Skip to main content
SpringerLink
Log in

Kinematic evaluation of one- and two-level Maverick lumbar total disc replacement caudal to a long thoracolumbar spinal fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Adjacent level degeneration that occurs above and/or below long fusion constructs is a documented clinical problem that is widely believed to be associated with the considerable change in stiffness caused by the fusion. Some researchers have suggested that early degeneration at spinal joints adjacent to a fusion could be treated by implanting total disc replacements at these levels. It is thought that further degeneration could be prevented through the disc replacement’s design aims to reproduce normal disc heights, kinematics and tissue loading. For this reason, there is a clinical need to evaluate if a total disc replacement can maintain both the quantity of motion (i.e. range) and the quality of motion (i.e. center of rotation and coupling) at segments adjacent to a long spinal fusion. The purpose of this study was to experimentally evaluate range of motion (ROM—the intervertebral motion measured) and helical axis of motion (HAM) changes due to one- and two-level Maverick total disc replacement (TDR) adjacent to a long spinal fusion.

Methods

Seven spine specimens (T8–S1) were used in this study (66 ± 19 years old, 3F/4 M). A continuous pure moment of ±5.0 Nm was applied to the specimen in flexion–extension (FE), lateral bending (LB) and axial rotation (AR), with a compressive follower preload of 400 N. The 5.0 Nm data were analyzed to evaluate the operated segment biomechanics at the level of the disc replacements. The data were also analyzed at lower moments using a modified version of Panjabi’s proposed “hybrid” method to evaluate adjacent segment kinematics (intervertebral motion at the segments adjacent to the fusion) under identical overall (T8–S1) specimen rotations. The motion of each vertebra was monitored with an optoelectronic camera system. The biomechanical test was completed for (1) the intact condition and repeated after each surgical technique was applied to the specimen, (2) capsulotomy at L4–L5 and L5–S1, (3) T8–L4 fusion and capsulotomy at L4–L5 and L5–S1, (4) Maverick at L4–L5, and (5) Maverick at L5–S1. The capsulotomy was performed to allow measurement of facet joint loads in a companion study. Paired t tests were used to determine if differences in the kinematic parameters measured were significant. Holm–Sidak corrections for multiple comparisons were applied where appropriate.

Results

Under the 5.0 Nm loads, L4–L5 ROMs tended to decrease in all directions following L4–L5 Maverick replacement (mean = 22 %, compared to the fused condition). Two-level Maverick implantation also tended to reduce L4–S1 ROM (mean 18, 7 and 31 % in FE, LB and AR, respectively, compared to the fused condition without TDR). Following TDR replacement, the HAM location tended to shift posteriorly in FE (at L5–S1), anteriorly in AR, and inferiorly in LB. However, although the above-mentioned trends were observed, neither one- nor two-level TDR replacement showed statistically significant ROM or HAM change in any of the three directions. At the identical T8–S1 posture identified by the modified hybrid analysis, the L4–L5 and L5–S1 levels underwent significant larger motions, relative to the overall specimen rotation, after fusion. In the hybrid analysis, there were no significant differences between the ROM after fusion with intact natural discs at L4–L5 and L5–S1 and the motions at those levels with one or two TDRs implanted.

Conclusions

The present results demonstrated that one or two Maverick discs implanted subjacent to a long thoracolumbar fusion preserved considerable and intact-like ranges of motion and maintained motion patterns similar to the intact specimen, in this ex vivo study with applied pure moments and compressive follower preload. The hybrid analysis demonstrated that, after fusion, the TDR-implanted levels are required to undergo large rotations, relative to those necessary before fusion, in order to achieve the same motion between T8 and S1. Additional clinical and biomechanical research is necessary to determine if such a kinematic demand would be made on these levels clinically and the biomechanical performance of these implants if it were.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Auerbach JD, Jones KJ, Milby AH, Anakwenze OA, Balderston RA (2009) Segmental contribution toward total lumbar range of motion in disc replacement and fusions: a comparison of operative and adjacent levels. Spine (Phila Pa 1976) 34:2510–2517. doi:10.1097/BRS.0b013e3181af2622

    Article  Google Scholar 

  2. Bertagnoli R, Yue JJ, Fenk-Mayer A, Eerulkar J, Emerson JW (2006) Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up. J Neurosurg Spine 4:91–97. doi:10.3171/spi.2006.4.2.91

