperative risk of adjacent disc disease. Following the approval for the clinical use in Japan, a post-marketing surveillance (PMS) study was conducted for two different types of CAD, namely, Mobi-C (metal-on-plastic design) and Prestige LP (metal-on-metal design). The objective of this prospective observational multicenter study was to analyze the first 2-year surgical results of the PMS study of 1-level ACDR in Japan. A total of 54 patients were registered (Mobi-C, n = 24, MC group; Prestige LP, n = 30, PLP group). Preoperative neurological assessment revealed radiculopathy in 31 patients (57.4%) and myelopathy in 15 patients (27.8%). Preoperative radiological assessment classified the disease category as disc herniation in 15 patients (27.8%), osteophyte in 6 patients (11.1%), and both in 33 patients (61.1%). The postoperative follow-up rates at 6 weeks, 6 months, 1 year, and 2 years after ACDR were 92.6%, 87.0%, 83.3%, and 79.6%, respectively. In both groups, patients' neurological condition improved significantly after surgery. Radiographic assessment revealed loss of mobility at the surgical level in 9.5% of patients in the MC group and in 9.1% of patients in the PLP group. No secondary surgeries at the initial surgical level and no serious adverse events were observed in either group. The present results suggest that 1-level ACDR is safe, although medium- to long-term follow-up is mandatory to further verify the validity of ACDR for Japanese patients.
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Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University
| | | | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
| | - Junichi Mizuno
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | | | | | | | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center
| | - Shinsuke Suzuki
- Department of Spinal Surgery, Sendai East Neurosurgical Hospital
| | | | | | - Satoshi Tani
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital
| | - Phyo Kim
- Neurologic Surgery, Symphony Clinic
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University
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Li C, Yu X, Xiong Y, Yang Y, Wang F, Zhao H. Mid-long-term follow-up of operated level kinematics after single-level artificial cervical disc replacement with Bryan disc. J Orthop Surg Res 2022; 17:149. [PMID: 35264233 PMCID: PMC8905739 DOI: 10.1186/s13018-022-03051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluation of the mid-long-term kinematics of single-level Bryan artificial cervical disc replacement (ACDR) in vivo by analyzing the center of rotation (COR) at the operated level. METHODS A retrospective analysis was conducted using data collected from 38 patients who underwent single-level Bryan ACDR from January 2010 to March 2013. Radiological parameters including range of motion (ROM), lordosis angle, translation, and COR were obtained. Clinical outcomes were assessed based on Odom Criteria, modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores. Correlations between COR and other follow-up data were discussed at the last follow-up. RESULTS Compared with preoperative values, the last follow-up data showed that 86.84% of cases achieved good-or-excellent outcomes based on Odom criteria; Significant improvements were observed across all scales assessed for clinical outcomes (P < 0.05); Lordosis angle was significantly increased in both the overall cervical spine and the operated level (P < 0.05); ROM of the overall cervical spine, operated level, and adjacent levels was preserved (P > 0.05); There was no significant change in COR at the operated level (P > 0.05). At the last follow-up and at the operated level, COR (Y) showed negative correlations with ROM and translation (P < 0.05), but no follow-up data correlated with COR (X) were found (P > 0.05). CONCLUSIONS Satisfactory clinical and radiological outcomes were achieved 7 years or more after single-level Bryan ACDR. At the operated level, preoperative COR was maintained, probably due to replicating the physiological interrelations of COR (Y), translation, and ROM.
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Affiliation(s)
- Chuanhong Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China.
| | - Yang Xiong
- School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Yongdong Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Fengxian Wang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - He Zhao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
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Muhlbauer MK, Tomasch E, Sinz W, Trattnig S, Steffan H. Cervical disc prostheses need a variable center of rotation for flexion / extension below disc level, plus a separate COR for lateral bending above disc level to more closely replicate in-vivo motion: MRI-based biomechanical in-vivo study. BMC Musculoskelet Disord 2022; 23:227. [PMID: 35260131 PMCID: PMC8905756 DOI: 10.1186/s12891-022-05121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cervical disc prostheses are used to preserve motion after discectomy, but they should also provide a near-physiological qualitative motion pattern. Nevertheless, they come in many completely different biomechanical concepts. This caused us to perform an in-vivo MR-based biomechanical study to further investigate cervical spine motion with the aim to gain new information for improving the design of future cervical arthroplasty devices. Methods Fifteen healthy volunteers underwent MRI-investigation (in order to avoid radiation exposure) of their cervical spines from C3 to C7; for each segment centers of rotation (COR) for flexion / extension were determined from 5 different positions, and CORs for lateral bending from 3 different positions. The motion path of the COR is then described and illustrated in relation to the respective COR for maximum flexion / extension or lateral bending, respectively, and the findings are translated into implications for a better biomechanical prosthesis-design. Results The COR for flexion / extension does not remain constant during motion. The CORs for the respective motion intervals were always found at different positions than the COR for maximum flexion /extension showing that the COR moves both along the x- and the y-axis throughout flexion / extension. For lateral bending a completely independent COR was found above disc-level. Conclusion Flexion / extension is not a simple circular motion. Disc prostheses need a variable COR for flexion / extension below disc level with the capability to move both along the x- and the y-axis during motion, plus a second completely independent COR for lateral bending above disc level to closely replicate in-vivo motion. These findings are important for improving the biomechanical design of such devices in the future.
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Affiliation(s)
- Manfred K Muhlbauer
- Neurosurgical Department, Klinik Donaustadt, Langobardenstrasse 122, 1220, Vienna, Austria.
| | - Ernst Tomasch
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Wolfgang Sinz
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Hermann Steffan
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
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LeVasseur CM, Pitcairn SW, Shaw JD, Donaldson WF, Lee JY, Anderst WJ. The Effects of Pathology and One-Level versus Two-Level Arthrodesis on Cervical Spine Intervertebral Helical Axis of Motion. J Biomech 2022; 133:110960. [DOI: 10.1016/j.jbiomech.2022.110960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
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Lindenmann S, Tsagkaris C, Farshad M, Widmer J. Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2022; 50:1705-1733. [PMID: 36496482 PMCID: PMC9794546 DOI: 10.1007/s10439-022-03088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns can help diagnose these diseases, plan surgical interventions and improve relevant tools and software. During the last decades, numerous studies based on diverse methodologies attempted to elucidate spinal mobility in different planes of motion. The authors aimed to summarize and compare the evidence about cervical spine kinematics under healthy and degenerative conditions. This includes an illustrated description of the spectrum of physiological cervical spine kinematics, followed by a comparable presentation of kinematics of the degenerative cervical spine. Data was obtained through a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As far as the degenerative conditions are concerned, kinematic data regarding disc degeneration and spondylolisthesis were available. Although the majority of the studies identified repeating motion patterns for most motion planes, discrepancies associated with limited sample sizes and different imaging techniques and/or spine configurations, were noted. Among healthy/asymptomatic individuals, flexion extension (FE) and lateral bending (LB) are mainly facilitated by the subaxial cervical spine. C4-C5 and C5-C6 were the major FE contributors in the reported studies, exceeding the motion contribution of sub-adjacent segments. Axial rotation (AR) greatly depends on C1-C2. FE range of motion (ROM) is distributed between the atlantoaxial and subaxial segments, while AR ROM stems mainly from the former and LB ROM from the latter. In coupled motion rotation is quantitatively predominant over translation. Motion migrates caudally from C1-C2 and the center of rotation (COR) translocates anteriorly and superiorly for each successive subaxial segment. In degenerative settings, concurrent or subsequent lesions render the association between diseases and mobility alterations challenging. The affected segments seem to maintain translational and angular motion in early and moderate degeneration. However, the progression of degeneration restrains mobility, which seems to be maintained or compensated by adjacent non-affected segments. While the kinematics of the healthy cervical spine have been addressed by multiple studies, the entire nosological and kinematic spectrum of cervical spine degeneration is partially addressed. Large-scale in vivo studies can complement the existing evidence, cover the gaps and pave the way to technological and clinical breakthroughs.
