Motion response of a polycrystalline diamond adaptive axis of rotation cervical total disc arthroplasty

Abstract

BackgroundCervical fusion is associated with adjacent segment degeneration. Cervical disc arthroplasty is considered an alternative to reduce risk of adjacent segment disease. Kinematics after arthroplasty should closely replicate healthy in vivo kinematics to reduce adjacent segment stresses. The purpose of this study was to assess the kinematics of a polycrystalline diamond cervical disc prosthesis. MethodsNine cadaveric C3–T1 spines were tested intact and after one (C5–C6) and two level (C5–C7) arthroplasty (Triadyme-C, Dymicron Inc., Orem, UT, USA). Kinematics were evaluated in flexion-extension, lateral bending, and axial rotation. FindingsProsthesis placement at C5–C6 and C6–C7 was 0.5 mm anterior and 0.6 mm posterior to midline respectively. C5–C6 flexion-extension motion was 12.8° intact and 10.5° after arthroplasty. C6–C7 flexion-extension motion was 10.0 and 11.4° after arthroplasty.C5–C6 lateral bending reduced from 8.5 to 3.7° after arthroplasty and at C6–C7 from 7.5 to 5.1°. C5–C6 axial rotation decreased from 10.4 to 6.2° after arthroplasty and at C6–C7 from 7.8 to 5.3°.Segmental lordosis increased by 4.2°, and middle disc height by 1.4 mm after arthroplasty. Change in center of rotation from intact to arthroplasty averaged 0.9 mm posteriorly and 0.1 mm caudally at C5–C6, and 1.4 mm posteriorly and 0.3 mm cranially at C6–C7. InterpretationThe cervical disc arthroplasty evaluated restored flexion-extension motion to intact levels and moderately increased segmental stiffness. Disc height increased by up to 1.5 mm and segmental lordosis by 4.2°. The unique prosthesis design allowed the axis of rotation after arthroplasty to closely mimic the native location.