    Article  PubMed  Google Scholar 

  3. Cho KJ, Suk SI, Park SR, Kim JH, Choi SW, Yoon YH, Won MH (2009) Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J 18:531–537. doi:10.1007/s00586-009-0883-2

    Article  PubMed  Google Scholar 

  4. Cripton PA, Bruehlmann SB, Orr TE, Oxland TR, Nolte LP (2000) In vitro axial preload application during spine flexibility testing: towards reduced apparatus-related artefacts. J Biomech 33:1559–1568

    Article  PubMed  CAS  Google Scholar 

  5. Dmitriev AE, Gill NW, Kuklo TR, Rosner MK (2008) Effect of multilevel lumbar disc arthroplasty on the operative- and adjacent-level kinematics and intradiscal pressures: an in vitro human cadaveric assessment. Spine J 8:918–925. doi:10.1016/j.spinee.2007.10.034

    Article  PubMed  Google Scholar 

  6. Eck KR, Bridwell KH, Ungacta FF, Riew KD, Lapp MA, Lenke LG, Baldus C, Blanke K (2001) Complications and results of long adult deformity fusions down to l4, l5, and the sacrum. Spine (Phila Pa 1976) 26:E182–192

    Google Scholar 

  7. Edwards CC II, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG (2004) Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine 29:1996–2005

    Article  PubMed  Google Scholar 

  8. Edwards CC 2nd, Bridwell KH, Patel A, Rinella AS, Jung Kim Y, Berra AB, Della Rocca GJ, Lenke LG (2003) Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5–S1 disc. Spine (Phila Pa 1976). doi:10.1097/01.BRS.0000084266.37210.85

    Google Scholar 

  9. Ekman P, Moller H, Shalabi A, Yu YX, Hedlund R (2009) A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J 18:1175–1186. doi:10.1007/s00586-009-0947-3

    Article  PubMed  Google Scholar 

  10. Erkan S, Rivera Y, Wu C, Mehbod AA, Transfeldt EE (2009) Biomechanical comparison of two-level Maverick disc replacement and a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion. Spine J. doi:10.1016/j.spinee.2009.04.014

    Google Scholar 

  11. Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16:338–345

    Article  PubMed  Google Scholar 

  12. Goel VK, Grauer JN, Patel T, Biyani A, Sairyo K, Vishnubhotla S, Matyas A, Cowgill I, Shaw M, Long R, Dick D, Panjabi MM, Serhan H (2005) Effects of charite artificial disc on the implanted and adjacent spinal segments mechanics using a hybrid testing protocol. Spine 30:2755–2764

    Article  PubMed  Google Scholar 

  13. Goertzen DJ, Lane C, Oxland TR (2004) Neutral zone and range of motion in the spine are greater with stepwise loading than with a continuous loading protocol. An in vitro porcine investigation. J Biomech 37:257–261

    Article  PubMed  Google Scholar 

  14. Grauer JN, Biyani A, Faizan A, Kiapour A, Sairyo K, Ivanov A, Ebraheim NA, Patel T, Goel VK (2006) Biomechanics of two-level Charite artificial disc placement in comparison to fusion plus single-level disc placement combination. Spine J 6:659–666. doi:10.1016/j.spinee.2006.03.011

    Article  PubMed  Google Scholar 

  15. Haberl H, Cripton PA, Orr TE, Beutler T, Frei H, Lanksch WR, Nolte LP (2004) Kinematic response of lumbar functional spinal units to axial torsion with and without superimposed compression and flexion/extension. Eur Spine J 13:560–566

    Article  PubMed  Google Scholar 

  16. Harding IJ, Charosky S, Vialle R, Chopin DH (2008) Lumbar disc degeneration below a long arthrodesis (performed for scoliosis in adults) to L4 or L5. Eur Spine J 17:250–254. doi:10.1007/s00586-007-0539-z

    Article  PubMed  Google Scholar 

  17. Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194S. doi:10.1016/j.spinee.2004.07.007

    Article  PubMed  Google Scholar 

  18. Huang RC, Wright TM, Panjabi MM, Lipman JD (2005) Biomechanics of nonfusion implants. Orthop Clin North Am 36:271–280

