Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns
Total disc replacement (TDR) has been recommended to reduce pain of presumed discogenic origin while preserving spinal motion. The floating core of Charité TDR is professed to allow the replication of the kinematics of a healthy disc under physiologic loads. While segmental motion after Charité TDR...
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| Veröffentlicht in: | The spine journal 2005-11, Vol.5 (6), p.590-599 |
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| creator | O'Leary, Patrick Nicolakis, Michael Lorenz, Mark A. Voronov, Leonard I. Zindrick, Michael R. Ghanayem, Alexander Havey, Robert M. Carandang, Gerard Sartori, Mark Gaitanis, Ioannis N. Fronczak, Stanley Patwardhan, Avinash G. |
| description | Total disc replacement (TDR) has been recommended to reduce pain of presumed discogenic origin while preserving spinal motion. The floating core of Charité TDR is professed to allow the replication of the kinematics of a healthy disc under physiologic loads. While segmental motion after Charité TDR has been measured, little is known about the effects of a physiologic compressive preload on vertebral motion and the motion of prosthesis components after TDR.
(1) Does Charité TDR allow restoration of normal load-displacement behavior of a lumbar motion segment under physiologic loads? (2) How do the prosthesis components move relative to each other under physiologic loads when implanted in a lumbar motion segment?
A biomechanical study using human lumbar spines (L1-sacrum).
Five lumbar spines (age: 52±9.3) were used. Specimens were tested under flexion (8 Nm) and extension (6 Nm) moments with compressive follower preloads of 0 N and 400 N in the following sequence: (i) intact, (ii) Charité TDR at L5-S1, (iii) simulated healed fusion at L5-S1 with Charité TDR at L4-L5. Segmental motion was measured optoelectronically. Motions between prosthesis end plates and core were visually assessed using sequential digital video-fluoroscopy over the full range of motion. Here we report on kinematics of 10 Charité TDRs: 5 at L5-S1 and 5 at L4-L5.
Charité TDR increased the flexion-extension range of motion of lumbar segments (p |
| doi_str_mv | 10.1016/j.spinee.2005.06.015 |
| format | Article |
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(1) Does Charité TDR allow restoration of normal load-displacement behavior of a lumbar motion segment under physiologic loads? (2) How do the prosthesis components move relative to each other under physiologic loads when implanted in a lumbar motion segment?
A biomechanical study using human lumbar spines (L1-sacrum).
Five lumbar spines (age: 52±9.3) were used. Specimens were tested under flexion (8 Nm) and extension (6 Nm) moments with compressive follower preloads of 0 N and 400 N in the following sequence: (i) intact, (ii) Charité TDR at L5-S1, (iii) simulated healed fusion at L5-S1 with Charité TDR at L4-L5. Segmental motion was measured optoelectronically. Motions between prosthesis end plates and core were visually assessed using sequential digital video-fluoroscopy over the full range of motion. Here we report on kinematics of 10 Charité TDRs: 5 at L5-S1 and 5 at L4-L5.
Charité TDR increased the flexion-extension range of motion of lumbar segments (p<.05). At 400 N preload, the range of motion increased from intact values of 6.8±4.4 to 10.0±2.4 degrees at L5-S1 and from 7.0±2.6 to 10.8±2.9 degrees at L4-L5. Charité TDR increased segmental lordosis by 8.1±6.9 degrees at L5-S1 (p<.05) and 5.4±3.5 degrees at L4-L5 (p<.05). Four patterns of prosthesis component motion were noted: (1) angular motion only between the upper end plate and core, with little or no visual evidence of core translation (9 of 10 TDRs at 0 N preload and 5 of 10 TDRs at 400 N preload); (2) lift-off of upper prosthesis end plate from core or of core from lower end plate (observed in extension in 9 of 10 TDRs under 0 N preload only); (3) core entrapment, resulting in a locked core over a portion of the range of motion (observed in extension in 8 of 10 TDRs under 400 N preload); (4) angular motion between both the upper and lower end plates and core, with visual evidence of core translation (1 of 10 TDRs at 0 N preload, 5 of 10 TDRs at 400 N preload). The pattern of load-displacement curves was substantially changed under a physiologic preload in 8 of 10 TDRs; instead of a relatively gradual change in angle with changing moment application as seen for an intact segment, the TDR displayed regions of both relatively small and relatively large angular changes with gradual moment application.