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Affiliation(s)
- Sara Lindenmann
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Christos Tsagkaris
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland ,Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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15
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Roch PJ, Saul D, Wüstefeld N, Spiering S, Lehmann W, Weiser L, Wachowski MM. The impact of bilateral facetectomy on the instantaneous helical axis of the functional thoracic spinal unit T4-5 during axial rotation. Int Biomech 2021; 8:42-53. [PMID: 34351832 PMCID: PMC8344236 DOI: 10.1080/23335432.2021.1958059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The location of the instantaneous helical axis (IHA) and the impact of the facet joints (FJ) on the kinematics in the thoracic spine remain inconclusive. This study aimed to examine the IHA in the functional spinal unit (FSU) T4-5 during axial rotation in intact conditions and after bilateral facetectomy. Four human T4-5 FSUs were examined with an established 6D measuring apparatus in intact conditions and after bilateral facetectomy. The IHA’s parameters migration, location, and direction in the horizontal plane were calculated. Defined preloads in different positions were applied. Under the intact conditions, the IHA migrated about 4 mm and from one to the contralateral side according to the applied preload. The location of the IHA was observed in the anterior part of the spinal canal. After bilateral facetectomy, the location of the IHA shifted ventrally about 10 mm compared to the intact conditions. Under intact conditions, the direction of the IHA was minimally dorsally reclined. After bilateral facetectomy, the IHA was significantly more ventrally inclined. The study determined the location of the IHA under intact conditions at the anterior part of the spinal canal. The IHA of the FSU T4-5 is substantially influenced by the guidance of the FJs.
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Affiliation(s)
- Paul Jonathan Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Dominik Saul
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Nikolai Wüstefeld
- Praxis Für Zahnheilkunde, Alexander Thiemann Und Nikolai Wüstefeld (Ang. ZA), Bad Driburg, North Rhine-Westphalia, Germany
| | - Stefan Spiering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Lukas Weiser
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Martin Michael Wachowski
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany.,DUO - Duderstadt Trauma Surgery and Orthopaedics, Duderstadt, Lower Saxony, Germany
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16
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Wawrose RA, Howington FE, LeVasseur CM, Smith CN, Couch BK, Shaw JD, Donaldson WF, Lee JY, Patterson CG, Anderst WJ, Bell KM. Assessing the biofidelity of in vitro biomechanical testing of the human cervical spine. J Orthop Res 2021; 39:1217-1226. [PMID: 32333606 PMCID: PMC7606317 DOI: 10.1002/jor.24702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
In vitro biomechanical studies of the osteoligamentous spine are widely used to characterize normal biomechanics, identify injury mechanisms, and assess the effects of degeneration and surgical instrumentation on spine mechanics. The objective of this study was to determine how well four standards in vitro loading paradigms replicate in vivo kinematics with regards to the instantaneous center of rotation and arthrokinematics in relation to disc deformation. In vivo data were previously collected from 20 asymptomatic participants (45.5 ± 5.8 years) who performed full range of motion neck flexion-extension (FE) within a biplane x-ray system. Intervertebral kinematics were determined with sub-millimeter precision using a validated model-based tracking process. Ten cadaveric spines (51.8 ± 7.3 years) were tested in FE within a robotic testing system. Each specimen was tested under four loading conditions: pure moment, axial loading, follower loading, and combined loading. The in vivo and in vitro bone motion data were directly compared. The average in vitro instant center of rotation was significantly more anterior in all four loading paradigms for all levels. In general, the anterior and posterior disc heights were larger in the in vitro models than in vivo. However, after adjusting for gender, the observed differences in disc height were not statistically significant. This data suggests that in vitro biomechanical testing alone may fail to replicate in vivo conditions, with significant implications for novel motion preservation devices such as cervical disc arthroplasty implants.
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Affiliation(s)
- Richard A. Wawrose
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Forbes E. Howington
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Clarissa M. LeVasseur
- Department of Orthopaedic Surgery, Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA 15203
| | - Clair N. Smith
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Brandon K. Couch
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Jeremy D. Shaw
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - William F. Donaldson
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Joon Y. Lee
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - Charity G. Patterson
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
| | - William J. Anderst
- Department of Orthopaedic Surgery, Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA 15203
| | - Kevin M. Bell
- School of Medicine, Department of Orthopaedic Surgery, Ferguson Lab for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA 15213
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The effect of cervical intervertebral disc degeneration on the motion path of instantaneous center of rotation at degenerated and adjacent segments: A finite element analysis. Comput Biol Med 2021; 134:104426. [PMID: 33979732 DOI: 10.1016/j.compbiomed.2021.104426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The motion path of instantaneous center of rotation (ICR) is a crucial kinematic parameter to dynamically characterize cervical spine intervertebral patterns of motion; however, few studies have evaluated the effect of cervical disc degeneration (CDD) on ICR motion path. The purpose of this study was to investigate the effect of CDD on the ICR motion path of degenerated and adjacent segments. METHOD A validated nonlinear three-dimensional finite element (FE) model of a healthy adult cervical spine was used. Progressive degeneration was simulated with six FE models by modifying intervertebral disc height and material properties, anterior osteophyte size, and degree of endplate sclerosis at the C5-C6 level. All models were subjected to a pure moment of 1 Nm and a compressive follower load of 73.6 N to simulate physical motion. ICR motion paths were compared among different models. RESULTS The normal FE model results were consistent with those of previous studies. In degenerative models, average ICR motion paths shifted significantly anterior at the degenerated segment (β = 0.27 mm; 95% CI: 0.22, 0.32) and posterior at the proximal adjacent segment (β = -0.09 mm; 95% CI: -0.15, -0.02) than those of the normal model. CONCLUSION CDD significantly affected ICR motion paths at the degenerated and proximal adjacent segments. The changes at adjacent segments may be a result of compensatory mechanisms to maintain the balance of the cervical spine. Surgical treatment planning should take into account the restoration of ICR motion path to normal. These findings could provide a basis for prosthesis design and clinical practice.
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18
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Zhou C, Li G, Wang C, Wang H, Yu Y, Tsai TY, Cha T. In vivo intervertebral kinematics and disc deformations of the human cervical spine during walking. Med Eng Phys 2020; 87:63-72. [PMID: 33461675 DOI: 10.1016/j.medengphy.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
The kinematics of the cervical spine during various functional neck motions has been widely reported. However, no data has been reported on the cervical intervertebral kinematics during walking, the most frequently performed daily functional activity. In this study, we evaluated cervical kinematics and disc deformation of asymptomatic subjects during a gait cycle using a dual fluoroscopic imaging system. Our measurements showed that the vertical translation of the cervical spine (1.6 ± 0.1 Hz) occurred at twice the frequency of the gait cycle (0.8 ± 0.1 Hz). The overall ranges of motion (ROMs) of the entire (C2-T1) cervical spine were 5.0 ± 3.1° in the flexion-extension rotation, 3.4 ± 1.0° in the lateral-bending rotation, and 5.8 ± 2.1° in the axial-twisting rotation during walking. Each intervertebral disc (measured at the disc centre location) dynamically deformed in its axial direction in a range of 16.2 ± 5.7% ~ 23.7 ± 8.7% (without significant differences among different segment levels, p > 0.05), similar to the ranges of shear deformations of the same disc (p > 0.05, except for the C7-T1 disc, where p = 0.010). These data could be useful for improvements of diagnosis and treatment methods of cervical pathologies.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA.
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Haiming Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA
| | - Yan Yu
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Harvard Medical School, 159 Wells Avenue, Newton, MA 02459, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Wang H, Zhou C, Yu Y, Wang C, Tsai TY, Han C, Li G, Cha T. Quantifying the ranges of relative motions of the intervertebral discs and facet joints in the normal cervical spine. J Biomech 2020; 112:110023. [DOI: 10.1016/j.jbiomech.2020.110023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/01/2020] [Accepted: 08/26/2020] [Indexed: 12/23/2022]
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20
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Shimokawa N, Sato H, Matsumoto H, Takami T. Complex Revision Surgery for Cervical Deformity or Implant Failure. Neurospine 2020; 17:543-553. [PMID: 33022159 PMCID: PMC7538361 DOI: 10.14245/ns.2040410.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/28/2020] [Indexed: 01/15/2023] Open
Abstract
Postoperative cervical deformity sometimes occurs in the short or long term after primary surgery for cervical disorders related to the degenerative aging spine, neoplastic etiologies, hemodialysis, infection, inflammation, trauma, etc. Cervical kyphosis after posterior decompression surgery, such as laminectomy or laminoplasty, is a common problem for spine surgeons. However, revision surgery for cervical deformity is definitely one of the most challenging areas for spine surgeons. There is no doubt that surgery for cervical deformity carries a high risk of surgery-related complications that might result in aggravation of health-related quality of life. Revision surgery is even more challenging. Hence, spine surgeons need to assess carefully the overall severity of the underlying condition before revision surgery, and try to refine the surgical strategy to secure safe surgery. Needless to say, spine surgeons are now facing great challenges in making spine surgery a much more reliable and convincing entity.
