Ebook Dynamic reconstruction of the spine: Part 1

Dynamic Reconstruction of the Spine
2nd Edition
Daniel H. Kim, MD, FAANS, FACS
Professor
Director of Spinal Neurosurgery
Reconstructive Peripheral Nerve Surgery
Department of Neurosurgery
Memorial Hermann
The University of Texas Health Science Center at Houston
Houston, Texas
Dilip K. Sengupta, MD, DrMed
Director, Clinical Research
Attending Spine Surgeon
Texas Back Institute
Plano, Texas
Frank P. Cammisa Jr., MD, FACS
Chief
Spinal Surgical Service
Attending Surgeon
Spine Care Institute
Hospital for Special Surgery
Professor of Orthopedic Surgery
Weill Medical College of Cornell University
New York, New York
Do Heum Yoon, MD, PhD
Professor
Department of Neurosurgery

Yonsei University College of Medicine
Seoul, Republic of Korea
Richard G. Fessler, MD, PhD
Professor
Department of Neurological Surgery
Rush University College of Medicine
Chicago, Illinois

701 illustrations
Thieme
New York • Stuttgart • Delhi • Rio de Janeiro


Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Timothy Y. Hiscock
Managing Editor: Sarah Landis
Editorial Assistant: Genevieve Kim
Production Editor: Mason Brown
International Production Director: Andreas Schabert
Senior Vice President, Editorial and Electronic
Product Development: Cornelia Schulze
International Marketing Director: Fiona Henderson
Director of Sales, North America: Mike Roseman
International Sales Director: Louisa Turrell
Vice President, Finance and Accounts: Sarah Vanderbilt
President: Brian D. Scanlan
Printer: Replika Press Pvt. Ltd.
Library of Congress Cataloging-in-Publication Data

Dynamic reconstruction of the spine
/ [edited by] Daniel H. Kim, Dilip K. Sengupta, Frank P. Cammisa Jr.,
Do Heum Yoon, Richard G. Fessler. -- 2nd edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60406-873-3 (hardback) -- ISBN 978-1-60406-874-0
(eISBN)
I. Kim, Daniel H., editor. II. Sengupta, Dilip K., editor. III. Cammisa,
Frank P., Jr., editor. IV. Yoon, Do Heum, editor. V. Fessler, Richard G.,
editor.
[DNLM: 1. Spine--surgery. 2. Arthroplasty, Replacement-methods. 3. Prostheses and Implants. WE 725]
RD768
617.5'6059--dc23
2014021235

Important note: Medical knowledge is ever-changing. As new
research and clinical experience broaden our knowledge, changes
in treatment and drug therapy may be required. The authors and
editors of the material herein have consulted sources believed to be
reliable in their efforts to provide information that is complete and
in accord with the standards accepted at the time of publication.
However, in view of the possibility of human error by the authors,
editors, or publisher of the work herein or changes in medical
knowledge, neither the authors, editors, nor publisher, nor any
other party who has been involved in the preparation of this work,
warrants that the information contained herein is in every respect
accurate or complete, and they are not responsible for any errors or
omissions or for the results obtained from use of such information.
Readers are encouraged to confirm the information contained
herein with other sources. For example, readers are advised to

check the product information sheet included in the package of
each drug they plan to administer to be certain that the information
contained in this publication is accurate and that changes have not
been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
Some of the product names, patents, and registered designs
referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always
made in the text. Therefore, the appearance of a name without
designation as proprietary is not to be construed as a representation
by the publisher that it is in the public domain.

Copyright © 2015 by Thieme Medical Publishers, Inc.
Thieme Publishers New York
333 Seventh Avenue, New York, NY 10001 USA
1-800-782-3488,
Thieme Publishers Stuttgart
Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421,
Thieme Publishers Delhi
A-12, Second Floor, Sector -2, NOIDA -201301
Uttar Pradesh, India
+91 120 45 566 00,
Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda.
Argentina Building 16th floor, Ala A, 228 Praia do Botafogo
Rio de Janeiro 22250-040 Brazil
+55 21 3736-3631
Printed in India
ISBN 978-1-60406-873-3
Also available as an ebook:
eISBN 978-1-60406-874-0

54321

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow
limits set by copyright legislation without the publisher's consent is
illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any
kind, translating, preparation of microfilms, and electronic data
processing and storage.


