EFFECTS OF NOVEL ANGLED CERVICAL DISC REPLACEMENT ON FACET JOINT STRESS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

BAI Chuanyi ¹ , ZHANG Weijie ¹ , LING Wei ² , TIAN Zhenxing ² , DANG Xiaoqian ¹ , WANG Kunzheng. ¹

1The First Department of Orthopaedics, the Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;;
2School of Aerospace,Xi’an Jiaotong University.;

Corresponding author：

Keywords：

Cervical spine; Artificial vertebral disc replacement; Biomechanics; Facet joint

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Objective To analyze the biomechanical changes of the adjacent cervical facet joints when the angled cervical prosthesis is replaced. Methods A total of 400 northwestern people were involved, with an age of 40 years or older.The cervical vertebra lateral X-ray films were taken, and the cervical angles were measured by professional computer aided design software, then the cervical intervertebral disc prosthesis with 10° angle was designed. The finite element models of C4，5
and C4-6 segments with intact cervical discs were developed; the C4，5 disc was replaced by the cervical prosthesis with 0° and 10° angle respectively; and then all models were subjected to axial loading, flexion/extension, lateral bending, and torsion loading conditions; the stress effects on adjacent facet joints after replacement were observed by comparing with that of the intact model. Results The cervical angles were (9.97 ± 3.64)° in C3，4, (9.95 ± 4.34)° in C4，5, (8.59 ± 3.75)° in C5，6, and (8.49 ± 3.39)° in C6，7, showing no significant difference between C3，4 and C4，5, C5，6 and C6，7 (P gt; 0.05) and showing significant differences between the other cervical angles (P lt; 0.05). When C4，5 model was axially loaded, no significant difference in equivalent shearing stress were observed in intact, 0°, and 10° groups; at flexion/extension loading, the stress was biggest in intact group, and was smallest in 10° group; at lateral bending, the stress got the high rank in intact group, and was minimum in 10° group; at torsion loading, the stress state of 10° group approached to the intact one condition. When C4-6 model was loaded, the facet joint stress of the replaced segment (C4，5) decreased significantly at axial loading, flexion/extension, and lateral bending; while no obvious decrease was observed at torsion loading; the stress of the adjacent inferior disc (C5，6) decreased significantly at axial loading
and lateral bending condition, while less decrease was observed at torsion loading, no significant change at flexion/extension condition, it approached to that of the intact one. Conclusion The finite element analysis reveals that the biomechanical properties of 10° designed prosthesis is approximate to that of the intact cervical disc, thus the 10° designed prosthesis can meet the requirements of biomechanical function reconstruction of the cervical spine.

Citation： BAI Chuanyi,ZHANG Weijie,LING Wei,TIAN Zhenxing,DANG Xiaoqian,WANG Kunzheng.. EFFECTS OF NOVEL ANGLED CERVICAL DISC REPLACEMENT ON FACET JOINT STRESS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 390-395. doi: Copy

1.	Denaro V, Di Martino A. Cervical spine surgery: an historical perspective. Clin Orthop Relat Res, 2011, 469(3): 639-648.
2.	Cepoiu-Martin M, Faris P, Lorenzetti D, et al. Artificial cervical disc arthroplasty (ACDA): a systematic review. Spine (Phila Pa 1976), 2011. [Epub ahead of print].
3.	Shim CS, Lee SH, Park HJ, et al. Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech, 2006, 19(7): 465-470.
4.	Kim HK, Kim MH, Cho DS, et al. Surgical outcome of cervical arthroplasty using bryan (r). J Korean Neurosurg Soc, 2009, 46(6): 532-537.
5.	Pal GP, Sherk HH. The vertieal stability of the cervieal spine. Spine (Phila Pa 1976), 1988, 13(5): 447-449.
6.	Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5 to 11 year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
7.	Kowalski RJ, Ferrara LA, Benzel EC, et al. Biomechanics of the spine. Neurosurg, 2005, 15(1): 42-59.
8.	Hacker RJ, Miller CG. Failed anterior cervical foramianotomy. J Neurosurg, 2003, 98(2 Suppl): 126-130.
9.	van Limbeek J, Jacobs WC, Anderson PG, et al. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J, 2000, 9(2): 129-136.
10.	Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
11.	Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
12.	Phillips FM, Allen TR, Regan JJ, et al. Cervical disc replacement in patients with and without previous adjacent level fusion surgery: a prospective study. Spine (Phila Pa 1976), 2009, 34(6): 556-565.
13.	胡孔和, 吴强, 李康华, 等. 人工颈椎间盘置换术后邻近下位关节突关节压力变化的生物力学研究. 中国临床解剖学杂志, 2009, 27(4): 474-476.
14.	Phillips FM, Tzermiadianos MN, Voronov LI, et al. Effect of two-level total disc replacement on cervical spine kinematics. Spine (Phila Pa 1976), 2009, 34(22): E794-799.
15.	Ren X, Wang W, Chu T, et al. The intermediate clinical outcome and its limitations of Bryan cervical arthroplasty for treatment of cervical disc herniation. J Spinal Disord Tech, 2011, 24(4): 221-229.
16.	Goffin J, van Loon J, Van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow -up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
17.	Sasso RC, Best NM, Metcalf NH, et al. Motion analysis of Bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial. J Spinal Disord Tech, 2008, 21(6): 393-399.
18.	Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignments after cervical anterior spinal fusion or patients with cervical myelopathy. J Spinal Disord, 1999, 12(1): 50-56.
19.	Park Y, Maeda T, Cho W, et al. Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal aligment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine J, 2010, 10(3): 193-199.
20.	Hacker B. Bryan disc related cervical kyphosis. Spine J, 2007, 7(1): 138-139.
21.	Yi S, Shin HC, Kim KN, et al. Modified techniques to prevent sagittal imbalance after cervical arthroplasty. Spine (Phila Pa 1976), 2007, 32(18): 1986-1991.
22.	Sears WR, Duggal N, Sekhon LH, et al. Segmental malalignment with the Bryan cervical disc prosthesis-contributing factors. J Spinal Disord Tech, 2007, 20(2): 111-117.
23.	于淼, 孙宇, 刘忠军, 等. 相邻双节段颈椎人工椎间盘置换术疗效的初步观察. 中国脊柱脊髓杂志, 2009, 19(1): 34-38.