Charité TDR restored near normal quantity of flexion-extension range of motion under a constant physiologic preload; however, the quality of segmental motion differed from the intact case over the flexion-extension range. Whereas some TDRs showed visual evidence of core translation, the predominant angular motion within the prosthesis occurred between the upper end plate and the polyethylene core. Likely factors affecting the function of the Charité TDR include implant placement and orientation, intraoperative change in lordosis, and magnitude of physiologic compressive preload. Further work is needed to assess the effects of the prosthesis motion patterns identified in the study on the load sharing at the implanted level and polyethylene core wear.</description><identifier>ISSN: 1529-9430</identifier><identifier>EISSN: 1878-1632</identifier><identifier>DOI: 10.1016/j.spinee.2005.06.015</identifier><identifier>PMID: 16291097</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Biomechanics ; Cadaver ; Elasticity ; Equipment Failure Analysis ; Female ; Follower preload ; Humans ; In Vitro Techniques ; Intervertebral Disc Displacement - complications ; Intervertebral Disc Displacement - diagnosis ; Intervertebral Disc Displacement - physiopathology ; Intervertebral Disc Displacement - surgery ; Joint Instability - etiology ; Joint Instability - physiopathology ; Joint Instability - prevention & control ; Joint Prosthesis ; Kinematics ; Lumbar spine ; Lumbar Vertebrae - physiopathology ; Lumbar Vertebrae - surgery ; Male ; Middle Aged ; Movement ; Prosthesis Design ; Prosthesis Implantation - methods ; Range of Motion, Articular ; Total disc replacement ; Weight-Bearing</subject><ispartof>The spine journal, 2005-11, Vol.5 (6), p.590-599</ispartof><rights>2005 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c275t-cd36dacc3fc9137890e6b770b46014a0d347e6fbe27abf51c2d4d3f9588bd7a93</citedby><cites>FETCH-LOGICAL-c275t-cd36dacc3fc9137890e6b770b46014a0d347e6fbe27abf51c2d4d3f9588bd7a93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.spinee.2005.06.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16291097$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O'Leary, Patrick</creatorcontrib><creatorcontrib>Nicolakis, Michael</creatorcontrib><creatorcontrib>Lorenz, Mark A.</creatorcontrib><creatorcontrib>Voronov, Leonard I.</creatorcontrib><creatorcontrib>Zindrick, Michael R.</creatorcontrib><creatorcontrib>Ghanayem, Alexander</creatorcontrib><creatorcontrib>Havey, Robert M.</creatorcontrib><creatorcontrib>Carandang, Gerard</creatorcontrib><creatorcontrib>Sartori, Mark</creatorcontrib><creatorcontrib>Gaitanis, Ioannis N.</creatorcontrib><creatorcontrib>Fronczak, Stanley</creatorcontrib><creatorcontrib>Patwardhan, Avinash G.</creatorcontrib><title>Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns</title><title>The spine journal</title><addtitle>Spine J</addtitle><description>Total disc replacement (TDR) has been recommended to reduce pain of presumed discogenic origin while preserving spinal motion. The floating core of Charité TDR is professed to allow the replication of the kinematics of a healthy disc under physiologic loads. While segmental motion after Charité TDR has been measured, little is known about the effects of a physiologic compressive preload on vertebral motion and the motion of prosthesis components after TDR.
(1) Does Charité TDR allow restoration of normal load-displacement behavior of a lumbar motion segment under physiologic loads? (2) How do the prosthesis components move relative to each other under physiologic loads when implanted in a lumbar motion segment?
A biomechanical study using human lumbar spines (L1-sacrum).
Five lumbar spines (age: 52±9.3) were used. Specimens were tested under flexion (8 Nm) and extension (6 Nm) moments with compressive follower preloads of 0 N and 400 N in the following sequence: (i) intact, (ii) Charité TDR at L5-S1, (iii) simulated healed fusion at L5-S1 with Charité TDR at L4-L5. Segmental motion was measured optoelectronically. Motions between prosthesis end plates and core were visually assessed using sequential digital video-fluoroscopy over the full range of motion. Here we report on kinematics of 10 Charité TDRs: 5 at L5-S1 and 5 at L4-L5.
