Models that incorporate spinal structures predict better wear performance of cervical artificial discs

Abstract

Background context: Wear simulators and their corresponding wear predictive models provide limited information on wear characteristics of artificial discs. Analyses in previous studies that controlled loading profiles according to International Standards Organization (ISO)/American Society for Testing and Materials standards did not account for factors such as the influence of anatomic structures. Retrieval analyses reveal failure modes that are not observed in benchtop simulations and thus indicate deficiencies associated with existing approaches.

Purpose: To understand the impact of the adjoining spinal structures of a ligamentous segment on the wear of an artificial cervical disc.

Study design: Prediction of wear in artificial disc implants (total disc replacement [TDR]) in situ using finite element modeling.

Methods: A novel predictive finite element model was used to evaluate wear in a simulated functional spinal unit (FSU). A predictive finite element wear model of the disc alone (TDR Only) was developed, along the lines of that proposed in the literature. This model was then incorporated into a ligamentous C5-C6 finite element model (TDR+FSU). Both of these models were subjected to a motion profile (rotation about three axes) with varying preloads of 50 to150 N at 1 Hz, consistent with ISO 18192. A subroutine based on Archard law simulated abrasive wear on the polymeric core up to 10 million cycles. The TDR+FSU model was further modified to simulate facetectomy, sequential addition of ligaments, and compressive load; simulations were repeated for 10 million cycles.

Results: The predicted wear patterns in the isolated disc (TDR Only) and in TDR+FSU were completely inconsistent. The TDR+FSU model predicted localized wear in certain regions, in contrast to the uniformly distributed wear pattern of the TDR-only model. In addition, the cumulative volumetric wear for the TDR-only model was 10 times that of the TDR+FSU model. The TDR+FSU model also revealed a separation at the articulating interface during extension and lateral bending. After facetectomy, the wear pattern remained lopsided, but linear wear increased eightfold, whereas volumetric wear almost tripled. This was accompanied by a reduction in observed liftoff. The addition of anterior longitudinal ligament/posterior longitudinal ligament did not affect volumetric or linear wear. On the removal of all ligaments and facet forces, and replacement of follower load with a compressive load, the wear pattern returned to an approximation of the TDR-only test case, whereas the cumulative volumetric wear became nearly equivalent. In this case, the liftoff phenomenon was absent.

Conclusions: Anatomic structures and follower load mitigate the wear of an artificial disc. The proposed model (TDR+FSU) would enable further study of the effects of clinical parameters (eg, surgical variables, different loading profiles, different disc designs, and bone quality) on wear in these implants.