To my family, wife Anslie, daughters Elise, Rebecca, and Sarah, for their loving support.
Daniel H. Kim
To my father, the late Naresh Chandra Sengupta, for giving me the inspiration to make this endeavor.
Dilip K. Sengupta
I dedicate this volume to my wife Gail and our children Annie, Trey, and Jack. I will always
appreciate their support throughout this endeavor.
Frank P. Cammisa Jr.
To my wife, Young-ran, and my sons, Dong-whan and Dong-min, for their encouragement, tolerance,
and unending love. I will always appreciate their support throughout this endeavor.
Do-Heum Yoon
To my teachers and mentors, Sean Mullan, Al Rhoton, Fred Brown, and Javad Hekmatpanah,
for giving me the opportunity to utilize the knowledge, skills, and advice that they so generously gave to me
for the benefit of the many patients for whom I have had the privilege to care.
Richard G. Fessler



| 27.02.15 - 10:53

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xi

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xiii

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xv

Part 1 Motion Preservation of the Spine in Context
1

Dynamic Stabilization of the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

Dilip K. Sengupta

2

Cervical and Lumbar Disc Replacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Do Heum Yoon, Karen M. Shibata, Daniel H. Kim, and Dilip K. Sengupta

3

The Rationale behind Dynamic Posterior Spinal Instrumentation. . . . . . . . . . . . . . . . . . . . . . . . . . .

20

Paul C. McAfee, Bryan W. Cunningham, and Dilip K. Sengupta

Part 2 Clinical Biomechanics of the Spine
4

Basic Principles in Biomechanics: Force and Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32

Paul C. Ivancic

5

Basic Principles in Biomechanics: Loads and Motion (Kinematics) . . . . . . . . . . . . . . . . . . . . . . . . . .

38

Vikas Kaul, Ata M. Kiapour, Constantine K. Demetropoulos, Anand K. Agarwal, and Vijay K. Goel

6

Center of Rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46

Dilip K. Sengupta

7

Biomechanical Testing of the Lumbar Spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

54

Avinash G. Patwardhan, Robert M. Havey, and Leonard I. Voronov

8

Kinematics of the Cervical Spine Motion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

61

Ata M. Kiapour and Constantine K. Demetropoulos

9

Biomechanical Testing Protocol for Evaluating Cervical Disc Arthroplasty. . . . . . . . . . . . . . . . .

70

Dilip K. Sengupta

10

Finite Element Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75

Ali Kiapour, Vivek Palepu, Ata M. Kiapour, Constantine K. Demetropoulos, and Vijay K. Goel

11

Biomaterials and Design Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85

Michael B. Mayor

Part 3 Restoration of the Cervical Movement Segment
12

Biomechanical Aspects Associated with Cervical Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . .

90

Dilip K. Sengupta

13

Rationale and Indications for Cervical Disc Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

98

Jesse L. Even, Joon Y. Lee, Moe R. Lim, and Alexander R. Vaccaro

vii

| 27.02.15 - 10:53

Contents

14

Metal-on-Metal Cervical Disc Prostheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

104

Darren R. Lebl, Federico P. Girardi, and Frank P. Cammisa Jr.

15

Design Rationale and Surgical Technique of Metal-on-Poly Cervical Disc Prostheses. . . . . .

112

Darren R. Lebl, Federico P. Girardi, and Frank P. Cammisa Jr.

16

Bryan Cervical Disc Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

118

Dilip K. Sengupta

17

M6-C Artificial Cervical Disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

125

Carl Lauryssen and Domagoj Coric

18

PEEK and Ceramic Cervical Disc Prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

135

Matthew N. Songer

19

Complexities of Single- versus Multilevel Cervical Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . .

145

William E. Neway III, Lisa Ferreara, and James Joseph Yue

20

Update on FDA IDE Trials on Cervical Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

152

Uday Pawar, Abhay Nene, and Dilip K. Sengupta

21

Complications of Cervical Disc Replacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

157

Troy Morrison, Richard D. Guyer, and Donna D. Ohnmeiss

22

Retrieval Analysis of Cervical Total Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

162

JayDeep Ghosh, Peng Huang, and Dilip K. Sengupta

Part 4 Restoration of the Lumbar Motion Segment
23

Kinematics of the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

172

Haibo Fan

24

Kinetics of the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

177

Ata M. Kiapour, Haibo Fan, and Constantine K. Demetropoulos

25

Rationale and Principles of Dynamic Stabilization in the Lumbar Spine. . . . . . . . . . . . . . . . . . . . .

184

Dilip K. Sengupta

26

Design Rationale, Indications, and Classification for Pedicle
Screw–Based Posterior Dynamic Stabilization Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

189

Dilip K. Sengupta

27

Dynamic Stabilization with Graf Ligamentoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

196

Young-Soo Kim, Dong-Kyu Chin, and Dilip K. Sengupta

28

Clinical Application of Dynesys Dynamic Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

202

Gilles G. DuBois and Dilip K. Sengupta

29

Dynamic Stabilization for Revision of Lumbar Spinal Pseudarthrosis with Transition . . . . .

