The Effect of Posterior Decompressive Procedures on Segmental Range of Motion Following Cervical Total Disc Arthroplasty Journal Article

Authors: Brody, M. J.; Patel, A. A.; Ghanayem, A. J.; Wojewnik, B; Carandang, G; Havey, R. M.; Voronov, L. I.; Vastardis, G.; Potluri, T.; Patwardhan, A. G.
Article Title: The Effect of Posterior Decompressive Procedures on Segmental Range of Motion Following Cervical Total Disc Arthroplasty
Abstract: STRUCTURED ABSTRACT: Study Design. We quantified the segmental biomechanics of a cervical total disc replacement (TDR) before and after progressive posterior decompression. We hypothesized that posterior decompressive procedures would not significantly increase range of motion (ROM) at the index TDR level.Objective. To quantify the kinematics of a cervical TDR before and after posterior cervical decompression.Summary of Background Data. A reported yet unaddressed issue is the potential for the development of same-segment disease following implantation of a cervical total disc replacement (TDR) and the implications of same-segment posterior decompression on TDR mechanics.Methods. Eight human cadaveric cervical spines C3-C7 were tested in flexion / extension, lateral bending and axial rotation while intact, following C5-C6 TDR, C5-C6 unilateral foraminotomy, C5-C6 bilateral foraminotomies and following C5 laminectomy in combination with the bilateral foraminotomies. Moment vs. angular motion curves were obtained for each testing step, and the load-displacement data was analyzed to determine the range of angular motion for each step.Results. Unilateral foraminotomy did not result in a statistically significant increase in flexion/extension ROM, and did not increase the ROM to a degree greater than normal. While bilateral foraminotomies did increase flexion/extension ROM, motion remained within a physiologic range. A full laminectomy added to the bilateral foraminotomies significantly increased ROM and was also associated with distortion of the load-displacement curves.Conclusion. With respect to segmental biomechanics as demonstrated, we believe that for same-segment disease, a unilateral foraminotomy can be performed safely. However, the impact of in vivo conditions was not accounted for in this model, and it is possible that cyclical loading and other physiologic stresses on such a construct may affect the behavior and lifespan of the implant in a way that cannot be predicted by a biomechanical study. Bilateral foraminotomies would require close observation and additional clinical follow-up, while complete laminectomy combined with bilateral foraminotomies should be avoided after TDR given the significant changes in kinematics. Additionally, future disc replacement designs may need to account for changes after posterior decompression for same-segment disease.
Journal Title: Spine
Volume: 39
Issue: 19
ISSN: 1528-1159; 0362-2436
Publisher: Unknown  
Date Published: 2014
Start Page: 1558
End Page: 1563
Language: ENG
Notes: JID: 7610646; ppublish