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Affiliation(s)
| | - Hidetoshi Sato
- Department of Neurosurgery, Tsukazaki Hospital, Hyogo, Japan
| | | | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Paths of the cervical instantaneous axis of rotation during active movements-patterns and reliability. Med Biol Eng Comput 2020; 58:1147-1157. [PMID: 32193862 DOI: 10.1007/s11517-020-02153-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
Abstract
The instantaneous helical axis (IHA) is a characteristic of neck movement that is very sensitive to changes in coordination and that has potential in the assessment of functional alterations. For its application in the clinical setting, normative patterns must be available, and its reliability must be established. The purpose of this work is to describe the continuous paths of the IHA during cyclic movements of flexion-extension (FE), lateral bending (LB), and axial rotation (AR) and to quantify their reliability. Fifteen healthy volunteers participated in the study; two repetitions were made on the same day (by different operators) and over an 8-day interval (by the same operator) to evaluate the inter-operator and inter-session reliability, respectively. The paths described by the IHA suggest a sequential movement of the vertebrae in the FE movement, with a large vertical displacement (mean, 10 cm). The IHA displacement in LB and AR movements are smaller. The paths described by the IHAs have a very high reliability for FE movement, although it is somewhat lower for LB and RA movements. The standard error of measurement (SEM) is less than 0.5 cm. These results show that the paths of the IHA are reliable enough to evaluate changes in the coordination of intervertebral movement. Graphical abstract A video photogrammetry system is used to record the cyclic movements of the neck, from which the continuous trajectories of the associated instantaneous helical axis (IHA) are calculated. We have analyzed the movements of flexion-extension (FE), lateral flexion (LB), and axial rotation (AR) for a sample of 15 healthy subjects. The measurements have been repeated with two different operators (in the same session) and in two separate sessions (same operator). IHA displacement patterns have been obtained in each movement, and the reliability of the measurement of such IHA trajectories has been estimated.
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Roch PJ, Wagner M, Weiland J, Gezzi R, Spiering S, Lehmann W, Saul D, Weiser L, Viezens L, Wachowski MM. Total disc arthroplasties change the kinematics of functional spinal units during lateral bending. Clin Biomech (Bristol, Avon) 2020; 73:130-139. [PMID: 31982810 DOI: 10.1016/j.clinbiomech.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Information about kinematics in different functional spinal units before and after total disc arthroplasties is necessary to improve prostheses and determine indications. There is little information about the nonstationary instantaneous helical axis of rotation under lateral bending in the cervical spine before and after total disc arthroplasty. METHODS Kinematic analyses were performed with an established measuring apparatus on 8 human functional spinal units (C3/C4, C5/C6) under intact conditions and after total disc arthroplasty with two different types of prostheses: Bryan and Prestige. The instantaneous helical axis, migration, and stiffness of the segments were calculated. FINDINGS The instantaneous helical axis direction was always inclined ventrally. Ventral inclination was significantly higher in segment C3/C4 than in segment C5/C6 under all conditions (p < 0.001). Both types of arthroplasties significantly increased ventral inclination compared to intact conditions. In both segments, the path length of the instantaneous helical axis' migration was significantly longer after total disc arthroplasty with Bryan (p = 0.001) and shorter after Prestige (p < 0.001) prostheses than under intact conditions. After both types of arthroplasties, the migration path length was significantly longer and the stiffness was significantly lower in segment C3/C4 than in segment C5/C6. INTERPRETATION Both types of arthroplasties changed the kinematics of both segments during lateral bending. Altered instantaneous helical axis migration, greater ventral inclination and less stiffness after both arthroplasties indicate unphysiological motion. Both arthroplasties had greater impact on segment C3/C4 than on segment C5/C6 in terms of hypermobility. Increased translational motion after total disc arthroplasty with a Bryan prosthesis might be caused by the prosthetic design.
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Affiliation(s)
- Paul Jonathan Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Markus Wagner
- Department of Ophthalmology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Jan Weiland
- Department of Trauma Surgery and Orthopaedics, Hospital Düren gGmbH, Roonstraße 30, 52351 Düren, Germany
| | - Riccardo Gezzi
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Stefan Spiering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Dominik Saul
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Lukas Weiser
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Lennart Viezens
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Martin Michael Wachowski
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; DUO - Duderstadt Trauma Surgery and Orthopaedics, Westertorstr. 7, 37115 Duderstadt, Germany
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Roch PJ, Wagner M, Weiland J, Spiering S, Lehmann W, Saul D, Weiser L, Viezens L, Wachowski MM. Total disc arthroplasties alter the characteristics of the instantaneous helical axis of the cervical functional spinal units C3/C4 and C5/C6 during flexion and extension in in vitro conditions. J Biomech 2020; 100:109608. [PMID: 31926589 DOI: 10.1016/j.jbiomech.2020.109608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
Total disc arthroplasty (TDA) increases the risk of adjacent segment disease (ASD). Kinematic analyses are necessary to compare the intact condition (IC) with alterations after TDA to develop better prostheses. A well-established 6D measuring apparatus (resolution < 2.4 μm; 400 positions/cycle) was used. Kinematics of the flexion and extension of 8 human cervical spine segments (cFSU) C3/C4 and C5/C6 (67.9 ± 13.2 y) were analyzed in the IC and after TDA (Bryan® Cervical Disc [B-TDA], Prestige LP® Cervical Disc [P-TDA]). The migration of the instantaneous helical axis (IHA) and the stiffness of the segments were calculated. Analyses demonstrated a stretched U-curved IHA migration in the sagittal plane. The IHA positions were significantly more cranial in cFSU C5/C6 than in C3/C4 in IC and after either TDA (IC: p < 0.001; B-TDA: p = 0.001; P-TDA: p = 0.045). In cFSU C3/C4 IHA positions shifted anteriocranially after either TDA (p < 0.001). In cFSU C5/C6, the IHA positions were significantly more anterocranial after B-TDA than in IC and after P-TDA (anterior: p < 0.001; cranial: p = 0.005). After B-TDA, the IHA migration path length was significantly longer in cFSU C3/C4 than in C5/C6 (p = 0.007) and longer than in IC in both cFSU (C3/C4: p = 0.047; C5/C6: p < 0.001). Stiffness was increased after both TDA. Various kinematic alterations were observed after both TDA. Increased translation and IHA position shifting after both TDA might indicate abnormal strain and a derogated benefit of TDA. These results imply the most abnormal strain after B-TDA. The lower cFSU might be more susceptible to alterations after TDA than the upper cFSU.
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Affiliation(s)
- Paul Jonathan Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Markus Wagner
- Department of Ophthalmology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Jan Weiland
- Department of Trauma Surgery and Orthopaedics, Hospital Düren gGmbH, Roonstraße 30, 52351 Düren, Germany
| | - Stefan Spiering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Dominik Saul
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Lukas Weiser
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Lennart Viezens
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Martin Michael Wachowski
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; DUO - Duderstadt Trauma Surgery and Orthopaedics, Westertorstr. 7, 37115 Duderstadt, Germany.
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Sang D, Cui W, Guo Z, Sang H, Liu B. The Differences Among Kinematic Parameters for Evaluating the Quality of Intervertebral Motion of the Cervical Spine in Clinical and Experimental Studies: Concepts, Research and Measurement Techniques. A Literature Review. World Neurosurg 2020; 133:343-357.e1. [DOI: 10.1016/j.wneu.2019.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
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Kim SH, Ham DW, Lee JI, Park SW, Ko MJ, Koo SB, Song KS. Locating the Instant Center of Rotation in the Subaxial Cervical Spine with Biplanar Fluoroscopy during In Vivo Dynamic Flexion-Extension. Clin Orthop Surg 2019; 11:482-489. [PMID: 31788173 PMCID: PMC6867919 DOI: 10.4055/cios.2019.11.4.482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Recently, biplanar fluoroscopy is used to evaluate the cervical kinematics, especially to locate the instant center of rotation (ICR) during in vivo motion. This study aims to ascertain the ICR at each cervical segment in the sagittal plane during dynamic motion and assess the differences from previous studies. Methods While three healthy subjects were performing full flexion-extension, two oblique views aligned horizontally and angled at approximately 55° were obtained by biplanar fluoroscopy. The minimum degree to detect significant movement in a helical axis model was set at 2°, and anterior-posterior and superior-inferior locations of each ICR were defined. To evaluate the possible distribution area and overlapping area of the ICR with disc space, we drew a circle by using the calculated distance between each coordination and the mean coordination of ICR as the radius. Results During flexion-extension motion, the mean superior-inferior location of the ICR became progressively more superior, except the C5–6 segment (p = 0.015), and the mean anterior-posterior location of the ICR became progressively more anterior without exception from C2–3 to C6–7 segments, but anterior-posterior ICR locations were not significantly different among segments. The overlapping area with the distribution circle of ICR was mainly located in the posterior half in the C3–4 segment, but the overlapping area was about 80% of the total disc space in C4–5 and C6–7 segments. The overlapping was more noticeable in the lower cervical segments after exclusion of the outlier data of the C5–6 segment in subject 1. Conclusions The ICR in the cervical spine showed a trend of moving progressively more superiorly and anteriorly and the disc space overlapping the distribution circle of ICR increased along the lower motion segments except the C5–6 segment. These findings could provide a good basis for level-specific cervical arthroplasty designs.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Ik Lee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Bum Koo
- Department of Bioengineering, Chung-Ang University College of Engineering, Seoul, Korea
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Adjacent segment motion following multi-level ACDF: a kinematic and clinical study in patients with zero-profile anchored spacer or plate. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2408-2416. [DOI: 10.1007/s00586-019-06109-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/14/2019] [Accepted: 08/08/2019] [Indexed: 02/08/2023]
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Placing ball and socket cervical total disc replacement using instant center of rotation. J Orthop 2019; 16:390-392. [PMID: 31110400 DOI: 10.1016/j.jor.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/27/2022] Open
Abstract
Background Authors aim to evaluate the correct placement of TDR using the instant center of rotation (ICR) as a guide. Methods Placement of disc would be divided into three groups using a standard of 1 mm from the ICR: Posterior to ICR, In line with ICR and Anterior to ICR. Results 49 patients, mean age was 39.96 ± 1.45 years. 42 intraop fluoroscopy images compared to 41 post op radiographic images demonstrated TDR in line with ICR. Conclusion Total discs replacements can be placed intraoperatively using proper technique with verification confirmed using the ICR postoperatively. Keywords Total disc replacement; instant center of rotation; ideal placement; fluoroscopy; adjacent segment disease; less exposure surgery.