207

Paul C. McAfee, Liana Chotikul, Erin M. Shucosky, and Jordan McAfee

30

Nonfusion Stabilization of the Degenerated Lumbar Spine with Cosmic . . . . . . . . . . . . . . . . . . .
Archibald von Strempel

viii

213


| 27.02.15 - 10:53

Contents

31

Minimally Invasive Posterior Dynamic Stabilization System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

222

Luiz Pimenta, Roberto Diaz, and Dilip K. Sengupta

32

Clinical Results of IDE Trial of Dynesys for Dynamic Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . .

228

Alex Ha and Dilip K. Sengupta

33

Classification, Design Rationale, and Mechanism of Action of Interspinous Process
Distraction Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

234

Chadi Tannoury and Frank M. Phillips

34

Clinical Results of Interspinous Process Spacers and Complications . . . . . . . . . . . . . . . . . . . . . . . .

240

Kern Singh, Alejandro Marquez-Lara, Sreeharsha V. Nandyala, and Miguel Pelton

35

Clinical Results of IDE Trial of X-Stop Interspinous Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

247

Elizabeth Yu and James F. Zucherman

36

Clinical Biomechanics of Lumbar Facet Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

253

Conor Regan, Moe R. Lim, Joon Y. Lee, and Todd J. Albert

37

The Current Status of Facet Replacement Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

258

Kern Singh, Sreeharsha V. Nandyala, Alejandro Marquez-Lara, Steven J. Fineberg, Matthew Oglesby,
Larry T. Khoo, Luiz Pimenta, Roberto Diaz, and Scott Webb

38

Biomechanics and Rationale of Prosthetic Nucleus Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . .

266

Naresh Kumar, Barry W. L. Tan, and Hee-Kit Wong

39

The Raymedica Prosthetic Disc Nucleus (PDN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

272

Naresh Kumar, Barry W. L. Tan, and Hee-Kit Wong

40

Classification of Lumbar Nucleus Replacement Systems, Mechanism of Action, and
Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

281

Tim Brown, Qi-Bin Bao, William F. Lavelle, Domagoj Coric, and Hansen A. Yuan

41

Biomechanical Consideration for Total Lumbar Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . .

287

Jean-Charles Le Huec, Antonio Faundez, and Stephane Aunoble

42

Indications for Total Lumbar Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

292

Dilip K. Sengupta and Rudolf Bertagnoli

43

Anterior Exposure to the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

298

Jonathan D. Krystal and Alok D. Sharan

44

Classification of Total Lumbar Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

304

Karin Büttner-Janz

45

Charité Artificial Disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

313

Fred H. Geisler

46

ProDisc-L Artificial Disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334

Jack E. Zigler and Rob D. Dickerman

47

Polymer-on-Metal Lumbar TDR Design Rationale and Classification. . . . . . . . . . . . . . . . . . . . . . . .

339

Christoph R. Schätz

ix


| 27.02.15 - 10:53

Contents

48

M6-L Artificial Lumbar Disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

343

Christoph R. Schätz

49

The Mobidisc Prosthesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

350

Jean-Paul Steib, Joël Delécrin, Jacques Beaurain, Jean Huppert, Hervé Chataigner, Marc Ameil, Thierry Dufour,
and Jérôme Allain

50

Metal-on-Metal Lumbar Total Disc Replacements (Maverick, FlexiCore, Kineflex) . . . . . . . . .

359

Brian J. C. Freeman and Julia S. Kuliwaba

51

Clinical Results of Total Lumbar Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

367

Kirill F. Ilalov, Richard D. Guyer, Jack E. Zigler, and Donna D. Ohnmeiss

52

Long-Term Outcomes of Lumbar Total Disc Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

374

Steven J. Fineberg, Sreeharsha V. Nandyala, Alejandro Marquez-Lara, Matthew Oglesby, and Kern Singh

53

Complications of Lumbar Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

380

Sang-Ho Lee and Chan-Shik Shim

54

Complications of Investigational Device Exemption Trial after Total Disc Replacement . . .

