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Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 1: misalignment of the vertebrae adjacent to a total disc replacement affects the facet joint and facet capsule forces in a probabilistic finite element analysis

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Abstract

Purpose

After total disc replacement with a ball-and-socket joint, reduced range of motion and progression of facet joint degeneration at the index level have been described. The aim of the study was to test the hypothesis that misalignment of the vertebrae adjacent to the implant reduces range of motion and increases facet joint or capsule tensile forces.

Methods

A probabilistic finite element analysis was performed using a lumbosacral spine model with an artificial disc at level L5/S1. Misalignment of the L5 vertebra, the gap size of the facet joints, the transection of the posterior longitudinal ligament, and the spinal shape were varied. The model was loaded with pure moments.

Results

Misalignment of the L5 vertebra reduced the range of motion up to 2°. A 2-mm displacement of the L5 vertebra in the anterior direction already led to facet joint forces of approximately 240 N. Extension, lateral bending, and axial rotation caused maximum facet joint forces between 280 and 380 N, while flexion caused maximum forces of approximately 200 N. A 2-mm displacement in the posterior direction led to capsule forces of approximately 80 N. Additional moments increased the maximum facet capsule forces to values between 120 and 230 N.

Conclusions

Misalignment of the vertebrae adjacent to an artificial disc strongly increases facet joint or capsule forces. It might, therefore, be an important reason for unsatisfactory clinical results. In an associated clinical study (Part 2), these findings are validated.

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Acknowledgments

Finite element analyses were performed at the Norddeutscher Verbund für Hoch- und Höchstleistungsrechnen (HLRN).

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    A. Rohlmann, S. Lauterborn, M. Dreischarf, H. Schmidt & T. Zander

  2. Center for Musculoskeletal Surgery, Clinic for Orthopaedics, Charité-University Medicine Berlin, Berlin, Germany

    M. Putzier & P. Strube

Authors
  1. A. Rohlmann
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  2. S. Lauterborn
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  3. M. Dreischarf
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  4. H. Schmidt
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  5. M. Putzier
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  6. P. Strube
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  7. T. Zander
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Correspondence to A. Rohlmann.

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Rohlmann, A., Lauterborn, S., Dreischarf, M. et al. Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 1: misalignment of the vertebrae adjacent to a total disc replacement affects the facet joint and facet capsule forces in a probabilistic finite element analysis. Eur Spine J 22, 2271–2278 (2013). https://doi.org/10.1007/s00586-013-2909-z

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  • DOI: https://doi.org/10.1007/s00586-013-2909-z

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