    Article  PubMed  Google Scholar 

  19. Kettler A, Marin F, Sattelmayer G, Mohr M, Mannel H, Durselen L, Claes L, Wilke HJ (2004) Finite helical axes of motion are a useful tool to describe the three-dimensional in vitro kinematics of the intact, injured and stabilised spine. Eur Spine J 13:553–559. doi:10.1007/s00586-004-0710-8

    Article  PubMed  CAS  Google Scholar 

  20. Kinzel GL, Hall AS, Hillberry BM (1972) Measurement of the total motion between two body segments-I. Analytical development. J Biomech 5:93–105

    Google Scholar 

  21. Kuhns CA, Bridwell KH, Lenke LG, Amor C, Lehman RA, Buchowski JM, Edwards C 2nd, Christine B (2007) Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5–S1 disc, minimum 5-year follow-up. Spine (Phila Pa 1976) 32:2771–2776. doi:10.1097/BRS.0b013e31815a7ece

    Article  Google Scholar 

  22. Kumar A, Beastall J, Hughes J, Karadimas EJ, Nicol M, Smith F, Wardlaw D (2008) Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976) 33:2909–2914. doi:10.1097/BRS.0b013e31818bdca7

    Article  Google Scholar 

  23. Lehman RA Jr, Lenke LG (2007) Long-segment fusion of the thoracolumbar spine in conjunction with a motion-preserving artificial disc replacement: case report and review of the literature. Spine (Phila Pa 1976) 32:E240–E245. doi:10.1097/01.brs.0000259211.22036.2a

    Article  Google Scholar 

  24. Niosi CA, Zhu QA, Wilson DC, Keynan O, Wilson DR, Oxland TR (2006) Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study. Eur Spine J 15:913–922. doi:10.1007/s00586-005-0948-9

    Article  PubMed  Google Scholar 

  25. Nunley PD, Jawahar A, Mukherjee DP, Ogden A, Khan Z, Kerr EJ III, Cavanaugh DA (2008) Comparison of pressure effects on adjacent disk levels after 2-level lumbar constructs: fusion, hybrid, and total disk replacement. Surg Neurol 70:247–251 (discussion 251). doi:10.1016/j.surneu.2008.04.011

    Google Scholar 

  26. Panjabi M, Henderson G, Abjornson C, Yue J (2007) Multidirectional testing of one- and two-level ProDisc-L versus simulated fusions. Spine (Phila Pa 1976) 32:1311–1319. doi:10.1097/BRS.0b013e318059af6f

    Article  Google Scholar 

  27. Panjabi M, Malcolmson G, Teng E, Tominaga Y, Henderson G, Serhan H (2007) Hybrid testing of lumbar CHARITE discs versus fusions. Spine (Phila Pa 1976) 32:959–966 (discussion 967). doi:10.1097/01.brs.0000260792.13893.88

    Google Scholar 

  28. Panjabi MM (2007) Hybrid multidirectional test method to evaluate spinal adjacent-level effects. Clin Biomech (Bristol, Avon) 22:257–265. doi:10.1016/j.clinbiomech.2006.08.006

  29. Panjabi MM, Henderson G, James Y, Timm JP (2007) Stabilimax (NZ) versus simulated fusion: evaluation of adjacent-level effects. Eur Spine J 16:2159–2165. doi:10.1007/s00586-007-0444-5

    Article  PubMed  Google Scholar 

  30. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29:1938–1944. pii:00007632-200409010-00019

    Google Scholar 

  31. Patwardhan AG, Havey RM, Carandang G, Simonds J, Voronov LI, Ghanayem AJ, Meade KP, Gavin TM, Paxinos O (2003) Effect of compressive follower preload on the flexion–extension response of the human lumbar spine. J Orthop Res 21:540–546

    Article  PubMed  Google Scholar 

  32. Patwardhan AG, Havey RM, Meade KP, Lee B, Dunlap B (1999) A follower load increases the load-carrying capacity of the lumbar spine in compression. Spine 24:1003–1009

    Article  PubMed  CAS  Google Scholar 

  33. Penta M, Sandhu A, Fraser RD (1995) Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 20:743–747

    Google Scholar 

  34. Quirno M, Kamerlink JR, Valdevit A, Kang M, Yaszay B, Duncan N, Boachie-Adjei O, Lonner BS, Errico TJ (2009) Biomechanical analysis of a disc prosthesis distal to a scoliosis model. Spine (Phila Pa 1976) 34:1470–1475. doi:10.1097/BRS.0b013e3181a8e418