386

Adewale O. Adeniran and Adam M. Pearson

55

Complications of Total Lumbar Disc Replacement and Salvage
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

390

Andre Van Ooij and Ilona M. Punt

56

Multilevel Total Lumbar Disc Replacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

399

James Joseph Yue, Lisa Ferrara, and Jason O. Toy

Part 5 Advancements in Lumbar Motion Preservation
57

Advancements in the Design of Lumbar Prosthetic Discs—Theken Disc and
Elastomeric Disc Physio-L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

408

Vijay K. Goel, Aakash Agarwal, Constantine K. Demetropoulos, Anand K. Agarwal, and Casey K. Lee

58

Concept of Total Joint Replacement in the Lumbar Spine (Flexuspine—Total Disc with
Posterior Approach) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

415

Jonathan A. Gimbel, Charley Gordon, and Eric Wagner

59

Assessment of Lumbar Motion Kinematics In Vivo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

423

Shaobai Wang, Guoan Li, and Kirkham Wood

60

Annulus Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

432

Michael Y. Wang and Faiz U. Ahmad

61

Minimally Invasive Technology for Lumbar Motion Preservation. . . . . . . . . . . . . . . . . . . . . . . . . . . .

437

Paul D. Kim and Choll W. Kim

62

Molecular and Genetic Therapy in Repair of the Degenerative Disc . . . . . . . . . . . . . . . . . . . . . . . . .

441

Michael P. McClincy, Gwendolyn Sowa, Nam Vo, Bing Wang, and James D. Kang

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

x

448


Preface
Confronted with a patient's demand of, "Doctor, I can't live
with this back pain any more; I want my back fixed," surgeons
could offer "spinal fusion" as a surgical option. Unfortunately,
this is no better than fixing a car door that does not open or
close properly by welding it to the frame permanently! This is
far from what is commonly understood as a "fix." Nonfusion
alternatives to spinal fusion have emerged from the limitations of fusion as experienced during the later part of the last
century. During the last decade, dynamic reconstruction of
the spine, either by disc replacement or dynamic stabilization, has gained attention in the surgical community. A large
number of new technologies have been introduced, many of
which have died prematurely, although a few survived the
test of time while our knowledge was being consolidated.
Dynamic reconstruction has to face many more challenges
for long-term survival than spinal fusion. A thorough knowledge of the biomechanics of normal and abnormal spine is
essential in the understanding of dynamic reconstruction
techniques. Therefore, in the second edition of this book, a
new section on clinical biomechanics was added following
the section on historical perspective. The two other sections
provide a thorough but critical discussion of cervical and
lumbar motion preservation techniques. In the first edition of
this book, as well as in most other similar publications, the

major emphasis was on comprehensive presentation of all
the new techniques, including inventor or surgeon views,
allowing specific insight into each system. But such presentation can't be free from bias. In the second edition, emphasis
was put on presentation of the scientific basis by indepen-

dent authors, much in the form of a peer-reviewed journal
article. Experience with IDE trials, complications with lumbar
disc replacement, and long-term clinical outcomes have been
presented separately. The discussions of the cervical and
lumbar disc prosthesis have been grouped to some extent,
according to the material structure of the prosthesis, for
example, metal-on-metal, or metal-on-plastic, etc. The directions of further development in the field of disc replacement
have been presented by the original inventors of disc replacements and biomechanics engineers. This section also
includes minimally invasive techniques, annulus repair, and
advances in genetic and molecular technologies for disc
repair.
The second edition of this book will prove useful to the
community practicing spinal surgery, including orthopedic
and neurosurgeons, residents and fellows, radiologists, medical students, nurses, and physician assistants. In addition,
researchers and biomedical engineers, inventors, and others
in the spine industry will find plenty of interest.
The dynamic reconstruction of the spine is an everchanging subject, and the speed of publication competes
with advancing knowledge and experience on this subject.
This book will bring the reader up to speed with information
on the biomechanical background, as well as an outline of the
current status and future directions for the treatment of
spinal pain.
Daniel H. Kim
Dilip K. Sengupta

xi



Acknowledgments
A tremendous amount of energy and teamwork accompanied the production of this book, and we are grateful to
the many dedicated individuals and companies that
contributed their time, talents, and resources. We would
like to acknowledge the valuable input of coeditors
Frank P. Cammisa Jr., MD, Richard G. Fessler, MD, and

Do Heum Yoon, MD, PhD, as well as the expertise and
insight of all the contributors.

