Biomechanical effects of uncinate process excision in cervical disc arthroplasty |
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| Affiliation: | 1. Center for NeuroTrauma Research, Department of Neurosurgery, 8701 Watertown Plank Road, Medical College of Wisconsin, Zablocki Veterans Administration Medical Center, Milwaukee, WI 53226, USA;2. School of Mechanical Engineering, Kelambakkam Vandalur Road, Rajan Nagar, Vellore Institute of Technology, Chennai Campus, Chennai 600127, India;1. University of Colorado Anschutz Medical Campus, Department of Orthopedic Surgery, 13001 E. 17th Place, Aurora, CO 80045, USA;3. Colorado State University, Department of Mechanical Engineering and School of Biomedical Engineering, Fort Collins, CO 80523, USA;4. University of Colorado Anschutz Medical Campus, Department of Neurosurgery, 13001 E. 17th Place, Aurora, CO 80045, USA;1. Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY, USA;2. Department of Orthopedic Surgery, Rush University, Chicago, IL, USA;3. Department of Orthopedic Surgery, Ohio State University, Columbus, OH, USA;1. Department of Biomedical Engineering, University of Shanghai for Science and Technology, 516 JunGong Road, Shanghai, China;2. Department of Orthopedic Surgery, YanBian University Hospital, China;3. Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, 607 O-bang, Gyongnam, Republic of Korea;4. Department of Neurosurgery, College of medicine, The Catholic University of Korea, 222 Banpo-Daero, Seoul, Republic of Korea |
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| Abstract: | BackgroundStudies on the role of uncinate process have been limited to responses of the intact spine and patient's outcomes, and procedures to perform the excision. The aim of this study was to determine the role of uncinate process on the biomechanical response at the index and adjacent levels in three artificial discs used in cervical disc arthroplasty.MethodsA validated finite element model of cervical spine was used. Flexion, extension, and lateral moments and follower load were applied to Bryan, Mobi-C, and Prestige LP artificial discs at C5-C6 level with and without uncinate process. Ranges of motion at index level and adjacent caudal and cranial segments, intradiscal pressures at adjacent segments, and facet loads at index level and adjacent segments were obtained. Data were normalized with respect to the preservation of uncinate process.FindingsUncinate process removal increased motions up to 27% at index and decreased up to 10% at adjacent levels, decreased disc pressures up to 14% at adjacent segments, decreased facet loads at adjacent segments up to 14%, while at index level, change in loads depended on mode and arthroplasty, with Mobi-C responding with up to 51% increase and Bryan disc up to 11% decrease, while Prestige LP increased loads by 17% in extension and decreased by 9%% in lateral bending.InterpretationAs surgical selection is based on morphology and surgeon's experience, the present computational findings provide quantitative information for an optimal choice of the device and procedure, while further studies (in vitro/clinical) would be required. |
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