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Guo Z, Cui W, Sang DC, Sang HP, Liu BG. Clinical Relevance of Cervical Kinematic Quality Parameters in Planar Movement. Orthop Surg 2019; 11:167-175. [PMID: 30884156 PMCID: PMC6594496 DOI: 10.1111/os.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
Comprehending cervical spinal motion underlies the understanding of the mechanisms of cervical disorders. We aimed to better define the clinical relevance of cervical spine kinematics, focusing on quality parameters describing cervical spine planar motion. The most common study focuses were kinematic quality parameters after cervical arthroplasty and in normal subjects, patients with cervical degeneration, and patients with cervical deformities. Kinematic quality parameters are important for cervical degeneration prevention, being detected sooner than differences on imaging examinations and being significantly related to the degree of cervical degeneration. Kinematic quality parameters are effective for evaluating the changes of cervical motion pattern after cervical fusion and non‐fusion, assessing operative and adjacent segments in the early stages, and predicting adjacent segment degeneration. However, owing to current research limitations, and controversy about the changes of kinematic quality parameters after different surgical procedures, current assessments are limited to cervical spine flexion and extension. Different osteotomy methods of cervical deformity have different effects on cervical motion patterns and quality parameters. Choosing the most effective surgical method remains a challenge and kinematic quality parameters in cervical deformity are important future research topics. This review highlights the instantaneous center of rotation, the center of rotation, and the instantaneous axis of rotation as being important kinematic quality parameters of cervical spinal motion. These can be used to detect abnormal cervical mobility, to diagnose cervical degeneration, to design disc protheses, and to evaluate surgical effects earlier than other methods. Owing to limitations of research methods there is variation in the way parameters are defined by various researchers. No uniform standard exists for defining degenerative motion quality parameters in normal asymptomatic, degenerative, and postoperative patients. Therefore, further study is required. New study techniques and defining kinematic quality parameters in normal subjects will clarify the definitions of these parameters, enhancing their future clinical usefulness.
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Affiliation(s)
- Ze Guo
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Da-Cheng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hong-Peng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bao-Ge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Dynamic Fusion Process in the Anterior Cervical Discectomy and Fusion with Self-Locking Stand-Alone Cages. World Neurosurg 2019; 125:e678-e687. [PMID: 30735878 DOI: 10.1016/j.wneu.2019.01.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-locking stand-alone cages can achieve satisfactory clinical results and fusion rate. However, there have been no reports on the causes and relationship of different fusion state. This study is to classify the different fusion states of the index level and to explore the potential contributing factors and links of them. METHODS From June 2008 to October 2011, 42 patients underwent anterior cervical discectomy and fusion with MC+ cages. More than 5 years' follow-up was reviewed. The fusion state and the relevant clinical and radiologic records were reviewed retrospectively. RESULTS At the last follow-up, the fusion proportion of type I, II, III, and IV was 11.7%, 16.9%, 26.9%, and 42.9%, respectively. The overall fusion rate was 97.4%. For all the fused types, significant improvement for the visual analog scale, Japanese Orthopaedic Association, and Neck Disability Index scores was found at the last follow-up (P < 0.05). However, there were no significant differences between the 4 types (P > 0.05). For sagittal vertical axis, type IV was significantly larger than that of type I, II, and III (P < 0.05), and for range of motion, type III was significantly larger than that of type II and IV (P < 0.05). CONCLUSIONS For anterior cervical discectomy and fusion with self-locking stand-alone cages, the fusion of the index level seems to be a progressive dynamic process during the mid-term follow-up, which may be influenced by the location of the cage, the aagittal vertical axis of the index level, and the global range of motion of the cervical spine. Satisfactory clinical results could be achieved by all the fused types.
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Ehrig R, Heller M. On intrinsic equivalences of the finite helical axis, the instantaneous helical axis, and the SARA approach. A mathematical perspective. J Biomech 2019; 84:4-10. [DOI: 10.1016/j.jbiomech.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/22/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
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Yu Y, Li JS, Guo T, Lang Z, Kang JD, Cheng L, Li G, Cha TD. Normal intervertebral segment rotation of the subaxial cervical spine: An in vivo study of dynamic neck motions. J Orthop Translat 2019; 18:32-39. [PMID: 31508305 PMCID: PMC6718920 DOI: 10.1016/j.jot.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/03/2022] Open
Abstract
Background Accurate knowledge of the intervertebral center of rotation (COR) and its corresponding range of motion (ROM) can help understand development of cervical pathology and guide surgical treatment. Methods Ten asymptomatic subjects were imaged using MRI and dual fluoroscopic imaging techniques during dynamic extension-flexion-extension (EFE) and axial left-right-left (LRL) rotation. The intervertebral segment CORs and ROMs were measured from C34 to C67, as the correlations between two variables were analyzed as well. Results During the EFE motion, the CORs were located at 32.4 ± 20.6%, -2.4 ± 11.7%, 21.8 ± 12.5% and 32.3 ± 25.5% posteriorly, and the corresponding ROMs were 13.8 ± 4.3°, 15.1 ± 5.1°, 14.4 ± 7.0° and 9.2 ± 4.3° from C34 to C67. The ROM of C67 was significantly smaller than other segments. The ROMs were not shown to significantly correlate to COR locations (r = −0.243, p = 0.132). During the LRL rotation cycle, the average CORs were at 85.6 ± 18.2%, 32.3 ± 25.3%, 15.7 ± 12.3% and 82.4 ± 31.3% posteriorly, and the corresponding ROMs were 3.5 ± 1.7°, 6.9 ± 3.8°, 9.6 ± 4.1° and 2.6 ± 2.5° from C34 to C67. The ROMs of C34 and C67 was significantly smaller than those of C45 and C56. A more posterior COR was associated with a less ROM during the neck rotation (r = −0.583, p < 0.001). The ROMs during EFE were significantly larger than those during LRL in each intervertebral level. Conclusion The CORs and ROMs of the subaxial cervical intervertebral segments were segment level- and neck motion-dependent during the in-vivo neck motions. The translational potential of this article Our study indicates that the subaxial cervical intervertebral CORs and ROMs were segment level- and neck motion-dependent. This may help to improve the artificial disc design as well as surgical technique by which the neck functional motion is restored following the cervical arthroplasty.