Daniel H. Kim
Dilip K. Sengupta

xiii



Contributors
Adewale O. Adeniran, MD
Department of Orthopedics
Dartmouth–Hitchcock Medical Center
Lebanon, New Hampshire

Qi-Bin Bao, PhD
Managing Director
Anide, LLC

Minneapolis, Minnesota

Aakash Agarwal, BTech
Research Assistant
Department of Bioengineering
University of Toledo
Toledo, Ohio

Jacques Beaurain, MD
Department of Neurosurgery
University Hospital Bocage Central
Dijon, France

Anand K. Agarwal, MD
Director of Product Development and Bio-Skilss Laboratories
Research Professor
Orthopedic Spine Surgeon
Departments of Bioengineering and Orthopaedic Surgery
Colleges of Engineering and Medicine
University of Toledo
Toledo, Ohio
Faiz U. Ahmad, MD, Mch
Assistant Professor
Emory University
Atlanta, Georgia

Rudolf Bertagnoli, Prof, Dr
Chief Executive Officer
Pro Spine
Bogen, Germany

Tim Brown, MS
Clinical and Scientific Research Associates, LLC
Marquette, Michigan
Karin Büttner-Janz, MD, PhD
Extraordinary Professor at Charité
Universitätsmedizin Berlin, Germany
Berlin, Germany

Todd J. Albert, MD
Richard H. Rothman Professor and Chair
Department of Orthopaedics
Professor of Neurosurgery
Thomas Jefferson University and Hospitals
President
The Rothman Institute
Philadelphia, Pennsylvania

Frank P. Cammisa Jr., MD, FACS
Chief
Spinal Surgical Service
Attending Surgeon
Spine Care Institute
Hospital for Special Surgery
Professor of Orthopedic Surgery
Weill Medical College of Cornell University
New York, New York

Jérôme Allain, MD
Professor
Department of Orthopedic surgery

Henri Mondor Hospital
Créteil, France

Hervé Chataigner, MD
Service de Chirurgie des Scolioses et Orthopedie Infantile
Department of Surgery and Orthopedics of Infantile Scoliosis
Hôpital St. Jacques
Cedex, France

Marc Ameil, MD
Department Orthopedic
Institution Clinic Saint Andre
Reims, France

Dong-Kyu Chin, MD
Department of Neurosurgery
The Spine and Spinal Cord Institute
Gangnam Severance Hospital
Seoul, Republic of Korea

Stephane Aunoble, MD
Département Orthopédie Pr Chauveaux.
Spine Unit Pr Le Huec, CHU Pellegrin
Université Bordeaux
Bordeaux, France

Liana Chotikul, RN, MSN, NP-C, CNOR, ONC
Orthopedic Surgery of Spine
Towson Orthopedics Associates
Towson, Maryland

xv


Contributors

Domagoj Coric, MD
Chief
Department of Neurosurgery
Carolinas Medical Center
Carolina Neurosurgery and Spine Associates
Charlotte, North Carolina
Bryan W. Cunningham, PhD
Director of Spinal Research
Orthopaedic Spinal Research Institute
University of Maryland St. Joseph Medical Center
Towson, Maryland
Joël Delécrin, MD
Associate Professor
Department of Orthopedics Surgery
CHU de Nantes Hospital–Saint Jacques
Cedex, France
Constantine K. Demetropoulos, PhD
Lead Researcher, Experimental Biomechanics
Biomechanics and Injury Mitigation Systems
Research and Exploratory Development Department
The Johns Hopkins University Applied Physics Laboratory
Laurel, Maryland
Roberto Diaz, MD
Assistant Professor, Chief of Neurosurgery

Neurosurgery Unit
Hospital Universitario San Ignacio
Pontificia Universidad Javeriana
Bogota, Colombia

xvi

Jesse L. Even, MD
Department of Orthopedic Spine Surgery
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Haibo Fan
Product Development Engineer
BioHorizons Implant Systems, Inc.
Birmingham, Alabama
Antonio Faundez, MD
Orthopaedic Spine Surgeon
La Tour Hospital and Geneva University Hospitals
Geneva, Switzerland
Lisa Ferreara, PhD
President
OrthoKinetic Technologies, LLC
Southport, North Carolina
Richard G. Fessler, MD, PhD
Professor
Department of Neurological Surgery
Rush University College of Medicine
Chicago, Illinois
Steven J. Fineberg, MD
Research Coordinator

Department of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois

Rob D. Dickerman, DO, PhD
Director of Neurosurgery
Presbyterian Hospital of Plano
Director of Neurosurgery
Spine Service, The Medical Center of Plano
Adjunct Professor
University of North Texas Health Science Center
Plano, Texas

Brian J. C. Freeman, MB, BCh, BAO, DM, FRCS (TR & Orth),
FRACS (Ortho)
Professor of Spinal Surgery
Discipline of Orthopaedics and Trauma
University of Adelaide
Head of Spinal Services
Department of Spinal Surgery
Royal Adelaide Hospital
Adelaide, Australia

Gilles G. DuBois, MD
Neurochirurgien des Hopitaux.
Neurosurgical Department
Clinique de l'Union.
Saint-Jean, France