Charité TDR increased the flexion-extension range of motion of lumbar segments (p<.05). At 400 N preload, the range of motion increased from intact values of 6.8±4.4 to 10.0±2.4 degrees at L5-S1 and from 7.0±2.6 to 10.8±2.9 degrees at L4-L5. Charité TDR increased segmental lordosis by 8.1±6.9 degrees at L5-S1 (p<.05) and 5.4±3.5 degrees at L4-L5 (p<.05). Four patterns of prosthesis component motion were noted: (1) angular motion only between the upper end plate and core, with little or no visual evidence of core translation (9 of 10 TDRs at 0 N preload and 5 of 10 TDRs at 400 N preload); (2) lift-off of upper prosthesis end plate from core or of core from lower end plate (observed in extension in 9 of 10 TDRs under 0 N preload only); (3) core entrapment, resulting in a locked core over a portion of the range of motion (observed in extension in 8 of 10 TDRs under 400 N preload); (4) angular motion between both the upper and lower end plates and core, with visual evidence of core translation (1 of 10 TDRs at 0 N preload, 5 of 10 TDRs at 400 N preload). The pattern of load-displacement curves was substantially changed under a physiologic preload in 8 of 10 TDRs; instead of a relatively gradual change in angle with changing moment application as seen for an intact segment, the TDR displayed regions of both relatively small and relatively large angular changes with gradual moment application.
Charité TDR restored near normal quantity of flexion-extension range of motion under a constant physiologic preload; however, the quality of segmental motion differed from the intact case over the flexion-extension range. Whereas some TDRs showed visual evidence of core translation, the predominant angular motion within the prosthesis occurred between the upper end plate and the polyethylene core. Likely factors affecting the function of the Charité TDR include implant placement and orientation, intraoperative change in lordosis, and magnitude of physiologic compressive preload. Further work is needed to assess the effects of the prosthesis motion patterns identified in the study on the load sharing at the implanted level and polyethylene core wear.</description><subject>Aged</subject><subject>Biomechanics</subject><subject>Cadaver</subject><subject>Elasticity</subject><subject>Equipment Failure Analysis</subject><subject>Female</subject><subject>Follower preload</subject><subject>Humans</subject><subject>In Vitro Techniques</subject><subject>Intervertebral Disc Displacement - complications</subject><subject>Intervertebral Disc Displacement - diagnosis</subject><subject>Intervertebral Disc Displacement - physiopathology</subject><subject>Intervertebral Disc Displacement - surgery</subject><subject>Joint Instability - etiology</subject><subject>Joint Instability - physiopathology</subject><subject>Joint Instability - prevention & control</subject><subject>Joint Prosthesis</subject><subject>Kinematics</subject><subject>Lumbar spine</subject><subject>Lumbar Vertebrae - physiopathology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Movement</subject><subject>Prosthesis Design</subject><subject>Prosthesis Implantation - methods</subject><subject>Range of Motion, Articular</subject><subject>Total disc replacement</subject><subject>Weight-Bearing</subject><issn>1529-9430</issn><issn>1878-1632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1q3DAQx0VpaT7aNwhBp97sjvwh2TkEwtI2hUChNGchS-OuFttyNNpAHinP0Rerll3oraeZw2_-M_Nj7EpAKUDIz7uSVr8glhVAW4IsQbRv2LnoVFcIWVdvc99WfdE3NZyxC6IdAHRKVO_ZmZBVL6BX58z_RFrDQsjDyDdbE33688pTSGbizpPlEdfJWJxxSXy_OIx83b6QD1P47S2fgnF0w9cYKG2RPHEb5px3oOeQfFj4alLCuNAH9m40E-HHU71kj1-__NrcFw8_vn3f3D0UtlJtKqyrpTPW1qPtRa26HlAOSsHQSBCNAVc3CuU4YKXMMLbCVq5x9di3XTc4Zfr6kn065uajnvZISc_5D5wms2DYk5ZdB7IRkMHmCNp8PUUc9Rr9bOKLFqAPivVOHxXrg2INUmfFeez6lL8fZnT_hk5OM3B7BDB_-ewxarIeF4vOR7RJu-D_v-EvJ6iSlw</recordid><startdate>200511</startdate><enddate>200511</enddate><creator>O'Leary, Patrick</creator><creator>Nicolakis, Michael</creator><creator>Lorenz, Mark A.