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Affiliation(s)
- Yan Yu
- Orthopaedic Bioengineering Research Center, Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Wellesley, MA, USA
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Tao Guo
- Orthopaedic Bioengineering Research Center, Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Wellesley, MA, USA
| | - Zhao Lang
- Orthopaedic Bioengineering Research Center, Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Wellesley, MA, USA
| | - James D. Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
- Corresponding author. Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Wellesley, MA, USA
- Corresponding author. Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, USA.
| | - Thomas D. Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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The inclusion of hyoid muscles improve moment generating capacity and dynamic simulations in musculoskeletal models of the head and neck. PLoS One 2018; 13:e0199912. [PMID: 29953539 PMCID: PMC6023174 DOI: 10.1371/journal.pone.0199912] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 06/16/2018] [Indexed: 11/19/2022] Open
Abstract
OpenSim musculoskeletal models of the head and neck can provide information about muscle activity and the response of the head and neck to a variety of situations. Previous models report weak flexion strength, which is partially due to lacking moment generating capacity in the upper cervical spine. Previous models have also lacked realistic hyoid muscles, which have the capability to improve flexion strength and control in the upper cervical spine. Suprahyoid and infrahyoid muscles were incorporated in an OpenSim musculoskeletal model of the head and neck. This model was based on previous OpenSim models, and now includes hyoid muscles and passive elements. The moment generating capacity of the model was tested by simulating physical experiments in the OpenSim environment. The flexor and extensor muscle strengths were scaled to match static experimental results. Models with and without hyoid muscles were used to simulate experimentally captured motions, and the need for reserve actuators was evaluated. The addition of hyoid muscles greatly increased flexion strength, and the model is the first of its kind to have realistic strength values in all directions. Less reserve actuator moment was required to simulate real motions with the addition of hyoid muscles. Several additional ways of improving flexion strength were investigated. Hyoid muscles add control and strength to OpenSim musculoskeletal models of the head and neck and improve simulations of head and neck movements.
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Jonas R, Demmelmaier R, Hacker SP, Wilke HJ. Comparison of three-dimensional helical axes of the cervical spine between in vitro and in vivo testing. Spine J 2018; 18:515-524. [PMID: 29074465 DOI: 10.1016/j.spinee.2017.10.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/28/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The range of motion is a well-accepted parameter for the assessment and evaluation of cervical motion. However, more qualitative data of the kinematics of the cervical spine are needed for the development and success of cervical disc arthroplasty. PURPOSE The aim of this study was to provide basic information about helical axes of human cervical spine under in vitro conditions. Furthermore, it should clarify whether the three-dimensional helical axes of cervical motion gained from in vitro experiments are in agreement with those gained from in vivo experiments, and therefore to prove its reliability. STUDY DESIGN/SETTING An in vitro test with pure moments and mono-segmental specimens was designed to investigate and compare the helical axes of the cervical spine. METHODS Six human cadaveric specimens (three male and three female) with an average age of 47.5 years (range: 34-58 years) were carefully selected. Each specimen was divided into three motion segments: C2-C3, C4-C5, and C6-C7. We performed 3.5 full cycles of rotation about all axes, flexion-extension, lateral bending, and axial rotation, by applying pure moments of 1.5 Nm without any preload. Following the in vitro tests, the three-dimensional helical axes were calculated and projected into the x-ray images. RESULTS Rotation analysis of all three directions revealed similar results for all six specimens. All calculated helical axes were similar to the published in vivo data. Furthermore, the instantaneous centers of rotation were in agreement with in vivo data. CONCLUSIONS The data gained from this study verify cervical kinematics during in vitro testing using pure moments. It can be assumed that other soft tissue such as muscles are not necessarily needed to simulate cervical kinematics in vitro.
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Affiliation(s)
- René Jonas
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Robert Demmelmaier
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University, Helmholtzstraße 14, 89081 Ulm, Germany.
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Laratta JL, Shillingford JN, Saifi C, Riew KD. Cervical Disc Arthroplasty: A Comprehensive Review of Single-Level, Multilevel, and Hybrid Procedures. Global Spine J 2018; 8:78-83. [PMID: 29456918 PMCID: PMC5810892 DOI: 10.1177/2192568217701095] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Degenerative disc disease and spondylosis resulting in radiculopathy and retrodiscal myelopathy are among the most frequently encountered cervical spinal disorders. Traditionally, anterior cervical discectomy and fusion (ACDF) has successfully achieved neural decompression and restored intradiscal height in these conditions. Unfortunately, nonunion and iatrogenic adjacent segment pathology associated with fusion procedures in the cervical spine has led to an interest in motion-preserving procedures. Cervical disc arthroplasty (CDA) was developed in hopes of preserving cervical biomechanics while mitigating the complications associated with ACDF. Through a systematic review of both published and ongoing studies on single- and multilevel CDA, and hybrid surgeries, we aim to provide evidence for their safety and efficacy in the treatment of various cervical pathologies. METHODS A systematic search of several large databases, including Cochrane Central, PubMed, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry was conducted to identify published studies and ongoing clinical trials on CDA and hybrid surgery. RESULTS Among the relevant studies reviewed, 3 were randomized controlled trials, 2 systematic reviews, as well as multiple prospective case series, biomechanical studies, and meta-analyses. CONCLUSION Over the past decade, multiple high-quality studies have shown that single-level CDA can offer equivalent clinical outcomes with a reduction in secondary procedures and total cost when compared to ACDF. However, more recently there has been an increasing prevalence of 2-level CDA and hybrid surgery. Although the data regarding these multilevel procedures is less robust, it appears that they may be as effective as their single-level counterparts.
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Affiliation(s)
- Joseph L. Laratta
- The Spine Hospital, New York–Presbyterian Healthcare System, Columbia University Medical Center, New York, NY, USA
| | - Jamal N. Shillingford
- The Spine Hospital, New York–Presbyterian Healthcare System, Columbia University Medical Center, New York, NY, USA,Jamal N. Shillingford, Department of Orthopaedic Surgery, The Spine Hospital, New York–Presbyterian Healthcare System, Columbia University Medical Center, 5141 Broadway, 3 Field West, New York, NY 10034, USA.
| | - Comron Saifi
- The Spine Hospital, New York–Presbyterian Healthcare System, Columbia University Medical Center, New York, NY, USA
| | - K. Daniel Riew
- The Spine Hospital, New York–Presbyterian Healthcare System, Columbia University Medical Center, New York, NY, USA
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Changes in cervical motion after cervical spinal motion preservation surgery. Acta Neurochir (Wien) 2018; 160:397-404. [PMID: 29101465 DOI: 10.1007/s00701-017-3375-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND For patients with single-level cervical radiculopathy, various types of motion preservation surgeries, such as total disc replacement (TDR), posterior cervical foraminotomy (PCF) and posterior percutaneous endoscopic foraminotomy and discectomy (PECF), are available. In addition to motion preservation, the quality of motion is an important issue. The aim of the present study was to evaluate the influence of these surgeries on cervical motion by comparing the instantaneous axis of rotation (IAR) among PECF, TDR and PCF at the index and superior/inferior adjacent segments. METHODS A retrospective review was performed of patients who underwent index surgery at C5-6 for cervical single-level foraminal disc herniation or foraminal stenosis. Patients with minimal degeneration at the index and other cervical spinal levels and flexion/extension cervical lateral radiographs both preoperatively and 6 months postoperatively were included (PECF, 11 patients; TDR, 11 patients; PCF, 12 patients). The IARs were calculated at the index segment and segments above and below the index segment from the flexion and extension cervical lateral radiographs, which were obtained preoperatively and 6 months postoperatively. A standardized cervical normogram was referenced to qualify shifts in the IAR. RESULTS Postoperatively, neck pain was significantly decreased, with no difference among the surgical methods. The IARs were not significantly changed after the PECF. Although significant inferior shift occurred at C6-7 after TDR (p = 0.02), the shift occurred within the normal range in the cervical normogram. However, significant inferior shifts in the IARs occurred after PCF at C5-6 (p = 0.02) and C6-7 (p = 0.02), and the IARs moved out of the normal range. CONCLUSIONS The IARs were significantly changed after PCF at either the index segment or the adjacent segment below. The shifts in IAR at the index and adjacent segments were not significant after PECF and TDR. The sample size was too small to allow definitive conclusions, but the present study showed that PECF may be another alternative to motion preservation surgeries.
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Yu Y, Mao H, Li JS, Tsai TY, Cheng L, Wood KB, Li G, Cha TD. Ranges of Cervical Intervertebral Disc Deformation During an In Vivo Dynamic Flexion-Extension of the Neck. J Biomech Eng 2017; 139:2613837. [PMID: 28334358 DOI: 10.1115/1.4036311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 12/26/2022]
Abstract
While abnormal loading is widely believed to cause cervical spine disc diseases, in vivo cervical disc deformation during dynamic neck motion has not been well delineated. This study investigated the range of cervical disc deformation during an in vivo functional flexion-extension of the neck. Ten asymptomatic human subjects were tested using a combined dual fluoroscopic imaging system (DFIS) and magnetic resonance imaging (MRI)-based three-dimensional (3D) modeling technique. Overall disc deformation was determined using the changes of the space geometry between upper and lower endplates of each intervertebral segment (C3/4, C4/5, C5/6, and C6/7). Five points (anterior, center, posterior, left, and right) of each disc were analyzed to examine the disc deformation distributions. The data indicated that between the functional maximum flexion and extension of the neck, the anterior points of the discs experienced large changes of distraction/compression deformation and shear deformation. The higher level discs experienced higher ranges of disc deformation. No significant difference was found in deformation ranges at posterior points of all the discs. The data indicated that the range of disc deformation is disc level dependent and the anterior region experienced larger changes of deformation than the center and posterior regions, except for the C6/7 disc. The data obtained from this study could serve as baseline knowledge for the understanding of the cervical spine disc biomechanics and for investigation of the biomechanical etiology of disc diseases. These data could also provide insights for development of motion preservation surgeries for cervical spine.