Fred H. Geisler, MD, PhD

Chief Medical Officer
Department of Neurosurgery
Rhausler, Inc.
Chicago, Illinois

Thierry Dufour, MD
Department of Neurosurgery
State Hospital La Source
Orleans, France

JayDeep Ghosh, MD
Spine Surgeon
Sir Ganga Ram Hospital
New Delhi, India


Contributors

Jonathan A. Gimbel, PhD
Senior Scientist
Flexuspine, Inc.
Pittsburgh, Pennsylvania
Federico P. Girardi, MD
Associate Orthopedic Surgeon
Associate Professor of Orthopedic Surgery
Department of Spinal Surgery, Orthopedics
Hospital for Special Surgery
Weill Medical College of Cornell University
New York, New York
Vijay K. Goel, PhD

Distinguished University Professor
Endowed Chair and McMaster–Gardner Professor
of Orthopaedic Bioengineering
Co-Director, Engineering Center for Orthopaedic
Research Excellence
Departments of Bioengineering and Orthopaedic Surgery
Colleges of Engineering and Medicine
University of Toledo
Toledo, Ohio
Charles R. Gordon, MD
Precision Spine Care
Tyler, Texas
Richard D. Guyer, MD
Spine Surgeon and President
Texas Back Institute
Plano, Texas
Associate Clinical Professor
Department of Orthopedics
University of Texas Southwestern School of Medicine
Dallas, Texas
Alex Ha, MD
Geisel School of Medicine
Dartmouth University
Hanover, New Hampshire
Robert M. Havey, BS
Biomechanical Engineer
Research
Edward Hines Jr. VA Hospital
Hines, Illinois
Peng Huang, MD, PhD

Department of Orthopaedic Surgery
The General Hospital of People's Liberation Army
Beijing, PR China
Jean Huppert, MD
Neurochirurgie
Clinique du Parc
Jarez, France

Hee Kit-Wong, MD
Professor
Orthopaedic Surgery
Head
Department of Orthopaedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Chair
University Orthopaedics, Hand and Reconstructive
Microsurgery Cluster
Head
University Spine Centre
National University Health System
Singapore
Kirill F. Ilalov, MD
Orthopaedic Spine Surgeon
The Center for Bone and Joint Disease
Hudson, Florida
Paul C. Ivancic, PhD
Assistant Professor
Biomechanics Research Laboratory
Department of Orthopaedics and Rehabilitation

Yale University School of Medicine:
New Haven, Connecticutt
James D. Kang, MD
UPMC Endowed Chair in Orthopaedic Spine Surgery
Professor of Orthopaedic and Neurological Surgery
University of Pittsburgh School of Medicine
Vice Chairman, Department of Orthopaedic Surgery
Director, Ferguson Laboratory for Spine Research
Pittsburgh, Pennsylvania
Vikas Kaul, MS
Consultant–Technology
Dassault Systèmes
Providence, Rhode Island
Larry T. Khoo, MD
The Spine Clinic of Los Angeles
Los Angeles, California
Ali Kiapour, PhD
Department of Bioengineering
University of Toledo
Toledo, Ohio
Ata M. Kiapour, PhD
Department of Orthopaedic Surgery
Boston Children's Hospital
Harvard Medical School
Boston, Massachusetts

xvii


Contributors

Choll W. Kim, MD, PhD
Director
Minimally Invasive Spine Center of Excellence
Minimally Invasive Spine Program
Spine Institute of San Diego
San Diego, California
Daniel H. Kim, MD, FAANS, FACS
Professor
Director of Spinal Neurosurgery
Reconstructive Peripheral Nerve Surgery
Department of Neurosurgery
Memorial Hermann
The University of Texas Health Science Center at Houston
Houston, Texas
Paul D. Kim, MD
Spine Institute of San Diego
San Diego, California
Young-Soo Kim, MD, PhD
Professor Emeritus
Department of Neurosurgery
Yonsei University
Exectutive Director
Kim Young Soo Hospital
Seoul, Republic of Korea

xviii

William F. Lavelle, MD
Assistant Professor

Department of Orthopedics
SUNY Upstate Medical University
Syracuse, New York
Darren R. Lebl, MD
Director
Complex Cervical Spine Symposium
Hospital for Special Surgery
The Spine Care Institute
Spine and Scoliosis Surgery
New York, New York
Casey K. Lee, MD
Clinical Professor
Department of Orthopedic Surgery
College of Medicine
New Jersey Medical School
Spine Care and Rehabilitation Inc.
Roseland, New Jersey
Joon Y. Lee, MD
Associate Professor
Department of Orthopaedics
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Jonathan D. Krystal, MD
Department of Orthopaedic Surgery
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, New York