    Article  Google Scholar 

  35. Rinella A, Bridwell K, Kim Y, Rudzki J, Edwards C, Roh M, Lenke L, Berra A (2004) Late complications of adult idiopathic scoliosis primary fusions to L4 and above: the effect of age and distal fusion level. Spine (Phila Pa 1976) 29:318–325. pii:00007632-200402010-00015

    Google Scholar 

  36. Rohlmann A, Burra NK, Zander T, Bergmann G (2007) Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine: a finite element analysis. Eur Spine J 16:1223–1231. doi:10.1007/s00586-006-0292-8

    Article  PubMed  Google Scholar 

  37. Schmidt H, Heuer F, Wilke HJ (2008) Interaction between finite helical axes and facet joint forces under combined loading. Spine (Phila Pa 1976) 33:2741–2748. doi:10.1097/BRS.0b013e31817c4319

    Article  Google Scholar 

  38. Seitsalo S, Schlenzka D, Poussa M, Osterman K (1997) Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J 6:393–397

    Article  PubMed  CAS  Google Scholar 

  39. Seo M, Choi D (2008) Adjacent segment disease after fusion for cervical spondylosis; myth or reality? Br J Neurosurg 22:195–199. doi:10.1080/02688690701790605

    Article  PubMed  Google Scholar 

  40. Tan JS, Singh S, Zhu QA, Dvorak MF, Fisher CG, Oxland TR (2008) The effect of cement augmentation and extension of posterior instrumentation on stabilization and adjacent level effects in the elderly spine. Spine (Phila Pa 1976) 33:2728–2740. doi:10.1097/BRS.0b013e318188b2e4

    Article  Google Scholar 

  41. Weinhoffer SL, Guyer RD, Herbert M, Griffith SL (1995) Intradiscal pressure measurements above an instrumented fusion. A cadaveric study. Spine (Phila Pa 1976) 20:526–531

    Google Scholar 

  42. Woltring HJ, Huiskes R, De Lange A, Veldpaus FE (1985) Finite centroid and helical axis estimation from noisy landmark measurements in the study of human joint kinematics. J Biomech 18:379–389

    Article  PubMed  CAS  Google Scholar 

  43. Zander T, Rohlmann A, Bergmann G (2009) Influence of different artificial disc kinematics on spine biomechanics. Clin Biomech (Bristol, Avon) 24:135–142. doi:10.1016/j.clinbiomech.2008.11.008

    Google Scholar 

  44. Zhu Q, Larson CR, Sjovold SG, Rosler DM, Keynan O, Wilson DR, Cripton PA, Oxland TR (2007) Biomechanical evaluation of the total facet arthroplasty system: 3-dimensional kinematics. Spine 32:55–62

    Article  PubMed  Google Scholar 

  45. Zhu QA, Park YB, Sjovold SG, Niosi CA, Wilson DC, Cripton PA, Oxland TR (2008) Can extra-articular strains be used to measure facet contact forces in the lumbar spine? An in vitro biomechanical study. Proc Inst Mech Eng H 222:171–184

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Medtronic Inc., Memphis, TN, USA for funding this study.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, Vancouver, Canada

    Qingan Zhu, Claire F. Jones, Timothy Schwab, Chadwick R. Larson & Peter A. Cripton

  2. Blusson Spinal Cord Centre, ICORD, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Qingan Zhu, Claire F. Jones, Timothy Schwab, Chadwick R. Larson & Peter A. Cripton

  3. Department of Orthopaedic and Spinal Surgery, Nanfang Hospital Southern Medical University, Guangzhou, Guangdong, China

    Qingan Zhu

  4. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Eyal Itshayek

  5. Department of Neurosurgery, Hadassah–Hebrew University Hospital, Jerusalem, Israel

    Eyal Itshayek

  6. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Lawrence G. Lenke

Authors
  1. Qingan Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eyal Itshayek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claire F. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy Schwab
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chadwick R. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter A. Cripton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter A. Cripton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhu, Q., Itshayek, E., Jones, C.F. et al. Kinematic evaluation of one- and two-level Maverick lumbar total disc replacement caudal to a long thoracolumbar spinal fusion. Eur Spine J 21 (Suppl 5), 599–611 (2012). https://doi.org/10.1007/s00586-012-2301-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2301-4

Keywords

Search

Navigation