Effect of a prosthetic disc nucleus on the mobility and disc height of the L4–5 intervertebral disc postnucleotomy

Abstract

Object. Current procedures for treatment of degenerative disc disease may not restore flexibility or disc height to the intervertebral disc. Recently, a prosthetic device, intended to replace the degenerated nucleus pulposus, was developed. In this biomechanical in vitro test the authors study the effect of implanting a prosthetic nucleus in cadaveric lumbar intervertebral discs postnucleotomy and determine if the flexibility and disc height of the L4–5 motion segment is restored. Methods. The prosthetic disc nucleus device consists of two hydrogel pellets, each enclosed in a woven polyethylene jacket. Six human cadaveric lumbar motion segments (obtained in individuals who, at the time of death, were a mean age of 56.7 years) were loaded with moments of ± 7.5 Nm in flexion—extension, lateral bending, and axial rotation. The following states were investigated: intact, postnucleotomy, and after device implantation. Range of motion (ROM) and neutral zone (NZ) measurements were determined. Change in disc height from the intact state was measured after nucleotomy and device implantation, with and without a 200-N preload. Conclusions. Compared with the intact state (100%), the nucleotomy increased the ROM in flexion—extension to 118%, lateral bending to 112%, and axial rotation to 121%; once the device was implanted the ROM was reduced to 102%, 88%, and 90%, respectively. The NZ increased the ROM to 210%, lateral bending to 173%, and axial rotation to 107% after nucleotomy, and 146%, 149%, 44%, respectively, after device implantation. A 200-N preload reduced the intact and postnucleotomy disc heights by approximately 1 mm and 2 mm, respectively. The original intact disc height was restored after implantation of the device. The results of the cadaveric L4–5 flexibility testing indicate that the device can potentially restore ROM, NZ, and disc height to the denucleated segment.