Sang-Ho Lee, MD, PhD

Chairman
Department of Neurosurgery
Wooridul Spine Hospital
Seoul, Republic of Korea

Julia S. Kuliwaba, BSc, PhD
Senior Scientist
Adelaide Centre for Spinal Research
SA Pathology
Adelaide, Australia

Jean-Charles Le Huec, MD, PhD
Professor
Orthospine Unit
Bordeaux University Hospital
Bordeaux, France

Naresh Kumar, MBBS, MS, FRCS Ed, FRCS (Orth & Trauma),
DNB, DM
Associate Professor
Department of Orthopaedic Surgery
Senior Consultant Orthopaedics
National University Health System
National University of Singapore
Singapore

Guoan Li, PhD
Director, Bioengineering Laboratory
Associate Professor
Harvard Medical School

Department of Orthopaedic Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts

Carl Lauryssen, MD
Co-Director of Spine Research and Development
Olympia Medical Center
Tower Orthopaedics
Beverly Hills, California

Moe R. Lim, MD
Associate Professor
Department of Orthopaedics
University of North Carolina–Chapel Hill
Chapel Hill, North Carolina


Contributors

Alejandro Marquez-Lara, MD
Research Coordinator
Department of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois

Matthew Oglesby, BA
Research Coordinator
Department of Orthopaedic Surgery
Rush University Medical Center

Chicago, Illinois

Michael B. Mayor, BEE, MD
William and Bessie Allyn Professor Emeritus
Geisel School of Medicine at Dartmouth
Adjunct Professor
Thayer School of Engineering at Dartmouth Hanover,
New Hampshire
Emeritus Attending
Orthopaedic Department
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire

Donna D. Ohnmeiss, DrMed
Texas Back Institute Research Foundation
Plano, Texas

Paul C. McAfee, MD, MBA
Chief of Spinal Surgery
University of Maryland St Joseph Medical Center
Towson, Maryland

Avinash G. Patwardhan, PhD
Professor
Department of Orthopaedic Surgery and Rehabilitation
Loyola University Chicago
Maywood, Illinois

Jordan McAfee, BSc
New York, New York

Michael P. McClincy, MD
Department of Orthopaedic Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Troy Morrison, DO
Orthopedic Surgery
Citizens Memorial Hospital
Bolivar, Missouri
Sreeharsha V. Nandyala, BA
Research Coordinator
Department of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois
Abhay Nene, MS
Consultant Spine Surgeon
Hinduja Hospital
Wadia Children's Hospital
Bombay, India
William E. Neway III, DO
Assistant Professor
Department of Orthopaedic Surgery
University of Alabama at Birmingham
Birmingham, Alabama

Vivek Palepu, PhD
ORISE Fellow
FDA, Center for Devices and Radiological Health
Office of Science and Engineering Laboratories
Division of Solid and Fluid Mechanics
Silver Spring, Maryland

Uday Pawar, MD
Junior Consultant Spine Surgeon
P.D. Hinduja National Hospital and Medical Research Centre
Mumbai, India
Adam M. Pearson, MD, MS
Assistant Professor of Orthopedics
Department of Orthopaedics
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire
Miguel Pelton, BS
Research Coordinator
Department of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois
Huang Peng, MD, PhD
Department of Orthopaedics
Chinese PLA General Hospital
Beijing, China
Frank M. Phillips, MD
Professor
Head, Section of Minimally Invasive Spine Surgery
Department of Orthopaedic Surgery
Spine Fellowship Co-Director
Rush University Medical Center
Chicago, Illinois

xix

Contributors

Luiz Pimenta, MD, PhD
Associate Professor
Department of Neurosurgery
University of California–San Diego
San Diego, California
Medical Director
Instituo de Patologia de Coluna
Sao Paulo, Brazil
Ilona M. Punt, PhD
Clinical Researcher
Department of Orthopaedic Surgery
Maastricht University Medical Center
Maastricht, Netherlands
Department of Physical Therapy
University of Applied Sciences of Western Switzerland
Geneva, Switzerland
Conor Regan, MD
Spine Surgeon
Wake Orthopaedics
Raleigh, North Carolina
Christoph R. Schätz, MD
Head
Department of Spine Center
Orthopädische Klinik Markgroningen
Markgroningen, Germany
Dilip K. Sengupta, MD, DrMed
Director, Clinical Research
Attending Spine Surgeon

