Does total disc arthroplasty in C3/C4-segments change the kinematic features of axial rotation?

We analyze how kinematic properties of C3/C4-segments are modified after total disc arthroplasty (TDA) with PRESTIGE(®) and BRYAN(®) Cervical Discs. The measurements were focused on small ranges of axial rotation (<0.8°) in order to investigate physiologic rotations, which frequently occur in vivo. Eight human segments were stimulated by triangularly varying, axially directed torque. By using a 6D-measuring device with high resolution the response of segmental motion was characterised by the instantaneous helical axis (IHA). Position, direction, and migration rate of the IHA were measured before and after TDA. External parameters: constant axially directed pre-load, constant flexional/extensional and lateral-flexional pre-torque. The applied axial torque and IHA-direction did not run parallel. The IHA-direction was found to be rotated backwards and largely independent of the rotational angle, amount of axial pre-load, size of pre-torque, and TDA. In the intact segments pre-flexion/extension hardly influenced IHA-positions. After TDA, IHA-position was shifted backwards significantly (BRYAN-TDA: ≈8mm; PRESTIGE-TDA: ≈6mm) and in some segments laterally as well. Furthermore it was significantly shifted ventrally by pre-flexion and dorsally by pre-extension. The rate of lateral IHA-migration increased significantly after BRYAN-TDA during rightward or leftward rotations. In conclusion after the TDA the IHA-positions shifted backwards with significant increase in variability of the IHA-positions after the BRYAN-TDA more than in PRESTIGE-TDA. The TDA-procedure altered the segment kinematics considerably. TDA causes additional translations of the vertebrae, which superimpose the kinematics of the adjacent levels. The occurrence of adjacent level disease (ALD) is not excluded after the TDA for kinematical reasons.

Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography.

Mobile image intensifier systems (C-arms) are used frequently in orthopedic and reconstructive surgery, especially in trauma and emergency settings, but image quality and radiation exposure levels may vary widely, depending on the extent of the C-arm operator's knowledge and experience. Current training programs consist mainly of theoretical instruction in C-arm operation, the physical foundations of radiography, and radiation avoidance, and are largely lacking in hands-on application. A computer-based simulation program such as that tested by the authors may be one way to improve the effectiveness of C-arm training. In computer simulations of various scenarios commonly encountered in the operating room, trainees using the virtX program interact with three-dimensional models to test their knowledge base and improve their skill levels. Radiographs showing the simulated patient anatomy and surgical implants are "reconstructed" from data computed on the basis of the trainee's positioning of models of a C-arm, patient, and table, and are displayed in real time on the desktop monitor. Trainee performance is signaled in real time by color graphics in several control panels and, on completion of the exercise, is compared in detail with the performance of an expert operator. Testing of this computer-based training program in continuing medical education courses for operating room personnel showed an improvement in the overall understanding of underlying principles of intraoperative radiography performed with a C-arm, with resultant higher image quality, lower overall radiation exposure, and greater time efficiency. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105125/-/DC1.

Migration of the instantaneous axis of motion during axial rotation in lumbar segments and role of the zygapophysial joints.

The biomechanical role of the zygapophysial joints was investigated for axial rotations of lumbar segments by recording the positions of the instantaneous helical axis (IHA) against the axial rotational angle and by relating these IHA-positions to anatomical landmarks. Cyclically varying pure axial moments were applied to 3 L1/L2, 7 L3/L4 and 3 L4/L5 segments. There were 800 segment positions per cycle taken by a custom-made high precision 3D-position measuring system. In intact segments IHA-migration reached from one zygapophysial joint to the other IHA-paths came up to 10-60 mm within small angular intervals (±1 deg). After removing the right joints, IHA-migration remained comparable with that of intact segments only for segment positions rotated to the right. Rotation to the left, however, approximately yielded stationary IHA-positions as found after resection of both joints. Hence, IHA-migration is determined by the joints already for small rotational angles. Each type of segment showed a typical pattern of IHA-migration.

Non-linearity of flexion-extension characteristics in spinal segments.

Spinal biomechanics is still known just fragmentary since the only description by angle-torque characteristics without simultaneous recording of migration of the instantaneous helical axis (IHA) is not sufficient. Time-dependent flexion/extension following a cyclic laterally directed torque was measured at all six degrees of freedom by a highly precise custom-made 6D apparatus. In order to enhance the localizing resolution of IHA migration as the function of the flexional/extensional angle, small ranges of motion (ROM) were used at several degrees of pre-extension. 4 L3/L4, 3 L4/L5 and 2 T2/T3 human segments were investigated. In extensional motion, wide dorsal IHA-migrations were measured in lumbar segments and correlated with the distinct asymmetric shapes of the characteristics in extensional motion. The respective increase of differential stiffness could mainly be traced back to the enlarging geometrical moment of inertia of the segments by the dorsally migrating IHA. Both thoracic segments showed a predominant IHA-migration in cranial/caudal direction. A simple model makes it evident that the opposite curvature morphology of lumbar and thoracic joint facets conditions the different directions of IHA migration.