A New CT Method for Assessing 3D Movements in Lumbar Facet Joints and Vertebrae in Patients before and after TDR

Per Svedmark, Svante Berg, Marilyn E Noz, Gerald Q Maguire Jr, Michael P Zeleznik, Lars Weidenhielm, Gunnar Nemeth, Henrik Olivecrona, Per Svedmark, Svante Berg, Marilyn E Noz, Gerald Q Maguire Jr, Michael P Zeleznik, Lars Weidenhielm, Gunnar Nemeth, Henrik Olivecrona

Abstract

This study describes a 3D-CT method for analyzing facet joint motion and vertebral rotation in the lumbar spine after TDR. Ten patients were examined before and then three years after surgery, each time with two CT scans: provoked flexion and provoked extension. After 3D registration, the facet joint 3D translation and segmental vertebral 3D rotation were analyzed at the operated level (L5-S1) and adjacent level (L4-L5). Pain was evaluated using VAS. The median (±SD) 3D movement in the operated level for the left facet joint was 3.2 mm (±1.9 mm) before and 3.5 mm (±1.7 mm) after surgery and for the right facet joint was 3.0 mm (±1.0 mm) before and 3.6 mm (±1.4 mm) after surgery. The median vertebral rotation in the sagittal plane at the operated level was 5.4° (±2.3°) before surgery and 6.8° (±1.7°) after surgery and in the adjacent level was 7.7° (±4.0°) before and 9.2° (±2.7°) after surgery. The median VAS was reduced from 6 (range 5-8) to 3 (range 2-8) in extension and from 4 (range 2-6) to 2 (range 1-3) in flexion.

Figures

Figure 1
Figure 1
A person lying on the jig in extension provocation (a) and in flexion provocation (b).
Figure 2
Figure 2
Example in 2D of choosing landmarks on L5 ((a) axial view, (b) coronal view, and (c) sagittal view).
Figure 3
Figure 3
2D overlay projection of the L5 vertebra in axial plane. The red part is the transformed vertebra superimposed on the reference vertebrae. One can see that it is an almost perfect match.
Figure 4
Figure 4
Patient 1: 2D projections where the prosthesis is visualized as towards the right of the midline. In the left axial view, the keel of the prosthesis is partly visualized. In the right coronal view it is shown that the prosthesis was placed slightly to the right of the midline.
Figure 5
Figure 5
3D isosurface illustrating the subsidence of the prosthesis (green) into the endplate of the L5 vertebra on Patient 8.
Figure 6
Figure 6
3D isosurface for Patient 4 viewed from behind the L5-S1 vertebrae. In the left joint of L5-S1 (red circle) the osteoarthritis is severe with visually displayed osteophytes in this view. Below the joint there are artefacts from the prosthesis in L5-S1 level.

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