</creator><creator>Voronov, Leonard I.</creator><creator>Zindrick, Michael R.</creator><creator>Ghanayem, Alexander</creator><creator>Havey, Robert M.</creator><creator>Carandang, Gerard</creator><creator>Sartori, Mark</creator><creator>Gaitanis, Ioannis N.</creator><creator>Fronczak, Stanley</creator><creator>Patwardhan, Avinash G.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200511</creationdate><title>Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns</title><author>O'Leary, Patrick ; Nicolakis, Michael ; Lorenz, Mark A. ; Voronov, Leonard I. ; Zindrick, Michael R. ; Ghanayem, Alexander ; Havey, Robert M. ; Carandang, Gerard ; Sartori, Mark ; Gaitanis, Ioannis N. ; Fronczak, Stanley ; Patwardhan, Avinash G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c275t-cd36dacc3fc9137890e6b770b46014a0d347e6fbe27abf51c2d4d3f9588bd7a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Biomechanics</topic><topic>Cadaver</topic><topic>Elasticity</topic><topic>Equipment Failure Analysis</topic><topic>Female</topic><topic>Follower preload</topic><topic>Humans</topic><topic>In Vitro Techniques</topic><topic>Intervertebral Disc Displacement - complications</topic><topic>Intervertebral Disc Displacement - diagnosis</topic><topic>Intervertebral Disc Displacement - physiopathology</topic><topic>Intervertebral Disc Displacement - surgery</topic><topic>Joint Instability - etiology</topic><topic>Joint Instability - physiopathology</topic><topic>Joint Instability - prevention & control</topic><topic>Joint Prosthesis</topic><topic>Kinematics</topic><topic>Lumbar spine</topic><topic>Lumbar Vertebrae - physiopathology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Movement</topic><topic>Prosthesis Design</topic><topic>Prosthesis Implantation - methods</topic><topic>Range of Motion, Articular</topic><topic>Total disc replacement</topic><topic>Weight-Bearing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O'Leary, Patrick</creatorcontrib><creatorcontrib>Nicolakis, Michael</creatorcontrib><creatorcontrib>Lorenz, Mark A.</creatorcontrib><creatorcontrib>Voronov, Leonard I.</creatorcontrib><creatorcontrib>Zindrick, Michael R.</creatorcontrib><creatorcontrib>Ghanayem, Alexander</creatorcontrib><creatorcontrib>Havey, Robert M.</creatorcontrib><creatorcontrib>Carandang, Gerard</creatorcontrib><creatorcontrib>Sartori, Mark</creatorcontrib><creatorcontrib>Gaitanis, Ioannis N.</creatorcontrib><creatorcontrib>Fronczak, Stanley</creatorcontrib><creatorcontrib>Patwardhan, Avinash G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O'Leary, Patrick</au><au>Nicolakis, Michael</au><au>Lorenz, Mark A.</au><au>Voronov, Leonard I.</au><au>Zindrick, Michael R.</au><au>Ghanayem, Alexander</au><au>Havey, Robert M.</au><au>Carandang, Gerard</au><au>Sartori, Mark</au><au>Gaitanis, Ioannis N.</au><au>Fronczak, Stanley</au><au>Patwardhan, Avinash G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns</atitle><jtitle>The spine journal</jtitle><addtitle>Spine J</addtitle><date>2005-11</date><risdate>2005</risdate><volume>5</volume><issue>6</issue><spage>590</spage><epage>599</epage><pages>590-599</pages><issn>1529-9430</issn><eissn>1878-1632</eissn><abstract>Total disc replacement (TDR) has been recommended to reduce pain of presumed discogenic origin while preserving spinal motion. The floating core of Charité TDR is professed to allow the replication of the kinematics of a healthy disc under physiologic loads. While segmental motion after Charité TDR has been measured, little is known about the effects of a physiologic compressive preload on vertebral motion and the motion of prosthesis components after TDR.
