Cargando…
In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern
BACKGROUND: In cervical arthroplasty, qualitative motion analysis generally investigates the position of the center of rotation (COR) before and after surgery. But is the pre-op COR suitable as reference? We believe that only a comparison against healthy individuals can answer whether a physiologica...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488089/ https://www.ncbi.nlm.nih.gov/pubmed/32907606 http://dx.doi.org/10.1186/s13018-020-01908-y |
_version_ | 1783581623684431872 |
---|---|
author | Muhlbauer, Manfred Thomasch, Ernst Sinz, Wolfgang Trattnig, Siegfried Steffan, Hermann |
author_facet | Muhlbauer, Manfred Thomasch, Ernst Sinz, Wolfgang Trattnig, Siegfried Steffan, Hermann |
author_sort | Muhlbauer, Manfred |
collection | PubMed |
description | BACKGROUND: In cervical arthroplasty, qualitative motion analysis generally investigates the position of the center of rotation (COR) before and after surgery. But is the pre-op COR suitable as reference? We believe that only a comparison against healthy individuals can answer whether a physiological motion pattern has been achieved. The aim of our study was to examine how the COR for flexion/extension after insertion of 3 biomechanically completely different types of disc prostheses compares to healthy volunteers, and whether and how prosthesis design contributes to a more natural or maybe even worse motion pattern. METHODS: In 15 healthy volunteers, MRI in flexion and in extension was taken, and the coordinates for the CORs (COR-HV) from C3 to C7 were determined. Then pre- and post-op flexion/extension x-rays from 30 patients with a one-level disc prosthesis underwent analysis for determination of COR from C3 to C7; 10 patients who received a Bryan, a Prestige STLP, or a Discover prosthesis were chosen, respectively. Change of post-op COR position was investigated in relation to the COR-HV. RESULTS: The pre-operative COR is not congruent with the COR found in healthy subjects and therefore cannot be used as reference for investigation whether a disc prosthesis resembles natural motion. However, the comparison with healthy individuals shows that prosthesis insertion can change the coordinates of the COR to any direction in all levels from C3/4 to C6/7 regardless of the operated segment. Prostheses with flexible biomechanical properties can contribute to shift the COR toward normal, but devices with unphysiological biomechanical design, like fixed ball socket designs, for instance, can make the motion pattern even worse. CONCLUSIONS: Even if the small cohorts in our study do not allow strong conclusions, it seems that in cervical arthroplasty, the biomechanical concept of the prosthesis has a significant impact whether a near-physiological motion pattern can be achieved or not. As it is a rumor but not scientifically proven that prosthesis design has no influence on clinical outcome, surgeons should only choose devices with flexible biomechanical properties for disc replacement. |
format | Online Article Text |
id | pubmed-7488089 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74880892020-09-16 In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern Muhlbauer, Manfred Thomasch, Ernst Sinz, Wolfgang Trattnig, Siegfried Steffan, Hermann J Orthop Surg Res Research Article BACKGROUND: In cervical arthroplasty, qualitative motion analysis generally investigates the position of the center of rotation (COR) before and after surgery. But is the pre-op COR suitable as reference? We believe that only a comparison against healthy individuals can answer whether a physiological motion pattern has been achieved. The aim of our study was to examine how the COR for flexion/extension after insertion of 3 biomechanically completely different types of disc prostheses compares to healthy volunteers, and whether and how prosthesis design contributes to a more natural or maybe even worse motion pattern. METHODS: In 15 healthy volunteers, MRI in flexion and in extension was taken, and the coordinates for the CORs (COR-HV) from C3 to C7 were determined. Then pre- and post-op flexion/extension x-rays from 30 patients with a one-level disc prosthesis underwent analysis for determination of COR from C3 to C7; 10 patients who received a Bryan, a Prestige STLP, or a Discover prosthesis were chosen, respectively. Change of post-op COR position was investigated in relation to the COR-HV. RESULTS: The pre-operative COR is not congruent with the COR found in healthy subjects and therefore cannot be used as reference for investigation whether a disc prosthesis resembles natural motion. However, the comparison with healthy individuals shows that prosthesis insertion can change the coordinates of the COR to any direction in all levels from C3/4 to C6/7 regardless of the operated segment. Prostheses with flexible biomechanical properties can contribute to shift the COR toward normal, but devices with unphysiological biomechanical design, like fixed ball socket designs, for instance, can make the motion pattern even worse. CONCLUSIONS: Even if the small cohorts in our study do not allow strong conclusions, it seems that in cervical arthroplasty, the biomechanical concept of the prosthesis has a significant impact whether a near-physiological motion pattern can be achieved or not. As it is a rumor but not scientifically proven that prosthesis design has no influence on clinical outcome, surgeons should only choose devices with flexible biomechanical properties for disc replacement. BioMed Central 2020-09-09 /pmc/articles/PMC7488089/ /pubmed/32907606 http://dx.doi.org/10.1186/s13018-020-01908-y Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Muhlbauer, Manfred Thomasch, Ernst Sinz, Wolfgang Trattnig, Siegfried Steffan, Hermann In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title | In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title_full | In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title_fullStr | In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title_full_unstemmed | In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title_short | In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
title_sort | in cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488089/ https://www.ncbi.nlm.nih.gov/pubmed/32907606 http://dx.doi.org/10.1186/s13018-020-01908-y |
work_keys_str_mv | AT muhlbauermanfred incervicalarthroplastyonlyprosthesiswithflexiblebiomechanicalpropertiesshouldbeusedforachievinganearphysiologicalmotionpattern AT thomaschernst incervicalarthroplastyonlyprosthesiswithflexiblebiomechanicalpropertiesshouldbeusedforachievinganearphysiologicalmotionpattern AT sinzwolfgang incervicalarthroplastyonlyprosthesiswithflexiblebiomechanicalpropertiesshouldbeusedforachievinganearphysiologicalmotionpattern AT trattnigsiegfried incervicalarthroplastyonlyprosthesiswithflexiblebiomechanicalpropertiesshouldbeusedforachievinganearphysiologicalmotionpattern AT steffanhermann incervicalarthroplastyonlyprosthesiswithflexiblebiomechanicalpropertiesshouldbeusedforachievinganearphysiologicalmotionpattern |