In vitro biomechanical study investigating L4–L5 kinematics and intradiscal pressure (IDP) with a facet replacement system.
To assess the influence of the Auxiliary Facet System (AFS).
Posterior dynamic systems are used in the treatment of low back pain to avoid adjacent segment degeneration. Facet replacement systems are supposed to stabilize a lumbar segment after facetectomy and neural decompression, and to provide an intersegmental range of motion (ROM).
The AFS is fixed by 4 pedicle screws, linked by 2 angulated rods, a polyaxial connector, and a crosslink. Flexibility tests were conducted on 6 human cadaver specimens (L3–S1) using a load testing device and the Polaris system. The specimens were loaded by steps of 1 Nm to 10 Nm in flexion/extension, lateral bending, and axial rotation. The following configurations were investigated: intact segment, instrumented, instrumented plus medial facetectomy, and facetectomy alone. The sagittal mean center of rotation (MCR) was calculated, and IDPs were measured in flexion/extension.
The ROM of the intact segment was 10.9° (9.4°–15.5°) in flexion/extension, 9.5° (6.8°–12.1°) in lateral bending, and 4.7° (3.4°–6.0°) degrees in axial rotation. Medial facetectomy and instrumentation led to −6% of ROM in flexion/extension and +1% lateral bending. Medial facetectomy without implant led to +106% of axial rotation (P = 0.028). The instrumentation reduced axial rotation to −38% (P = 0.028). This decrease was because of the presence of the cross-link. The MCR was located around the middle of the superior L5 endplate in intact and instrumented specimens. It moved cranial after facetectomy without instrumentation. The implant decreased the maximal IDP during flexion/extension to −17% (P = 0.028).
The AFS had a minor influence on flexion/extension and lateral bending, and the MCR kept physiologic. Bilateral facetectomy yielded an increase in axial rotation, which was stabilized by the implant. The AFS seemed to reduce IDPs.
The influence of a facet replacement system on L4–L5 segmental range of motion was tested. This implant had a minor influence on flexion/extension and lateral bending compared with the intact segment. Medial facetectomy alone increased axial rotation, which was decreased by the implant.
*Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris
†Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Strasbourg
‡Département de Chirurgie Orthopédique, Institut Mutualiste Montsouris, Paris, France.
Address correspondence and reprint requests to Yann Philippe Charles, MD, Laboratoire de Biomécanique, CNRS UMR 8005, Arts et Métiers ParisTech, 151, Boulevard de l'Hôpital, Paris 75013, France; E-mail: email@example.com
Acknowledgment date: October 7, 2009. First revision date: December 3, 2009. Second revision date: February 26, 2010; Acceptance date: March 1, 2010.
The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States.
Corporate/Industry funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., royalties, stocks, stock options, decision making position.
Supported by Clariance Spine.