(1) Does Charité TDR allow restoration of normal load-displacement behavior of a lumbar motion segment under physiologic loads? (2) How do the prosthesis components move relative to each other under physiologic loads when implanted in a lumbar motion segment?
A biomechanical study using human lumbar spines (L1-sacrum).
Five lumbar spines (age: 52±9.3) were used. Specimens were tested under flexion (8 Nm) and extension (6 Nm) moments with compressive follower preloads of 0 N and 400 N in the following sequence: (i) intact, (ii) Charité TDR at L5-S1, (iii) simulated healed fusion at L5-S1 with Charité TDR at L4-L5. Segmental motion was measured optoelectronically. Motions between prosthesis end plates and core were visually assessed using sequential digital video-fluoroscopy over the full range of motion. Here we report on kinematics of 10 Charité TDRs: 5 at L5-S1 and 5 at L4-L5.
Charité TDR increased the flexion-extension range of motion of lumbar segments (p<.05). At 400 N preload, the range of motion increased from intact values of 6.8±4.4 to 10.0±2.4 degrees at L5-S1 and from 7.0±2.6 to 10.8±2.9 degrees at L4-L5. Charité TDR increased segmental lordosis by 8.1±6.9 degrees at L5-S1 (p<.05) and 5.4±3.5 degrees at L4-L5 (p<.05). Four patterns of prosthesis component motion were noted: (1) angular motion only between the upper end plate and core, with little or no visual evidence of core translation (9 of 10 TDRs at 0 N preload and 5 of 10 TDRs at 400 N preload); (2) lift-off of upper prosthesis end plate from core or of core from lower end plate (observed in extension in 9 of 10 TDRs under 0 N preload only); (3) core entrapment, resulting in a locked core over a portion of the range of motion (observed in extension in 8 of 10 TDRs under 400 N preload); (4) angular motion between both the upper and lower end plates and core, with visual evidence of core translation (1 of 10 TDRs at 0 N preload, 5 of 10 TDRs at 400 N preload). The pattern of load-displacement curves was substantially changed under a physiologic preload in 8 of 10 TDRs; instead of a relatively gradual change in angle with changing moment application as seen for an intact segment, the TDR displayed regions of both relatively small and relatively large angular changes with gradual moment application.
Charité TDR restored near normal quantity of flexion-extension range of motion under a constant physiologic preload; however, the quality of segmental motion differed from the intact case over the flexion-extension range. Whereas some TDRs showed visual evidence of core translation, the predominant angular motion within the prosthesis occurred between the upper end plate and the polyethylene core. Likely factors affecting the function of the Charité TDR include implant placement and orientation, intraoperative change in lordosis, and magnitude of physiologic compressive preload. Further work is needed to assess the effects of the prosthesis motion patterns identified in the study on the load sharing at the implanted level and polyethylene core wear.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>16291097</pmid><doi>10.1016/j.spinee.2005.06.015</doi><tpages>10</tpages></addata></record> |
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| identifier | ISSN: 1529-9430 |
| ispartof | The spine journal, 2005-11, Vol.5 (6), p.590-599 |
| issn | 1529-9430 1878-1632 |
| language | eng |
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| source | MEDLINE; ScienceDirect Freedom Collection (Elsevier) |
| subjects | Aged Biomechanics Cadaver Elasticity Equipment Failure Analysis Female Follower preload Humans In Vitro Techniques Intervertebral Disc Displacement - complications Intervertebral Disc Displacement - diagnosis Intervertebral Disc Displacement - physiopathology Intervertebral Disc Displacement - surgery Joint Instability - etiology Joint Instability - physiopathology Joint Instability - prevention & control Joint Prosthesis Kinematics Lumbar spine Lumbar Vertebrae - physiopathology Lumbar Vertebrae - surgery Male Middle Aged Movement Prosthesis Design Prosthesis Implantation - methods Range of Motion, Articular Total disc replacement Weight-Bearing |
| title | Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns |
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