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An underlying assumption in this study was that uncovertebral joints would be preserved at the time of implantation to avoid the possibility of segmental instability after total disc replacement with bilateral uncovertebral joint resection. In addition, a spinal segment with an intact, healthy intervertebral disc was modeled and analyzed as a control reference. Using an in vivo image-based FE method, we computed von Mises stresses and the levels of strain energy density (SED). In this extended study, load sharing at the facet and uncovertebral joints was analyzed and compared among segments implanted with Bryan, Prestige LP, and Pro-Disc-C artificial discs. Given that proper placement of implants in arthroplasty provides better restoration of the natural kinematics of the joint, 1 investigating how the underlying articular mechanism of an artificial disc impacts the biomechanical environment of the spinal segment should help achieve better performance of the prosthesis.
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However, this raised additional concerns regarding load sharing by facet and uncovertebral joints at the treated level, due to reduced loads transferred to the device's core causing greater shared load burdens for the facet and uncovertebral joints. 13 Based on the hypothesis that subsidence is related to high implant-interface stress, prostheses with a flexible core (nucleus) were shown to have less likelihood of subsidence, by absorbing high strain energy.
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1 In our previous work, we analyzed 3 different disc prostheses-Bryan (Medtronic, Inc.), Prestige LP (Medtronic, Inc.), and ProDisc-C (Synthes, Inc.)-using an image-based FE method to investigate the propensity of subsidence caused by device design. 2ĭespite its encouraging short-term outcomes with artificial cervical disc arthroplasty, however, there are concerns regarding complications related to device design as well as subsidence, dislocation, and instability due to misalignment. The concept has been supported by early clinical outcomes showing that artificial cervical discs were capable of preserving segmental motion 8, 19 with improved pain and function scores. 8 Therefore, artificial disc arthroplasty, by preserving segmental motion and alleviating the stress burden at adjacent levels, is believed to decrease the propensity for ASD. 1, 9, 12, 18, 23 Evidence of ASD has been shown in many biomechanical studies in which removal of segmental motion increases stiffness at the fused segment, resulting in elevated stress at adjacent levels, where degeneration is potentially accelerated. 3 However, immobility of the fused level has been associated with accelerated degeneration at levels adjacent to the fused site, which is a major long-term concern with ACDF surgery. By direct decompression along with disc height and neuroforaminal restoration, ACDF has achieved a success rate of over 90%, with resolution of symptoms and return to normal daily activities after surgery. A rtificial cervical disc arthroplasty has been introduced to limit the development of ASD that can occur with ACDF.