In vivo study of the kinematics in axial rotation of the lumbar spine after total intervertebral disc replacement: long-term results: a 10–14 years follow up evaluation

Introduction: We did not find any in vivo study of spinal segment kinematics after disc replacement, especially over the long term. In vitro studies did show that it restores almost normal kinematics except for axial rotation. The goal of this study is to develop a new technique in order to analyse axial rotation of a spinal segment, in vivo, after total disc replacement. Materials and methods: A comparative retrospective study of motion in axial rotation at L4L5 level was carried out on 17 patients with artificial discs versus six healthy volunteers. Five patients carried one prostheses at L4L5 level and 12 carried two prosthesis at L4L5 and L5S1 levels. The follow up ranged from 10.8 to 14.3 years (average 12.4±1, median 12.6). Dynamic radiographs in axial rotation were made using a special protocol. A new technique associating a stereographic method and image processing software was developed in order to evaluate the range of motion in axial rotation as well as the mechanical coupling. Results: The standard deviation of angular measurements was 1.8°. Eleven (65%) patients had a normal mobility in torsion, identical to those of the volunteers and of the literature, whereas six (35%) had an abnormal increased mobility. If only one disc was replaced, mobility in torsion was identical to that of the volunteers, in the case of two replaced discs, 50% (6/12) of the patients had an abnormal increased mobility. In the sub-group of normal mobility, the coupling was identical to that of the volunteers. In the sub-group of increased mobility, the coupling was different with a strong flexion (10°), increased by about 7° (P<0.001). Conclusion: The implementation of only one discal prosthesis SB Charité seems to restore kinematics close to that of the healthy volunteers and comparable to the literature. The implementation of two adjacent prostheses does not restore normal kinematics in 50% of the cases. It is probable that the existence of active stabilizing elements explains the difference with the in vitro studies carried out beforehand.