Texas Back Institute
Plano, Texas
Alok D. Sharan, MD
Chief
Orthopedic Spine Service
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
Karen M. Shibata
Medical Writer/Editor
Santa Clara, California
Chan-Shik Shim, MD, PhD
Medical Director
Department of Neurosurgery
Wooridul Spine Center Dubai
Dubai, United Arab Emirates
Erin M. Shucosky, RN
Case Manager/Clinical Research Coordinator
Scoliosis and Spine Center
Towson Orthopaedics Associates
Towson, Maryland

xx

Kern Singh, MD
Associate Professor
Department of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois
Matthew N. Songer, MD, MBA

Assistant Clinical Professor
Michigan State College of Human Medicine
Adjunct Professor
Michigan Technological University
Adjunct Professor
Northern Michigan University
Marquette, Michigan
Gwendolyn Sowa, MD, PhD
Associate Professor
Departments of Physical Medicine and Rehabilitation and
Orthopaedic Surgery
University of Pittsburgh
Pittsburgh, Pennsylvania
Jean-Paul Steib, MD
Professor
Service de Chirurgie du Rachis
Pavillon Chirurgical B
Hôpitaux Universitaires de Strasbourg
Strasbourg, France
Archibald von Strempel, MD, DEng, Prof.
Landeskrankenhaus Feldkirch
Orthopadische Abteilung
Feldkirch, Austria
Barry W. L. Tan, MBBS (Singapore), MRCS (Edinburgh)
University Orthopaedics, Hand and Reconstructive
Microsurgery Cluster
National University Hospital
National University Health System
Singapore
Chadi Tannoury, MD

Assistant Professor
Department of Orthopedic Surgery
Boston University
Boston, Massachusetts
Jason O. Toy, MD
Department of Orthopaedics and Rehabilitation
Yale University School of Medicine
New Haven, Connecticut


Contributors

Alexander R. Vaccaro, MD, PhD
The Everrett J. and Marion Gordon Professor of
Orthopaedic Surgery
Professor of Neurosurgery
Co-Director of the Delaware Valley Spinal Cord Injury Center
Co-Chief Spine Surgery
Co-Director Spine Surgery
Thomas Jefferson University and the Rothman Institute
Philadelphia, Pennsylvania
Andre Van Ooij, MD
Department of Orthopaedic Surgery
University Hospital Maastricht
University Hospital
Maastricht, The Netherlands
Nam Vo, PhD
Assistant Professor
Ferguson Laboratory for Spine Research
Department of Orthopaedic Surgery

University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Leonard I. Voronov, MD, PhD
Adjunct Instructor
Department of Orthopaedic Surgery and Rehabilitation
Loyola University Chicago
Maywood, Illinois
Erik Wagner
Chief Technology Officer
Flexuspine
Pittsburgh, Pennsylvania
Bing Wang, MD, PhD
Associate Professor
Department of Orthopaedic Surgery and Neurology
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Michael Y. Wang, MD, FACS
Professor
Departments of Neurosurgery and Rehab Medicine
University of Miami Miller School of Medicine
Miami, Florida
Shaobai Wang, PhD
Instructor
Department of Orthopaedic Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
Scott Webb, DO
Florida Spine Institute
Clearwater, Florida

Hee-Kit Wong, MD
Professor and Head
Department of Orthopaedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Chair, University Orthopaedics
Hand and Reconstructive Microsurgery Cluster
Head, University Spine Centre
National University Health System
Singapore
Kirkham Wood, MD
Chief, Spine Service
Associate Professor
Department of Orthopaedic Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
Do Heum Yoon, MD, PhD
Professor
Department of Neurosurgery
Yonsei University College of Medicine
Seoul, Republic of Korea
Elizabeth Yu, MD
Assistant Professor, Division of Spine Surgery
Department of Orthopaedics
The Ohio State University Wexner Medical Center
Columbus, Ohio
Hansen A. Yuan, MD
Professor Emeritus

Department of Orthopedic and Neurosurgery
SUNY Upstate Medical Center
Syracuse, New York
James Joseph Yue, MD
Associate Professor
Department of Orthopaedic Surgery and Rehabilitation
Yale School of Medicine
New Haven, Connecticutt
Jack E. Zigler, MD, FACS, FAAOS
Medical Director
Texas Back Institute
Plano, Texas
James F. Zucherman, MD
Spine Surgeon
Senior Spine Partner
San Francisco Orthopaedic Surgeons Medical Group
San Francisco, California

xxi



| 20.02.15 - 13:22

Part 1
Motion Preservation of the
Spine in Context

1 Dynamic Stabilization of the Lumbar
Spine

2

2 Cervical and Lumbar Disc Replacement

7

3 The Rationale behind Dynamic Posterior
Spinal Instrumentation

20

1