Unique biomechanical signatures of Bryan, Prodisc C, and Prestige LP cervical disc replacements: a finite element modelling study
The purpose of the study is to examine the biomechanical alterations in the index and adjacent levels of the human cervical spine after cervical arthroplasty with Bryan, Prodisc C, or Prestige LP.
A previously validated C2–T1 osteoligamentous finite element model was used to perform virtual C5–6 arthroplasty using three different FDA-approved artificial cervical discs. Motion-controlled moment loading protocol was used. Moment was varied until Bryan, Prodisc C, and Prestige LP models displayed the same total range of motion across C3–C7 as the intact spine model at 2 Nm of pure moment loading. Range of motion (ROM) and facet force (FF) were recorded at the index level. ROM, FF, and intradiscal pressure (IDP) were recorded at the adjacent levels.
Prodisc C and Prestige LP led to supraphysiologic ROM and FF at the index level while decreasing ROM and FF at the adjacent levels. In contrast, Bryan reduced ROM and FF at the index level. Bryan increased ROM and FF at the adjacent levels in flexion, but decreased ROM and FF in the adjacent levels in extension. Prodisc C decreased IDP at the adjacent levels. Bryan reduced IDP in extension only. Prestige LP increased adjacent-level IDP.
The distinct designs and material compositions of the three artificial discs result in varying biomechanical alterations at the index and adjacent levels in the cervical spine after implantation. The findings confirm the design and material influence on the spine biomechanics, as well as the advantages and contraindications of cervical arthroplasty in general.
These slides can be retrieved under Electronic Supplementary Material.
KeywordsCervical artificial disc Cervical arthroplasty Cervical total disc replacement Finite element modelling Biomedical engineering
Anterior cervical discectomy and fusion
Range of motion
Finite element modeling
This material is the result of work supported by the U.S. Department of Defense, Medical Research and Materiel Command, Grant W81XWH-16-1-0010, with the resources and use of facilities at the Zablocki VA Medical Center, Milwaukee, Wisconsin, and the Center for NeuroTrauma Research (CNTR) from the Department of Neurosurgery. The last author is a part-time employee of the VA Medical Center, Milwaukee, Wisconsin. Any views expressed in this article are those of the authors and not necessarily representative of the funding organizations.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Chang UK, Kim DH, Lee MC, Willenberg R, Kim SH, Lim J (2007) Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine 7(1):40–46. https://doi.org/10.3171/SPI-07/07/040 CrossRefPubMedGoogle Scholar
- 3.Chen WM, Jin J, Park T, Ryu KS, Lee SJ (2018) Strain behavior of malaligned cervical spine implanted with metal-on-polyethylene, metal-on-metal, and elastomeric artificial disc prostheses—a finite element analysis. Clin Biomech (Bristol, Avon) 59:19–26. https://doi.org/10.1016/j.clinbiomech.2018.08.005 CrossRefGoogle Scholar
- 4.Galbusera F, Anasetti F, Bellini CM, Costa F, Fornari M (2010) The influence of the axial, antero-posterior and lateral positions of the center of rotation of a ball-and-socket disc prosthesis on the cervical spine biomechanics. Clin Biomech (Bristol, Avon) 25(5):397–401. https://doi.org/10.1016/j.clinbiomech.2010.01.010 CrossRefGoogle Scholar
- 7.Gandhi AA, Kode S, DeVries NA, Grosland NM, Smucker JD, Fredericks DC (2015) Biomechanical analysis of cervical disc replacement and fusion using single level, two level, and hybrid constructs. Spine (Phila Pa 1976) 40(20):1578–1585. https://doi.org/10.1097/BRS.0000000000001044 CrossRefGoogle Scholar
- 8.Hu N, Cunningham BW, McAfee PC, Kim SW, Sefter JC, Cappuccino A, Pimenta L (2006) Porous coated motion cervical disc replacement: a biomechanical, histomorphometric, and biologic wear analysis in a caprine model. Spine (Phila Pa 1976) 31(15):1666–1673. https://doi.org/10.1097/01.brs.0000224537.79234.21 CrossRefGoogle Scholar
- 10.Kang H, Park P, La Marca F, Hollister SJ, Lin CY (2010) Analysis of load sharing on uncovertebral and facet joints at the C5–6 level with implantation of the Bryan, Prestige LP, or ProDisc-C cervical disc prosthesis: an in vivo image-based finite element study. Neurosurg Focus 28(6):E9. https://doi.org/10.3171/2010.3.FOCUS1046 CrossRefPubMedGoogle Scholar
- 11.Li Y, Zhang Z, Liao Z, Mo Z, Liu W (2017) Finite element analysis of influence of axial position of center of rotation of a cervical total disc replacement on biomechanical parameters: simulated 2-level replacement based on a validated model. World Neurosurg 106:932–938. https://doi.org/10.1016/j.wneu.2017.07.079 CrossRefPubMedGoogle Scholar
- 12.Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL (2009) Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976) 34(15):1554–1560. https://doi.org/10.1097/BRS.0b013e3181aa643b CrossRefGoogle Scholar
- 13.Tan QC, Feng YF, Zhang Y, Wu ZX, Ma ZS, Sang HX, Yan YB, Lei W, Zhao X (2015) A novel total cervical prosthesis for single-level cervical subtotal corpectomy: radiologic and histomorphometric analysis in a caprine model. J Spinal Disord Tech 28(3):E166–172. https://doi.org/10.1097/BSD.0000000000000202 CrossRefPubMedGoogle Scholar
- 16.Ren C, Song Y, Xue Y, Yang X (2014) Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J 23(5):1115–1123. https://doi.org/10.1007/s00586-014-3220-3 CrossRefPubMedGoogle Scholar
- 17.ASTM (2006) Standard guide for functional, kinematic, and wear assessment of total disc prostheses. ASTMF2423–05Google Scholar
- 19.ISO (2005) Implants for surgery—wear of total intervertebral spinal disc prostheses—part 1: loading and displacement parameters for wear testing and corresponding environmental conditions for tests. ISO/DIS 18192–1Google Scholar
- 28.Wang Z, Zhao H, Liu JM, Tan LW, Liu P, Zhao JH (2016) Resection or degeneration of uncovertebral joints altered the segmental kinematics and load-sharing pattern of subaxial cervical spine: A biomechanical investigation using a C2–T1 finite element model. J Biomech 49(13):2854–2862. https://doi.org/10.1016/j.jbiomech.2016.06.027 CrossRefPubMedGoogle Scholar