Leonard I. Voronov MD, PhD , Robert M. Havey BS , Simon G. Sjovold MASc , Michael Funk MS , Gerard Carandang BS , Daniel Zindrick BS , David M. Rosler MS , Avinash G. Patwardhan PhD
{"title":"全关节突置换术与全椎间盘置换术的运动学分析","authors":"Leonard I. Voronov MD, PhD , Robert M. Havey BS , Simon G. Sjovold MASc , Michael Funk MS , Gerard Carandang BS , Daniel Zindrick BS , David M. Rosler MS , Avinash G. Patwardhan PhD","doi":"10.1016/j.esas.2009.09.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Total disc replacement (TDR) and total facet replacement (TFR) have been the focus of recent kinematics evaluations. Yet their concurrent function as a total joint replacement of the lumbar spine's 3-joint complex has not been comprehensively reported. This study evaluated the effect of a TFR specifically designed to replace the natural facets and supplement the function with the natural disc and with TDR. The ability to replace degenerated facets to complement a pre-existing or simultaneously implanted TDR may allow surgeons to completely address degenerative pathologies of the 3-joint complex of the lumbar spine. We hypothesized that TFR would reproduce the biomechanical function of the natural facets when implanted in conjunction with TDR.</p></div><div><h3>Methods</h3><p>Lumbar spines (L1-5, 51.3 ± 14.2 years, N = 6) were tested sequentially as follows: (1) intact, (2) after TDR implantation, and (3) after TFR implantation in conjunction with TDR, all at L3-4. Specimens were tested in flexion-extension (+ 8 Nm to − 6 Nm), lateral bending (± 6 Nm), and axial rotation (± 5 Nm). A 400 N compressive follower preload was applied during flexion-extension tests. Three-dimensional segmental motion was recorded and analyzed using analysis of variance in Systat (Systat Software Inc., Chicago, Illinois) and multiple comparisons with Bonferroni correction.</p></div><div><h3>Results</h3><p>The TDR implantation (TDR + natural facets) allowed similar lateral bending (<em>P</em> = .66), but it generally increased flexion-extension (<em>P</em> = .06) and axial rotation (<em>P</em> < .05) range of motion (ROM) at the implanted level compared to intact. The TFR + TDR (following replacement of the natural facets with TFR) decreased ROM to levels similar to intact in lateral bending (<em>P</em> = .70) and axial rotation (<em>P</em> = .23). The TFR + TDR flexion-extension ROM was reduced in comparison to intact and TDR + natural facets (<em>P</em> < .05).</p></div><div><h3>Conclusions</h3><p>The TFR with TDR was able to restore stability to the lumbar segment after bilateral facetectomy, while allowing near-normal motions in all planes.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"3 3","pages":"Pages 85-90"},"PeriodicalIF":0.0000,"publicationDate":"2009-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2009.09.002","citationCount":"4","resultStr":"{\"title\":\"Kinematics of total facet replacement (TFAS-TL) with total disc replacement\",\"authors\":\"Leonard I. Voronov MD, PhD , Robert M. Havey BS , Simon G. Sjovold MASc , Michael Funk MS , Gerard Carandang BS , Daniel Zindrick BS , David M. Rosler MS , Avinash G. Patwardhan PhD\",\"doi\":\"10.1016/j.esas.2009.09.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Total disc replacement (TDR) and total facet replacement (TFR) have been the focus of recent kinematics evaluations. Yet their concurrent function as a total joint replacement of the lumbar spine's 3-joint complex has not been comprehensively reported. This study evaluated the effect of a TFR specifically designed to replace the natural facets and supplement the function with the natural disc and with TDR. The ability to replace degenerated facets to complement a pre-existing or simultaneously implanted TDR may allow surgeons to completely address degenerative pathologies of the 3-joint complex of the lumbar spine. We hypothesized that TFR would reproduce the biomechanical function of the natural facets when implanted in conjunction with TDR.</p></div><div><h3>Methods</h3><p>Lumbar spines (L1-5, 51.3 ± 14.2 years, N = 6) were tested sequentially as follows: (1) intact, (2) after TDR implantation, and (3) after TFR implantation in conjunction with TDR, all at L3-4. Specimens were tested in flexion-extension (+ 8 Nm to − 6 Nm), lateral bending (± 6 Nm), and axial rotation (± 5 Nm). A 400 N compressive follower preload was applied during flexion-extension tests. Three-dimensional segmental motion was recorded and analyzed using analysis of variance in Systat (Systat Software Inc., Chicago, Illinois) and multiple comparisons with Bonferroni correction.</p></div><div><h3>Results</h3><p>The TDR implantation (TDR + natural facets) allowed similar lateral bending (<em>P</em> = .66), but it generally increased flexion-extension (<em>P</em> = .06) and axial rotation (<em>P</em> < .05) range of motion (ROM) at the implanted level compared to intact. The TFR + TDR (following replacement of the natural facets with TFR) decreased ROM to levels similar to intact in lateral bending (<em>P</em> = .70) and axial rotation (<em>P</em> = .23). The TFR + TDR flexion-extension ROM was reduced in comparison to intact and TDR + natural facets (<em>P</em> < .05).</p></div><div><h3>Conclusions</h3><p>The TFR with TDR was able to restore stability to the lumbar segment after bilateral facetectomy, while allowing near-normal motions in all planes.</p></div>\",\"PeriodicalId\":88695,\"journal\":{\"name\":\"SAS journal\",\"volume\":\"3 3\",\"pages\":\"Pages 85-90\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2009-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.esas.2009.09.002\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SAS journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1935981009000036\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SAS journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1935981009000036","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Kinematics of total facet replacement (TFAS-TL) with total disc replacement
Background
Total disc replacement (TDR) and total facet replacement (TFR) have been the focus of recent kinematics evaluations. Yet their concurrent function as a total joint replacement of the lumbar spine's 3-joint complex has not been comprehensively reported. This study evaluated the effect of a TFR specifically designed to replace the natural facets and supplement the function with the natural disc and with TDR. The ability to replace degenerated facets to complement a pre-existing or simultaneously implanted TDR may allow surgeons to completely address degenerative pathologies of the 3-joint complex of the lumbar spine. We hypothesized that TFR would reproduce the biomechanical function of the natural facets when implanted in conjunction with TDR.
Methods
Lumbar spines (L1-5, 51.3 ± 14.2 years, N = 6) were tested sequentially as follows: (1) intact, (2) after TDR implantation, and (3) after TFR implantation in conjunction with TDR, all at L3-4. Specimens were tested in flexion-extension (+ 8 Nm to − 6 Nm), lateral bending (± 6 Nm), and axial rotation (± 5 Nm). A 400 N compressive follower preload was applied during flexion-extension tests. Three-dimensional segmental motion was recorded and analyzed using analysis of variance in Systat (Systat Software Inc., Chicago, Illinois) and multiple comparisons with Bonferroni correction.
Results
The TDR implantation (TDR + natural facets) allowed similar lateral bending (P = .66), but it generally increased flexion-extension (P = .06) and axial rotation (P < .05) range of motion (ROM) at the implanted level compared to intact. The TFR + TDR (following replacement of the natural facets with TFR) decreased ROM to levels similar to intact in lateral bending (P = .70) and axial rotation (P = .23). The TFR + TDR flexion-extension ROM was reduced in comparison to intact and TDR + natural facets (P < .05).
Conclusions
The TFR with TDR was able to restore stability to the lumbar segment after bilateral facetectomy, while allowing near-normal motions in all planes.
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