Multidirectional flexibility analysis of anterior and posterior lumbar artificial disc reconstruction: in vitro human cadaveric spine model.
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概要
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The in vitro multidirectional flexibility analysis was conducted to investigate the initial biomechanical effect of biomimetic artificial intervertebral disc replacement from either anterior or posterior approach in a cadaveric lumbosacral spine model. Two designs of anterior total and posterior subtotal artificial discs were developed using bioactive three-dimensional fabric and bioresorbable hydroxyapatite/poly-l-lactide material (3DF disc). Both models were designed to obtain the stable interface bonding to vertebral endplates with maximum surface area occupation. Using seven cadaveric lumbosacral spines, the following three anterior reconstruction methods were sequentially performed at L4–5 level: anterior 3DF disc replacement; anterior BAK cages (BAK); and posterior pedicle screw fixation and anterior BAK cages combined (BAK + PS). The L2–3 level received two methods of posterior reconstructions: subtotal 3DF disc replacement (two implants), and posterior interbody cages and pedicle screw fixation (PLIF). Six unconstrained pure moments were applied and three-dimensional segmental motions were measured with an optoelectronic motion measurement system. The center of rotation (COR) calculation was conducted radiographically using flexion-extension films. Both anterior and posterior 3DF replacements statistically demonstrated equivalent range of motions (ROMs) in all loading modes compared to intact segment. Anterior BAK, BAK + PS, and PLIF demonstrated significantly lower ROMs when compared to intact and 3DF groups (P<0.05). The 3DF reconstruction tended to realign the COR to the posterior third or surrounding position at the operative disc level. The stand-alone lumbar 3DF disc replacement demonstrated biomechanical characteristics nearly equivalent to the intact spinal segments even through anterior or posterior approach in vitro, suggesting an excellent clinical potential.
著者
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Minami A
Dep. Of Orthopaedic Surgery Graduate School Of Medicine Hokkaido Univ.
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Mcafee Paul
Spine And Scoliosis Center St. Joseph's Hospital
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Cunningham Bryan
Spine And Scoliosis Center St. Joseph's Hospital
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Minami Akio
北海道大学保健管理センター
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Cunningham Bryan
Orthopaedic Research Laboratory And Department Of Orthopaedic Surgery Union Memorial Hospital
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Cunningham Bryan
Orthopaedic Research Laboratory Union Memorial Hospital
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Minami Akio
Department Of Orthopaedic Surgery Hokkaido Graduate University School Of Medicine
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Ito Manabu
Orthopaedic Surgery Hokkaido Univ. Graduate School Of Medicine
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Abumi Kuniyoshi
Department Of Orthopaedic Surgery Hokkaido University Graduate School Of Medicine
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Hu Nianbin
Spine And Scoliosis Center St. Joseph's Hospital
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Arisue Makoto
Oral And Maxillofacial Surgery School Of Dentistry Health Sciences Univ. Of Hokkaido
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Shikinami Yasuo
Takiron Co. Ltd
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Arisue Makoto
Department Of Orthopaedic Surgery Hokkaido University Graduate School Of Medicine
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Arisue Makoto
Department Of Oral Maxillo-facial Surgery School Of Dentistry Health Sciences University Of Hokkaido
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Cunningham Bryan
Orthopaedic Biomechanics Laboratory
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Cunningham Bryan
St. Joseph's Hospital
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Cunningham Bryan
Orthopaedic Spinal Research Laboratory St Joseph Medical Center
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Hu Niabin
Orthopaedic Research Laboratory Union Memorial Hospital
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Mcafee Paul
Orthopaedic Spinal Research Laboratory St Joseph Medical Center
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Mcafee Paul
Department Of Orthopedic Surgery Rush University Medical Center
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Mcafee Paul
Scoliosis & Spine Center
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Kotani Yoshihisa
Dept. Of Orthop. Surg. Hokkaido University
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Arisue Makoto
Dep. Of Orthopaedic Surgery Graduate School Of Medicine Hokkaido Univ.
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Shono Yasuhiro
Department Of Orthopaedic Surgery Hokkaido University School Of Medicine
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Mcafee Paul
St. Joseph Hospital Scoliosis And Spine Center
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