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Affiliation(s)
- Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 2000065, China;Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
| | - Jing-Sheng Li
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA 02215
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Kirkham B Wood
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA 94063
| | - Guoan Li
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114 e-mail:
| | - Thomas D Cha
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
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Prediction of Cervical Spinal Joint Loading and Secondary Motion Using a Musculoskeletal Multibody Dynamics Model Via Force-Dependent Kinematics Approach. Spine (Phila Pa 1976) 2017; 42:E1403-E1409. [PMID: 28368985 DOI: 10.1097/brs.0000000000002176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cervical spine biomechanical investigation using multibody dynamics. OBJECTIVE To develop a comprehensive cervical spine multibody dynamics model incorporated with the force-dependent kinematics (FDK) approach, and to study the influence of soft tissue deformation on the joint loading prediction. SUMMARY OF BACKGROUND DATA Musculoskeletal multibody dynamics models have been widely used to analyze joint loading. Current cervical spine musculoskeletal models, however, neglect the joint internal motion caused by soft tissue deformation. A novel FDK approach is introduced, which can predict joint internal motion and spinal joint loading simultaneously. METHODS A comprehensive cervical spine musculoskeletal model with the posterior facet joints and essential ligaments was developed. To quantify the influence of soft tissue structures on joint loading prediction, four different models with different features were created. These newly developed models were validated, under flexion-extension movement. The predicted intervertebral disc loads (from C3-C4 to C5-C6) were compared with the published cadaveric experimental results. Moreover, the predicted facet joint forces, ligament forces, and anterior-posterior translations of instantaneous centers of rotation were also studied. RESULTS The obtained intervertebral disc loads were varied among different models. Model 3 provided the closest prediction of joint loading to the experimental results. Moreover, the facet joint and ligament forces were in similar range of magnitude as literature findings. The predicted instantaneous centers of rotation translational changes were in accordance with the in vivo kinematics observation. CONCLUSION In the present study, a validated cervical spine musculoskeletal model was developed, using multibody dynamics and FDK approach. It can simulate the function of musculature and consider joint internal motion, and thus provides more reliable joint loading prediction. This newly developed cervical model can be used as an efficient tool to study the biomechanical behaviors of human cervical spine, and to understand the fundamental pathologies of spinal pains. LEVEL OF EVIDENCE N /A.
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Preoperative Radiographic Parameters to Predict a Higher Pseudarthrosis Rate After Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2017; 42:1772-1778. [PMID: 28459780 DOI: 10.1097/brs.0000000000002219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine whether postoperative pseudarthrosis can be predicted from specific preoperative radiograph measurements. SUMMARY OF BACKGROUND DATA Various factors reportedly influence the occurrence of pseudarthrosis after anterior cervical discectomy and fusion (ACDF). However, to our knowledge, there are no reports on the relationships between preoperative radiographic parameters and pseudarthrosis. METHODS We analyzed 84 consecutive patients (45 males, 39 females, mean age, 58.9 ± 11.2 yrs) who underwent ACDF. In all patients, allografts filled with local chip bone were inserted after discectomy and anterior plating was performed. On preoperative plain radiographs, we analyzed C2-C7 sagittal vertical axis, T1 sagittal slope, segmental motion, global cervical motion, and location of fusion segments. Pseudarthrosis was diagnosed as interspinous motion >1 mm with superjacent interspinous motion ≥4 mm on magnified dynamic lateral radiographs. Multivariate logistic regression was used to analyze the risk factors for pseudarthrosis and the receiver operating characteristic (ROC) curve was used to define a cutoff value. RESULTS One hundred and twenty-five segments from 84 patients were included. The pseudarthrosis rate was 29% based on number of patients (24/84) and 20% based on number of segments (25/125). Multilevel surgery and segments at the lowest levels showed higher pseudarthrosis rates (P = 0.01). Per multivariate logistic regression analysis, greater preoperative segmental motion, greater preoperative T1 sagittal slope, and C6-7 segments were associated with a higher risk of pseudarthrosis (all P < 0.05). A segmental motion cutoff value of 12° demonstrated pseudarthrosis with sensitivity of 87%, specificity of 84%, and area under the curve of 0.899, indicating moderate accuracy. CONCLUSION Greater preoperative segmental motion, greater preoperative T1 sagittal slope, and lower fusion levels could be risk factors for pseudarthrosis following ACDF. Preoperative segmental motion >12° is likely to be an important indicator of the development of pseudarthrosis. LEVEL OF EVIDENCE 3.
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Inoue M, Mizuno T, Sakakibara T, Kato T, Yoshikawa T, Inaba T, Kasai Y. Trajectory of instantaneous axis of rotation in fixed lumbar spine with instrumentation. J Orthop Surg Res 2017; 12:177. [PMID: 29145877 PMCID: PMC5689179 DOI: 10.1186/s13018-017-0677-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Several studies showed instantaneous axis of rotation (IAR) in the intact spine. However, there has been no report on the trajectory of the IAR of a damaged spine or that of a fixed spine with instrumentation. It is the aim of this study to investigate the trajectory of the IAR of the lumbar spine using the vertebra of deer. Methods Functional spinal units (L5–6) from five deer were evaluated with six-axis material testing machine. As specimen models, we prepared a normal model, a damaged model, and a pedicle screw (PS) model. We measured the IAR during bending in the coronal and sagittal planes and axial rotation. In the bending test, four directions were measured: anterior, posterior, right, and left. In the rotation test, two directions were measured: right and left. Results The IAR of the normal model during bending moved in the bending direction. The IAR of the damaged model during bending moved in the bending direction, but the magnitude of displacement was bigger compared to that of the normal model. In the PS model, the IAR during bending test hardly moved. During rotation test, the IAR of the normal model and PS model located in the spinal canal, but the IAR of the damaged model located in the posterior part of the vertebral body. Conclusions In this study, the IAR of damaged model was scattering and that of PS model was concentrating. This suggests that higher mechanical load applied to the dura tube and nerve roots in the damaged model and less mechanical load applied to that in the PS model.
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Affiliation(s)
- Masataka Inoue
- Department of Mechanical Engineering, Graduate School of Engineering, Mie University, 1577 Kurimamachiya-cho, Tsu City, 514-8507, Mie prefecture, Japan
| | - Tetsutaro Mizuno
- Department of Spinal Surgery and Medical Engineering, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, 514-8507, Mie prefecture, Japan
| | - Toshihiko Sakakibara
- Department of Spinal Surgery and Medical Engineering, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, 514-8507, Mie prefecture, Japan
| | - Takaya Kato
- Community-University Research Cooperation Center, Mie University, 1577 Kurimamachiya-cho, Tsu City, 514-8507, Mie prefecture, Japan
| | - Takamasa Yoshikawa
- Department of Mechanical Engineering, Graduate School of Engineering, Mie University, 1577 Kurimamachiya-cho, Tsu City, 514-8507, Mie prefecture, Japan
| | - Tadashi Inaba
- Department of Mechanical Engineering, Graduate School of Engineering, Mie University, 1577 Kurimamachiya-cho, Tsu City, 514-8507, Mie prefecture, Japan
| | - Yuichi Kasai
- Department of Spinal Surgery and Medical Engineering, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, 514-8507, Mie prefecture, Japan.
