39. MAVERICK TOTAL DISC REPLACEMENT IN THE LOWER LUMBAR SPINE ADJACENT TO A LONG SPINAL FUSION: AN IN VITRO BIOMECHANICAL STUDY OF KINEMATICS

Abstract

Purpose: A long spinal fusion across the thoracolumbar region is sometimes applied in scoliosis. Adjacent level degeneration below these constructs has been documented. Treatment with an artificial disc replacement below the fusion has been proposed to prevent degeneration there. There is currently little data detailing the expected biomechanics of this situation. The objective of this study was to evaluate range of motion (ROM) and helical axis of motion (HAM) changes due to one- and two-level Maverick total disc replacement adjacent to a long spinal fusion.

Method: A multidirectional flexibility testing protocol with compressive follower preload was used to test seven human cadaveric spine specimens (T8-S1). A continuous pure moment ±5.0 Nm was applied in flexion-extension (FE), lateral bending (LB) and axial rotation (AR), with a compressive follower preload of 400 N. The motion of each vertebra was monitored with an optoelectronic camera system. The test was completed for the intact condition and after each surgical technique:

1. T8-L4 fusion and facet capsulotomy at L4–L5 and L5-S1;

2. L4–L5 Maverick;

3. L5-S1 Maverick.

Maverick total disc replacement and fusion with the CD Horizon system was performed. Repeated measures ANOVA was used to analyze changes in ROM and HAM of the L4–L5 and L5-S1 segments.

Results: Following L4-L5 Maverick replacement, L4-L5 ROMs tended to decrease slightly (on average from 6.2°±2.8° to 5.1°±3.8° in FE, 1.1°±1.1° to 0.9°±0.5° in LB and 1.3°±0.9° to 1.0°±0.6° in AR). With two-level Maverick implantation, L5-S1 ROMs tended to increase slightly in FE (from 6.6°±2.6° to 7.1°±3.9°), and to decrease slightly in LB (from 1.5°±0.9° to 1.0°±0.3°) and AR (from 1.5°±1.5° to 1.1°±0.6°), compared to the fused condition. As a trend, HAM location shifted posteriorly in FE and AR, and inferiorly in LB following Maverick replacement. However, neither ROM nor HAM at these two segments showed any significant change due to the implantation of one-or two-level Maverick total disc replacement in any of the three directions.

Conclusion: The present results suggested that lower lumbar segments with Maverick disc replacement exhibited intact-like kinematics in both extent and quality of motion.