A new device used in the restoration of kinematics after total facet arthroplasty

Abstract

D Vermesan,1 R Prejbeanu,1 C Vlad Daliborca,1 H Haragus,1 M Magureanu,2 M Marrelli,3–5 L Promenzio,4 M Caprio,6 R Cagiano,6,* M Tatullo3,5,* 1Victor Babes University of Medicine and Pharmacy, Timisoara, 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Maxillofacial Unit, Dental Center Calabrodental, 4Orthopedics and Traumatology Unit, Marrelli Hospital, 5Biomedical Section, Tecnologica Research Institute, Crotone, 6Department of Biomedical Sciences and Human Oncology, Medical Faculty, Aldo Moro University of Bari, Bari, Italy *These authors contributed equally to this work Abstract: Facet degeneration can lead to spinal stenosis and instability, and often requires stabilization. Interbody fusion is commonly performed, but it can lead to adjacent-segment disease. Dynamic posterior stabilization was performed using a total facet arthroplasty system. The total facet arthroplasty system was originally intended to restore the natural motion of the posterior stabilizers, but follow-up studies are lacking due to limited clinical use. We studied the first 14 cases (long-term follow-up) treated with this new device in our clinic. All patients were diagnosed with lumbar stenosis due to hypertrophy of the articular facets on one to three levels (maximum). Disk space was of normal height. The design of this implant allows its use only at levels L3–L4 and L4–L5. We implanted nine patients at the L4–L5 level and four patients at level L3–L4. Postoperative follow-up of the patients was obtained for an average of 3.7 years. All patients reported persistent improvement of symptoms, visual analog scale score, and Oswestry Disability Index score. Functional scores and dynamic radiographic imaging demonstrated the functional efficacy of this new implant, which represents an alternative technique and a new approach to dynamic stabilization of the vertebral column after interventions for spine decompression. The total facet arthroplasty system represents a viable option for dynamic posterior stabilization after spinal decompression. For the observed follow-up, it preserved motion without significant complications or apparent intradisk or adjacent-disk degeneration. Keywords: lumbar stenosis, dynamic facet arthroplasty, dynamic stabilization, vertebral fusion