{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:42:20Z","timestamp":1770813740580,"version":"3.50.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["812765"],"award-info":[{"award-number":["812765"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018693","name":"HORIZON EUROPE Framework Programme","doi-asserted-by":"publisher","award":["956004"],"award-info":[{"award-number":["956004"]}],"id":[{"id":"10.13039\/100018693","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Arthroplasty in the cervical spine is performed using Total Disc Replacement (TDR) implants. This study investigates the safety and tribology of a design-optimized ceramic TDR bearing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Samples of an optimized bearing geometry were manufactured from the bioceramic BIOLOX\n                      <jats:sup>\u00ae<\/jats:sup>\n                      <jats:italic>delta<\/jats:italic>\n                      (CeramTec GmbH, Germany) and tested in a six degree of freedom universal joint simulator in diluted calf serum at body temperature. The investigated load and motion profiles simulated movements of daily living; three pure rotations under static load and three rotations coupled under sinusoidal load as well as adverse events (three subluxation test conditions).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Dynamic coefficients of friction during flexion\/extension and lateral bending were \u00b5\u2009=\u20090.16\u2009\u00b1\u20090.011 and \u00b5\u2009=\u20090.16\u2009\u00b1\u20090.070, respectively. Friction factors during flexion\/extension and lateral bending were f\u2009=\u20090.14\u2009\u00b1\u20090.0092 and f\u2009=\u20090.13\u2009\u00b1\u20090.063, whereas the friction factor in axial rotation was f\u2009=\u20090.033\u2009\u00b1\u20090.0028 and for three coupled rotations under sinusoidal load, it was f\u2009=\u20090.13\u2009\u00b1\u20090.028. The design demonstrated a sufficient resistance against subluxation, with subluxation forces more than 3.5-fold the 20N that are typically required as acceptance criteria in FDA safety and effectiveness data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Friction values were found to be comparable to or higher than those typically reported for ceramic-on-ceramic hip replacements. Furthermore, the results indicated that the optimized bearing design is sufficiently resistant to subluxation.\n                      <jats:italic>Significance:<\/jats:italic>\n                      Test protocols to investigate safety and tribology of cervical TDRs are proposed and their results are reported for a design-optimized ceramic TDR bearing.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0339851","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:27:30Z","timestamp":1770316050000},"page":"e0339851","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced preclinical testing of a design-optimized ceramic bearing for a cervical total disc replacement"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3969-2772","authenticated-orcid":true,"given":"Lucia","family":"K\u00f6lle","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Pryce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew R.","family":"Beadling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Bryant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-6717","authenticated-orcid":true,"given":"Richard M.","family":"Hall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Helgason","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"pone.0339851.ref001","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00586-017-5432-9","article-title":"The global spine care initiative: a summary of the global burden of low back and neck pain studies","volume":"27","author":"EL Hurwitz","year":"2018","journal-title":"Eur Spine J"},{"issue":"1","key":"pone.0339851.ref002","doi-asserted-by":"crossref","first-page":"217","DOI":"10.21037\/jss.2019.12.09","article-title":"Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis of rates of adjacent-level surgery to 7-year follow-up","volume":"6","author":"JH Badhiwala","year":"2020","journal-title":"J Spine Surg"},{"issue":"6","key":"pone.0339851.ref003","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1093\/neuros\/nyx579","article-title":"Cervical Disc Arthroplasty: Current Evidence and Real-World Application","volume":"83","author":"PD Nunley","year":"2018","journal-title":"Neurosurgery"},{"issue":"10","key":"pone.0339851.ref004","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1007\/s11517-025-03371-5","article-title":"Towards biomimetic evolution of artificial intervertebral disc: a review","volume":"63","author":"A Khanna","year":"2025","journal-title":"Med Biol Eng Comput"},{"key":"pone.0339851.ref005","doi-asserted-by":"crossref","first-page":"110960","DOI":"10.1016\/j.jocn.2024.110960","article-title":"Predicting the biomechanical behavior of lumbar intervertebral discs: a comparative finite element analysis of a novel artificial disc design","volume":"132","author":"A Khanna","year":"2025","journal-title":"J Clin Neurosci"},{"issue":"3","key":"pone.0339851.ref006","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jbiomech.2011.11.045","article-title":"Friction in metal-on-metal total disc arthroplasty: effect of ball radius","volume":"45","author":"P Moghadas","year":"2012","journal-title":"J Biomech"},{"key":"pone.0339851.ref007","unstructured":"K\u00f6lle L, Ignasiak D, Ferguson S, Helgason B. 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