1. Denaro V, Di Martino A. Cervical spine surgery: an historical perspective. Clin Orthop Relat Res, 2011, 469(3): 639-648.
2. Cepoiu-Martin M, Faris P, Lorenzetti D, et al. Artificial cervical disc arthroplasty (ACDA): a systematic review. Spine (Phila Pa 1976), 2011. [Epub ahead of print].
3. Shim CS, Lee SH, Park HJ, et al. Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech, 2006, 19(7): 465-470.
4. Kim HK, Kim MH, Cho DS, et al. Surgical outcome of cervical arthroplasty using bryan (r). J Korean Neurosurg Soc, 2009, 46(6): 532-537.
5. Pal GP, Sherk HH. The vertieal stability of the cervieal spine. Spine (Phila Pa 1976), 1988, 13(5): 447-449.
6. Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5 to 11 year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
7. Kowalski RJ, Ferrara LA, Benzel EC, et al. Biomechanics of the spine. Neurosurg, 2005, 15(1): 42-59.
8. Hacker RJ, Miller CG. Failed anterior cervical foramianotomy. J Neurosurg, 2003, 98(2 Suppl): 126-130.
9. van Limbeek J, Jacobs WC, Anderson PG, et al. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J, 2000, 9(2): 129-136.
10. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
11. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
12. Phillips FM, Allen TR, Regan JJ, et al. Cervical disc replacement in patients with and without previous adjacent level fusion surgery: a prospective study. Spine (Phila Pa 1976), 2009, 34(6): 556-565.
13. 胡孔和, 吴强, 李康华, 等. 人工颈椎间盘置换术后邻近下位关节突关节压力变化的生物力学研究. 中国临床解剖学杂志, 2009, 27(4): 474-476.
14. Phillips FM, Tzermiadianos MN, Voronov LI, et al. Effect of two-level total disc replacement on cervical spine kinematics. Spine (Phila Pa 1976), 2009, 34(22): E794-799.
15. Ren X, Wang W, Chu T, et al. The intermediate clinical outcome and its limitations of Bryan cervical arthroplasty for treatment of cervical disc herniation. J Spinal Disord Tech, 2011, 24(4): 221-229.
16. Goffin J, van Loon J, Van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow -up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
17. Sasso RC, Best NM, Metcalf NH, et al. Motion analysis of Bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial. J Spinal Disord Tech, 2008, 21(6): 393-399.
18. Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignments after cervical anterior spinal fusion or patients with cervical myelopathy. J Spinal Disord, 1999, 12(1): 50-56.
19. Park Y, Maeda T, Cho W, et al. Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal aligment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine J, 2010, 10(3): 193-199.
20. Hacker B. Bryan disc related cervical kyphosis. Spine J, 2007, 7(1): 138-139.
21. Yi S, Shin HC, Kim KN, et al. Modified techniques to prevent sagittal imbalance after cervical arthroplasty. Spine (Phila Pa 1976), 2007, 32(18): 1986-1991.
22. Sears WR, Duggal N, Sekhon LH, et al. Segmental malalignment with the Bryan cervical disc prosthesis-contributing factors. J Spinal Disord Tech, 2007, 20(2): 111-117.
23. 于淼, 孙宇, 刘忠军, 等. 相邻双节段颈椎人工椎间盘置换术疗效的初步观察. 中国脊柱脊髓杂志, 2009, 19(1): 34-38.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTS OF NOVEL ANGLED CERVICAL DISC REPLACEMENT ON FACET JOINT STRESS

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