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European Spine Journal

, Volume 16, Issue 3, pp 411–421 | Cite as

Total disc arthroplasty: consequences for sagittal balance and lumbar spine movement

  • C. Tournier
  • S. Aunoble
  • J. C. Le Huec
  • J. P. Lemaire
  • P. Tropiano
  • V. Lafage
  • W. Skalli
Original Article

Abstract

This in vivo biomechanical study was undertaken to analyze the consequences for sagittal balance and lumbar spine movement in three different lumbar disc prostheses. A total of 105 patients underwent total disc replacement in three different centers. The Maverick® prosthesis was used in 46 patients, the SB Charité® device was used in 49 patients and the Prodisc® device was utilized in 10 patients. The analysis was computer assisted, using Spineview® and Matlab® softwares. The intra and inter-observer reliability and measurement uncertainty was performed. The analysis of lateral X-ray films in flexion–extension allowed to measure the prosthesis positioning, the range of motion (ROM), the localization of the mean center of rotation (MCR), the vertebral translation and the disc height, for each prosthesis device. The sagittal balance was analyzed on a full spine film. The parameters studied were described by Duval-Beaupère. The results were compared to the data found in literature, and compared to 18 asymptomatic volunteers, and 61 asymptomatic subjects, concerning the sagittal balance. The prostheses allowed an improvement of the ROM of less than 2°. The ROM of L5–S1 prostheses ranged from 11.6 to 15.6% of the total lumbar motion during flexion–extension. At L4–L5 level, the ROM decreased when there was an arthrodesis associated at the L5–S1 level. There was no difference of ROM between the three prostheses devices. The MCR was linked to the ROM, but did not depend on the prosthesis offcentering. The disc height improved for any prosthesis, and decreased in flexion or in extension, when the prosthesis was offcentered. An increase of translation indicated a minor increase of the ROM at L4–L5 level after Maverick® or SB Charité® implantation. The L5–S1 arthrodesis was linked with an increase of the pelvic tilt. The lumbar lordosis curvature increased between L4 and S1, even more when a prosthesis was placed at the L3–L4 level. Total disc arthroplasty is useful in the surgical management of discogenic spinal pathology. The three prostheses studied allowed to retorate the disc height, the ROM, without disrupting the sagittal balance, but induced modification of the lumbar curvature.

Keywords

Prostheses and implants Total disc replacement Spine kinematics Spine balance Mean center of rotation 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • C. Tournier
    • 1
  • S. Aunoble
    • 2
  • J. C. Le Huec
    • 2
  • J. P. Lemaire
    • 3
  • P. Tropiano
    • 4
  • V. Lafage
    • 1
  • W. Skalli
    • 1
  1. 1.Ecole Nationale Supérieure des Arts et MétiersParisFrance
  2. 2.Université Victor Segalen, Bordeaux2Bordeaux cedexFrance
  3. 3.Clinique du Point MédicalDijonFrance
  4. 4.Centre Hospitalier Universitaire Marseille NordMarseille cedex 20France

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