• Martin Michael Wachowski, Jan Weiland, Markus Wagner, Riccardo Gezzi, Dietmar Kubein-Meesenburg, and Hans Nägerl.
• Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany. martin.wachowski@web.de.
• Eur Spine J. 2017 Sep 1; 26 (9): 2425-2433.

PurposeThe kinematical properties of C5/C6 segments in axial rotation are evaluated before and after total disc arthroplasty (TDA) with PRESTIGE®-and BRYAN® Cervical Disc (Medtronic) under flexion/extension as parameters and compared with those of C3/C4.MethodsEight human segments were stimulated by triangularly varying, axially directed torque (T z(t)) under compressing static axial preloads. Using a 6D-measuring device with high resolution, the response of segmental motion was characterized by the instantaneous helical axis (IHA). The position, direction, and migration path length of the IHA were measured before and after TDA (parameter: position of the axially directed preload).ResultsThe periodic torque T z(t) generated IHA migrations whereupon the IHA direction was constantly rotated to the dorsal by ≈15.5°. After TDA, the IHA0 (neutral positions) were significantly shifted to the dorsal (PRESTIGE®: 4.3 mm, BRYAN®: 7.0 mm) just as the points of balance of the entire IHA migration paths.ConclusionsDue to the configuration of the vertebral joints and their interaction with the intervertebral disc, the IHA migrates during the axial rotation within a distinct domain of each C5/C6-segment. Implantation of the PRESTIGE® and BRYAN® prostheses significantly alters these kinematical properties by dorsal displacements of the domains. Statistically TDA of C3/C4 and of C5/C6 are not correlated. Under axial rotation of the cervical spine, additional lateral and/or ventral/dorsal displacements are produced by TDA. Consequently, adjacent level disease (ALD) may be mechanically stimulated.

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