Biomechanical evaluation of the ProDisc-C stability following graded posterior cervical injury

Document Type

Article

Abstract

© AANS 2018. OBJECTIVE There are limited data regarding the implications of revision posterior surgery in the setting of previous cervical arthroplasty (CA). The purpose of this study was to analyze segmental biomechanics in human cadaveric specimens with and without CA, in the context of graded posterior resection. METHODS Fourteen human cadaveric cervical spines (C3-T1 or C2-7) were divided into arthroplasty (ProDisc-C, n = 7) and control (intact disc, n = 7) groups. Both groups underwent sequential posterior element resections: unilateral foraminotomy, laminoplasty, and finally laminectomy. Specimens were studied sequentially in two different loading apparatuses during the induction of flexion-extension, lateral bending, and axial rotation. RESULTS Range of motion (ROM) after artificial disc insertion was reduced relative to that in the control group during axial rotation and lateral bending (13% and 28%, respectively; p < 0.05) but was similar during flexion and extension. With sequential resections, ROM increased by a similar magnitude following foraminotomy and laminoplasty in both groups. Laminectomy had a much greater effect: mean (aggregate) ROM during flexion-extension, lateral bending, and axial rotation was increased by a magnitude of 52% following laminectomy in the setting of CA, compared to an 8% increase without arthroplasty. In particular, laminectomy in the setting of CA introduced significant instability in flexionextension, characterized by a 90% increase in ROM from laminoplasty to laminectomy, compared to a 16% increase in ROM from laminoplasty to laminectomy without arthroplasty (p < 0.05). CONCLUSIONS Foraminotomy and laminoplasty did not result in significant instability in the setting of CA, compared to controls. Laminectomy alone, however, resulted in a significant change in biomechanics, allowing for significantly increased flexion and extension. Laminectomy alone should be used with caution in the setting of previous CA.

Keywords

Artificial cervical disc, Biomechanics, Cervical arthroplasty, Foraminotomy, Graded resection, Laminectomy, Laminoplasty, Range of motion

Publication Date

11-1-2018

Publication Title

Journal of Neurosurgery: Spine

ISSN

15475654

E-ISSN

15475646

Volume

29

Issue

5

First Page

515

Last Page

524

PubMed ID

30168784

Digital Object Identifier (DOI)

10.3171/2018.3.SPINE171248

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