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Anatomic Facet Replacement System (AFRS) Restoration of Lumbar Segment Mechanics to Intact: A Finite Element Study and In Vitro Cadaver Investigation

Vijay Goel, PhD,1 Ankit Mehta, BS,1 Jayant Jangra, BS,1 Ahmed Faizan, BS,1 Ali Kiapour, MS,1 Robert Hoy, MEng,2 Andrew Fuath, PhD2

1Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Ohio 2Facet Solutions Inc. Logan, Utah

Abstract 

Background

Many decompression procedures involve complete or partial facetectomy. Spinal fusion usually stabilizes the motion segment after complete facetectomies. However, problems with fusion, such as adjacent-level degeneration, have increased interest in motionpreservation technologies. Facet arthroplasty may become an important posterior motion-preservation device, but its biomechanical literature is sparse.

Methods

We conducted an in vitro investigation and finite element study to compare the biomechanical effects of an artificial facet system to the intact spine. In the in vitro study, we tested human osteo-ligamentous segments (L3-S1) in intact, injured, and artificial facet–repaired conditions. For the finite element study, we used a 3-dimensional ligamentous L3-S1 segment model. We simulated destabilization in the intact model by removing the facets across the L4-L5 functional unit, then repaired it with appropriately sized facet implants and compared the ranges of motion, facet loads, disc pressures, and device loads. We also analyzed a finite element model with a rigid posterior pedicle-rod fixation system. We subjected the cadaveric specimens and the models to 400N of follower load plus a 10Nm moment in extension, flexion, bending, and rotation. We used a novel technique to apply the follower load in the finite element models such that preload induced minimal vertebral rotation during the range of motion.

Results

The predicted ranges of motion for the intact and implanted models were consistent with cadaver data. After destabilization and facet replacement, the artificial facet system restored motion in all loading modes to intact values. The implant facet loads were similar to intact facet loads in extension and axial rotation, but less in lateral bending. The intradiscal pressure at the implanted level for the facet replacement device was similar to the intact pressure, whereas with the rigid system the intradiscal pressure was up to 70% less than the intact pressure. The maximum von-Mises stress predicted in the facet replacement construct was 85MPa in extension at the bone–pedicle screw interface, compared with 174MPa in the rigid system. Contact stresses at implant mating surfaces were minimal.

Conclusions

The artificial facet system replicated natural facet kinematics. The cadaveric ranges of motion and the predicted finite element–based data indicated that the implant can “restore” the normal function of the segment after artificial facet replacement.

Clinical Relevance

Compared to rigid posterior pedicle-rod fixation, the artificial facet system restored the intact mechanics at the implanted level and may prevent adjacent-level degeneration.

keywords: 
artificial facet, lumbar spine, biomechanics, finite element technique
Volume 1 Issue 1
doi: 
10.1016/S1935-9810(07)70046-4