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The Effect of Posterior Decompressive Procedures on Segmental Range of Motion After Cervical Total Disc Arthroplasty

Brody, Michael J. MD*,†; Patel, Alpesh A. MD, FACS; Ghanayem, Alexander J. MD*,†; Wojewnik, Bartosz MD*,†; Carandang, Gerard MS; Havey, Robert M. BS; Voronov, Leonard I. MD, PhD*,†; Vastardis, Georgios MD*,†; Potluri, Tejaswy MS; Patwardhan, Avinash G. PhD*,†

doi: 10.1097/BRS.0000000000000481
Cervical Spine

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 total disc replacement (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 after implantation of a cervical 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, after C5–C6 TDR, C5–C6 unilateral foraminotomy, C5–C6 bilateral foraminotomies, and after C5 laminectomy in combination with the bilateral foraminotomies. Moment versus angular motion curves were obtained for each testing step, and the load-displacement data were 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. Although bilateral foraminotomies did increase flexion-extension ROM, motion remained within a physiological 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 think 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 physiological 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, whereas complete laminectomy combined with bilateral foraminotomies should be avoided after TDR given the significant changes in kinematics. In addition, future disc replacement designs may need to account for changes after posterior decompression for same-segment disease.

Level of Evidence: N/A

We investigated the effect of posterior decompressive procedures on segmental kinematics after total disc arthroplasty in the cervical spine. Although limited posterior decompression preserved physiological motion, same-level laminectomy in the presence of bilateral foraminotomies resulted in increased segmental range of motion and distorted load-displacement curves.

*Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL

Department of Veterans Affairs, Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL; and

Department of Orthopaedic Surgery, Northwestern University School of Medicine, Chicago, IL.

Address correspondence and reprint requests to Avinash G. Patwardhan, PhD, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South 1st Ave, Ste 1700, Maywood, IL 60153; E-mail: apatwar@lumc.edu

Acknowledgment date: October 18, 2013. Revision date: April 18, 2014. Acceptance date: April 29, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Department of Orthopaedic Surgery, Loyola University Chicago (Institutional Support); US Department of Veterans Affairs (Institutional Support); and DePuy/Synthes Spine (Educational Grant) funds were received to support this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants/grants pending, royalties, and stock/stock options.

© 2014 by Lippincott Williams & Wilkins