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Anderst W, Rynearson B, West T, Donaldson W, Lee J. Dynamic in vivo 3D atlantoaxial spine kinematics during upright rotation. J Biomech 2017; 60:110-115. [PMID: 28662932 DOI: 10.1016/j.jbiomech.2017.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
Abstract
Diagnosing dysfunctional atlantoaxial motion is challenging given limitations of current diagnostic imaging techniques. Three-dimensional imaging during upright functional motion may be useful in identifying dynamic instability not apparent on static imaging. Abnormal atlantoaxial motion has been linked to numerous pathologies including whiplash, cervicogenic headaches, C2 fractures, and rheumatoid arthritis. However, normal C1/C2 rotational kinematics under dynamic physiologic loading have not been previously reported owing to imaging difficulties. The objective of this study was to determine dynamic three-dimensional in vivo C1/C2 kinematics during upright axial rotation. Twenty young healthy adults performed full head rotation while seated within a biplane X-ray system while radiographs were collected at 30 images per second. Six degree-of-freedom kinematics were determined for C1 and C2 via a validated volumetric model-based tracking process. The maximum global head rotation (to one side) was 73.6±8.3°, whereas maximum C1 rotation relative to C2 was 36.8±6.7°. The relationship between C1/C2 rotation and head rotation was linear through midrange motion (±20° head rotation from neutral) in a nearly 1:1 ratio. Coupled rotation between C1 and C2 included 4.5±3.1° of flexion and 6.4±8.2° of extension, and 9.8±3.8° of contralateral bending. Translational motion of C1 relative to C2 was 7.8±1.5mm ipsilaterally, 2.2±1.2mm inferiorly, and 3.3±1.0mm posteriorly. We believe this is the first study describing 3D dynamic atlantoaxial kinematics under true physiologic conditions in healthy subjects. C1/C2 rotation accounts for approximately half of total head axial rotation. Additionally, C1 undergoes coupled flexion/extension and contralateral bending, in addition to inferior, lateral and posterior translation.
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Affiliation(s)
- William Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, United States.
| | - Bryan Rynearson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Tyler West
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - William Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Joon Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
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Ersen A, Sahin M. Polydimethylsiloxane-based optical waveguides for tetherless powering of floating microstimulators. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:55005. [PMID: 28500857 PMCID: PMC5997005 DOI: 10.1117/1.jbo.22.5.055005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/20/2017] [Indexed: 05/05/2023]
Abstract
Neural electrodes and associated electronics are powered either through percutaneous wires or transcutaneous powering schemes with energy harvesting devices implanted underneath the skin. For electrodes implanted in the spinal cord and the brain stem that experience large displacements, wireless powering may be an option to eliminate device failure by the breakage of wires and the tethering of forces on the electrodes. We tested the feasibility of using optically clear polydimethylsiloxane (PDMS) as a waveguide to collect the light in a subcutaneous location and deliver to deeper regions inside the body, thereby replacing brittle metal wires tethered to the electrodes with PDMS-based optical waveguides that can transmit energy without being attached to the targeted electrode. We determined the attenuation of light along the PDMS waveguides as 0.36 ± 0.03 ?? dB / cm and the transcutaneous light collection efficiency of cylindrical waveguides as 44 % ± 11 % by transmitting a laser beam through the thenar skin of human hands. We then implanted the waveguides in rats for a month to demonstrate the feasibility of optical transmission. The collection efficiency and longitudinal attenuation values reported here can help others design their own waveguides and make estimations of the waveguide cross-sectional area required to deliver sufficient power to a certain depth in tissue.
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Affiliation(s)
- Ali Ersen
- New Jersey Institute of Technology, Department of Biomedical Engineering, Newark, New Jersey, United States
| | - Mesut Sahin
- New Jersey Institute of Technology, Department of Biomedical Engineering, Newark, New Jersey, United States
- Address all correspondence to: Mesut Sahin, E-mail:
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Aiyangar A, Zheng L, Anderst W, Zhang X. Instantaneous centers of rotation for lumbar segmental extension in vivo. J Biomech 2017; 52:113-121. [DOI: 10.1016/j.jbiomech.2016.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Song YS, Yang KY, Youn K, Yoon C, Yeom J, Hwang H, Lee J, Kim K. Validation of Attitude and Heading Reference System and Microsoft Kinect for Continuous Measurement of Cervical Range of Motion Compared to the Optical Motion Capture System. Ann Rehabil Med 2016; 40:568-74. [PMID: 27606262 PMCID: PMC5012967 DOI: 10.5535/arm.2016.40.4.568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/21/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To compare optical motion capture system (MoCap), attitude and heading reference system (AHRS) sensor, and Microsoft Kinect for the continuous measurement of cervical range of motion (ROM). Methods Fifteen healthy adult subjects were asked to sit in front of the Kinect camera with optical markers and AHRS sensors attached to the body in a room equipped with optical motion capture camera. Subjects were instructed to independently perform axial rotation followed by flexion/extension and lateral bending. Each movement was repeated 5 times while being measured simultaneously with 3 devices. Using the MoCap system as the gold standard, the validity of AHRS and Kinect for measurement of cervical ROM was assessed by calculating correlation coefficient and Bland–Altman plot with 95% limits of agreement (LoA). Results MoCap and ARHS showed fair agreement (95% LoA<10°), while MoCap and Kinect showed less favorable agreement (95% LoA>10°) for measuring ROM in all directions. Intraclass correlation coefficient (ICC) values between MoCap and AHRS in –40° to 40° range were excellent for flexion/extension and lateral bending (ICC>0.9). ICC values were also fair for axial rotation (ICC>0.8). ICC values between MoCap and Kinect system in –40° to 40° range were fair for all motions. Conclusion Our study showed feasibility of using AHRS to measure cervical ROM during continuous motion with an acceptable range of error. AHRS and Kinect system can also be used for continuous monitoring of flexion/extension and lateral bending in ordinary range.
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Affiliation(s)
- Young Seop Song
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Interdisciplinary Program of Bioengineering, Graduate School, Seoul National University, Seoul, Korea
| | - Kyung Yong Yang
- School of Computer Science and Engineering, Seoul National University, Seoul, Korea
| | - Kibum Youn
- School of Computer Science and Engineering, Seoul National University, Seoul, Korea
| | - Chiyul Yoon
- Interdisciplinary Program of Bioengineering, Graduate School, Seoul National University, Seoul, Korea
| | - Jiwoon Yeom
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeoncheol Hwang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Interdisciplinary Program of Bioengineering, Graduate School, Seoul National University, Seoul, Korea
| | - Jehee Lee
- School of Computer Science and Engineering, Seoul National University, Seoul, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Interdisciplinary Program of Bioengineering, Graduate School, Seoul National University, Seoul, Korea
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Gilchrist I, Moglo K, Storr M, Pelland L. Effects of head flexion posture on the multidirectional static force capacity of the neck. Clin Biomech (Bristol, Avon) 2016; 37:44-52. [PMID: 27289496 DOI: 10.1016/j.clinbiomech.2016.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/05/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck muscle force protects vertebral alignment and resists potentially injurious loading of osteoligamentous structures during head impacts. As the majority of neck muscles generate moments about all three planes of motion, it is not clear how the force capacity of the neck might be modulated by direction of force application and head posture. The aim of our study was to measure the multidirectional moment-generating capacity of the neck and to evaluate effects of 20° of head flexion, a common head position in contact sports, on the measured capacity. METHODS We conducted a cross-sectional study, with 25 males, 20-30years old, performing maximum voluntary contractions, with ballistic intent, along eight directions, set at 45° intervals in the horizontal plane of the head. Three-dimensional moments at C3 and T1 were calculated using equations of static equilibrium. The variable of interest was the impulse of force generated from 0-50ms. Effects of direction of force application and head posture, neutral and 20° flexion, were evaluated by two-way analysis of variance and linear regression. FINDINGS Impulse of force was lower along diagonal planes, at 45° from the mid-sagittal plane, compared to orthogonal planes (P<0.001). Compared to neutral posture, head flexion produced a 55.2% decrease in impulse capacity at C3 and 45.9% at T1. INTERPRETATION The risk of injury with head impact would intrinsically be higher along diagonal planes and with a 20° head down position due to a lower moment generating capacity of the neck in the first 50ms of force application.
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Affiliation(s)
- Ian Gilchrist
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Human Mobility Research Centre, Queen's University, Kingston, Ontario, Canada
| | - Kodjo Moglo
- Royal Military College, Kingston, Ontario, Canada
| | - Michael Storr
- Kingston General Hospital, Department of Pediatrics, Kingston, Ontario, Canada
| | - Lucie Pelland
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Human Mobility Research Centre, Queen's University, Kingston, Ontario, Canada.
