Parameters that effect spine biomechanics following cervical disc replacement

Area of Science:

• Biomechanical Engineering
• Spine Surgery
• Medical Device Analysis

Background:

• Total disc replacement (TDR) is proposed as a more physiologic alternative to spinal fusion.
• Long-term clinical data on TDR implant efficacy remains limited.
• Discrepancies exist between in vitro biomechanical studies and in vivo clinical assessments of TDR.

Purpose of the Study:

• To identify and discuss potential biomechanical challenges impacting TDR.
• To enhance understanding of TDR devices and improve clinical outcomes.
• To highlight areas for future research in TDR biomechanics and clinical application.

Main Methods:

• Literature review of existing TDR biomechanical studies and clinical data.
• Analysis of biomechanical effects related to surgical techniques (e.g., preserving uncinate processes, implant placement).
• Exploration of advanced modeling techniques, including patient-specific finite element analysis with muscle force consideration.

Main Results:

• Various factors, including surgical parameters and implant design, significantly influence TDR biomechanics.
• Long-term performance issues like bone remodeling, subsidence, and wear require further investigation.
• In vivo assessment of spinal kinematics following TDR presents ongoing challenges.

Conclusions:

• Addressing identified biomechanical challenges is crucial for optimizing TDR clinical outcomes.
• Further research, including probabilistic studies and advanced kinematic analysis, is needed to reconcile biomechanical findings with clinical results.
• Patient-specific modeling and comprehensive in vivo kinematic evaluation are essential for advancing TDR technology.