Total disc arthroplasties change the kinematics of functional spinal units during lateral bending

Abstract

Background: Information about kinematics in different functional spinal units before and after total disc arthroplasties is necessary to improve prostheses and determine indications. There is little information about the nonstationary instantaneous helical axis of rotation under lateral bending in the cervical spine before and after total disc arthroplasty.

Methods: Kinematic analyses were performed with an established measuring apparatus on 8 human functional spinal units (C3/C4, C5/C6) under intact conditions and after total disc arthroplasty with two different types of prostheses: Bryan and Prestige. The instantaneous helical axis, migration, and stiffness of the segments were calculated.

Findings: The instantaneous helical axis direction was always inclined ventrally. Ventral inclination was significantly higher in segment C3/C4 than in segment C5/C6 under all conditions (p < 0.001). Both types of arthroplasties significantly increased ventral inclination compared to intact conditions. In both segments, the path length of the instantaneous helical axis' migration was significantly longer after total disc arthroplasty with Bryan (p = 0.001) and shorter after Prestige (p < 0.001) prostheses than under intact conditions. After both types of arthroplasties, the migration path length was significantly longer and the stiffness was significantly lower in segment C3/C4 than in segment C5/C6.

Interpretation: Both types of arthroplasties changed the kinematics of both segments during lateral bending. Altered instantaneous helical axis migration, greater ventral inclination and less stiffness after both arthroplasties indicate unphysiological motion. Both arthroplasties had greater impact on segment C3/C4 than on segment C5/C6 in terms of hypermobility. Increased translational motion after total disc arthroplasty with a Bryan prosthesis might be caused by the prosthetic design.

Keywords: Biomechanics; Cervical spine; Instantaneous helical axis; Kinematics; Lateral bending; Total disc arthroplasty.