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A Biomechanical Analysis of an Artificial Disc With a Shock-absorbing Core Property by Using Whole-cervical Spine Finite Element Analysis. Spine (Phila Pa 1976) 2016; 41:E893-E901. [PMID: 26825785 DOI: 10.1097/brs.0000000000001468] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical comparison among the intact C2 to C7 segments, the C5 to C6 segments implanted with fusion cage, and three different artificial disc replacements (ADRs) by finite element (FE) model creation reflecting the entire cervical spine below C2. OBJECTIVE The aim of this study was to analyze the biomechanical changes in subaxial cervical spine after ADR and to verify the efficacy of a new mobile core artificial disc Baguera C that is designed to absorb shock. SUMMARY OF BACKGROUND DATA Scarce references could be found and compared regarding the cervical ADR devices' biomechanical differences that are consequently related to their different clinical results. METHODS One fusion device (CJ cage system, WINNOVA) and three different cervical artificial discs (Prodisc-C Nova (DePuy Synthes), Discocerv (Scient'x/Alphatec), Baguera C (Spineart)) were inserted at C5-6 disc space inside the FE model and analyzed. Hybrid loading conditions, under bending moments of 1 Nm along flexion, extension, lateral bending, and axial rotation with a compressive force of 50 N along the follower loading direction, were used in this study. Biomechanical behaviors such as segmental mobility, facet joint forces, and possible wear debris phenomenon inside the core were investigated. RESULTS The segmental motions as well as facet joint forces were exaggerated after ADR regardless of type of the devices. The Baguera C mimicked the intact cervical spine regarding the location of the center of rotation only during the flexion moment. It also showed a relatively wider distribution of the contact area and significantly lower contact pressure distribution on the core than the other two devices. A "lift off" phenomenon was noted for other two devices according to the specific loading condition. CONCLUSION The mobile core artificial disc Baguera C can be considered biomechanically superior to other devices by demonstrating no "lift off" phenomenon, and significantly lower contact pressure distribution on core. LEVEL OF EVIDENCE N/A.
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Mao H, Driscoll SJ, Li JS, Li G, Wood KB, Cha TD. Dimensional changes of the neuroforamina in subaxial cervical spine during in vivo dynamic flexion-extension. Spine J 2016; 16:540-6. [PMID: 26681352 PMCID: PMC4866915 DOI: 10.1016/j.spinee.2015.11.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/10/2015] [Accepted: 11/23/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neuroforaminal stenosis is one of the key factors causing clinical symptoms in patients with cervical radiculopathy. Previous quantitative studies on the neuroforaminal dimensions have focused on measurements in a static position. Little is known about dimensional changes of the neuroforamina in the cervical spine during functional dynamic neck motion under physiological loading conditions. PURPOSE This study aimed to investigate the in vivo dimensional changes of the neuroforamina in human cervical spine (C3-C7) during dynamic flexion-extension neck motion. STUDY DESIGN A case-control study was carried out. METHODS Ten asymptomatic subjects were recruited for this study. The cervical spine of each subject underwent magnetic resonance image scanning for construction of three-dimensional (3-D) vertebrae models from C3 to C7. The cervical spine was then imaged using a dual fluoroscopic system while the subject performed a dynamic flexion-extension neck motion in a sitting position. The 3-D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral motion. The dimensions (area, height, and width) were measured for each cervical neuroforamen (C3/C4, C4/C5, C5/C6, and C6/C7) in the following functional positions: neutral position, maximal flexion, and maximal extension. Repeated measures analysis of variance and post hoc analysis were used to examine the differences between levels and positions. RESULTS Compared with the neutral position, almost all dimensional parameters (area, height, and width) of the subaxial cervical neuroforamina decreased in extension and increased in flexion, except the neuroforaminal area at C5/C6 (p=.07), and the neuroforaminal height at C6/C7 (p=.05) remained relatively constant from neutral to extension. When comparisons of the overall change fromextension to flexion were made between segments, the overall changes of the neuroforaminal area and height revealed no significant differences between segments, and the width overall change of the upper levels (C3/C4 and C4/C5) was significantly greater than the lower levels (C5/C6 and C6/C7) (p<.01). CONCLUSIONS The dimensional changes of the cervical neuroforamina showed segment-dependent characteristics during the dynamic flexion-extension. These data may have implications for diagnosis and treatment of patients with cervical radiculopathy.
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Affiliation(s)
- Haiqing Mao
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA,Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Sean J Driscoll
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Jing-Sheng Li
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St-GRJ 1215, Boston 02114, MA, USA.
| | - Kirkham B Wood
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Thomas D Cha
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
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Chang PY, Chang HK, Wu JC, Huang WC, Fay LY, Tu TH, Wu CL, Cheng H. Differences between C3-4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up. J Neurosurg Spine 2016; 24:752-9. [PMID: 26824584 DOI: 10.3171/2015.10.spine141217] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4-5 and C5-6 discs account for more motion than the C3-4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3-4 and non-C3-4 CDA groups (i.e., those including C4-5, C5-6, and C6-7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3-4 CDA group and 77 in the non-C3-4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3-4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3-4 was infrequent, the improved clinical outcomes of CDA were similar at C3-4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3-4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.
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Affiliation(s)
- Peng-Yuan Chang
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University
| | - Hsuan-Kan Chang
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University
| | - Jau-Ching Wu
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University
| | - Li-Yu Fay
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University;,Institute of Pharmacology, National Yang-Ming University; and
| | - Tsung-Hsi Tu
- Departments of 1 Neurosurgery, Neurological Institute and.,School of Medicine, National Yang-Ming University;,Molecular Medicine Program, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan
| | - Ching-Lan Wu
- Radiology, Taipei Veterans General Hospital;,School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- Departments of 1 Neurosurgery, Neurological Institute and.,Radiology, Taipei Veterans General Hospital;,School of Medicine, National Yang-Ming University
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Anderst W. Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography. J Orthop Res 2016; 34:22-30. [PMID: 26331480 DOI: 10.1002/jor.23042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/28/2015] [Indexed: 02/04/2023]
Abstract
Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.
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Affiliation(s)
- William Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
The application of mechanical principles to problems of the spine dates to antiquity. Significant developments related to spinal anatomy and biomechanical behaviour made by Renaissance and post-Renaissance scholars through the end of the 19th century laid a strong foundation for the developments since that time. The objective of this article is to provide a historical overview of spine biomechanics with a focus on the developments in the 20th century. The topics of spine loading, spinal posture and stability, spinal kinematics, spinal injury, and surgical strategies were reviewed.
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Affiliation(s)
- T R Oxland
- Departments of Orthopaedics and Mechanical Engineering, University of British Columbia, Vancouver, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Room 5460-818 West 10th Ave., V5Z 1M9, Vancouver, BC, Canada.
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50
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Dong J, Lu M, Lu T, Liang B, Xu J, Qin J, Cai X, Huang S, Wang D, Li H, He X. Artificial disc and vertebra system: a novel motion preservation device for cervical spinal disease after vertebral corpectomy. Clinics (Sao Paulo) 2015. [PMID: 26222819 PMCID: PMC4496753 DOI: 10.6061/clinics/2015(07)06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the range of motion and stability of the human cadaveric cervical spine after the implantation of a novel artificial disc and vertebra system by comparing an intact group and a fusion group. METHODS Biomechanical tests were conducted on 18 human cadaveric cervical specimens. The range of motion and the stability index range of motion were measured to study the function and stability of the artificial disc and vertebra system of the intact group compared with the fusion group. RESULTS In all cases, the artificial disc and vertebra system maintained intervertebral motion and reestablished vertebral height at the operative level. After its implantation, there was no significant difference in the range of motion (ROM) of C(3-7) in all directions in the non-fusion group compared with the intact group (p>0.05), but significant differences were detected in flexion, extension and axial rotation compared with the fusion group (p<0.05). The ROM of adjacent segments (C(3-4), C(6-7)) of the non-fusion group decreased significantly in some directions compared with the fusion group (p<0.05). Significant differences in the C(4-6) ROM in some directions were detected between the non-fusion group and the intact group. In the fusion group, the C(4-6) ROM in all directions decreased significantly compared with the intact and non-fusion groups (p<0.01). The stability index ROM (SI-ROM) of some directions was negative in the non-fusion group, and a significant difference in SI-ROM was only found in the C(4-6) segment of the non-fusion group compared with the fusion group. CONCLUSION An artificial disc and vertebra system could restore vertebral height and preserve the dynamic function of the surgical area and could theoretically reduce the risk of adjacent segment degeneration compared with the anterior fusion procedure. However, our results should be considered with caution because of the low power of the study. The use of a larger sample should be considered in future studies.
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Affiliation(s)
- Jun Dong
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Meng Lu
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Teng Lu
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Baobao Liang
- Second Affiliated Hospital of Xi′an Jiaotong University, Department of Plastic Surgery, Xi′an, China
| | - Junkui Xu
- Xi′an Honghui Hospital of Xi′an Jiaotong University, Department of Orthopedics, Xi′an, China
| | - Jie Qin
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Xuan Cai
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Sihua Huang
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Dong Wang
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Haopeng Li
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
| | - Xijing He
- Second Affiliated Hospital of Xi′an Jiaotong University, Second Department of Orthopedics, Xi′an, China
- Corresponding Author: E-mail:
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