{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:33:37Z","timestamp":1789601617447,"version":"build-2803163510"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>The purpose of this study was to evaluate the failure risk of cervical vertebrae after total disc replacement with a keel-design prosthesis (ProDisc-C), taking into consideration the effects of vertebral body height, multilevel replacement, and the association with an adjacent fusion cage. Although promising clinical results have been reported for the ProDisc-C, some clinical studies have reported vertebral body\u2013splitting fractures at single- and multilevel arthroplasty sites. This implant has central keels to provide solid initial stability, and some authors associate the potential risk of vertebral body failure with the keel design, especially in patients with small vertebral body height or when the implant is used at multiple levels.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The study was performed using a specimen-specific C4\u20136 cervical-segment finite-element model to assess the compressive strains on the C-5 vertebral body for each cervical segment configuration, and synthetic polyurethane models to experimentally predict the compressive load at failure for 3 vertebral body heights.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The use of a keeled ProDisc-C prosthesis at multiple levels or in combination with a fusion cage increases by a factor of 2\u20133 the compressive strains at the C-5 vertebral body relative to single-level arthroplasty. All implanted segment configurations tested demonstrated a continuum of the load at failure and the vertebral body height, but no significant differences were found between the 3 vertebral body heights in each segment configuration.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The use of a keeled ProDisc-C prosthesis at 2 adjacent levels or combined with a fusion cage presented the lowest load-at-failure values, 2 times higher on average than the ones occurring during physiological tasks. This fact indicates an identical and limited risk of vertebral body failure for these 2 segment configurations, whereas vertebral body height appears to slightly affect this risk. However, for some tasks that place higher physical demands on the neck, beyond what was represented by our models, there may also be risk of microdamage initiation, which is not present in the single-level arthroplasty.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.spine14217","type":"journal-article","created":{"date-parts":[[2015,3,6]],"date-time":"2015-03-06T15:01:03Z","timestamp":1425654063000},"page":"639-646","source":"Crossref","is-referenced-by-count":16,"title":["Failure analysis of C-5 after total disc replacement with ProDisc-C at 1 and 2 levels and in combination with a fusion cage: finite-element and biomechanical models"],"prefix":"10.3171","volume":"22","author":[{"given":"Ant\u00f3nio","family":"Completo","sequence":"first","affiliation":[{"name":"Mechanical Engineering Department, University of Aveiro; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Orthopedics Department, Coimbra University Hospital, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f3nio","family":"Ramos","sequence":"additional","affiliation":[{"name":"Mechanical Engineering Department, University of Aveiro; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Mechanical Engineering Department, University of Aveiro; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine14217","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E194","DOI":"10.1227\/01.NEU.0000163419.59635.78","article-title":"Fusion around cervical disc prosthesis: case report","volume":"57","author":"Bartels","year":"2005"},{"key":"b2-spine14217","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1097\/00007632-200103150-00013","article-title":"The effects of hook pattern and kyphotic angulation on mechanical strength and apical rod strain in a long-segment posterior construct using a synthetic model","volume":"26","author":"Belmont","year":"2001"},{"key":"b3-spine14217","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.ocl.2005.02.009","article-title":"Cervical total disc replacement, part two: clinical results","volume":"36","author":"Bertagnoli","year":"2005"},{"key":"b4-spine14217","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3171\/spi.2005.2.4.0403","article-title":"Early results after ProDisc-C cervical disc replacement","volume":"2","author":"Bertagnoli","year":"2005"},{"key":"b5-spine14217","series-title":"Fundamentals of Orthopaedic Biomechanics","author":"Burstein","year":"1994"},{"key":"b6-spine14217","series-title":"Neurosurg Rev","first-page":"53","article-title":"Biomechanical comparison of inside-outside screws, cables, and regular screws, using a sawbone model","volume":"28","author":"Caglar","year":"2005"},{"key":"b7-spine14217","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1016\/0021-9290(92)90051-2","article-title":"A comparison of the fatigue behavior of human trabecular and cortical bone tissue","volume":"25","author":"Choi","year":"1992"},{"key":"b8-spine14217","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"214","DOI":"10.3171\/2009.9.SPINE08952","article-title":"Comparative fixation methods of cervical disc arthroplasty versus conventional methods of anterior cervical arthrodesis: serration, teeth, keels, or screws?","volume":"12","author":"Cunningham","year":"2010"},{"key":"b9-spine14217","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1097\/01.bsd.0000211258.90378.10","article-title":"Sagittal split fractures in multilevel cervical arthroplasty using a keeled prosthesis","volume":"20","author":"Datta","year":"2007"},{"issue":"Suppl 5","key":"b10-spine14217","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S653","DOI":"10.1007\/s00586-009-1211-6","article-title":"Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation","volume":"21","author":"Faizan","year":"2012"},{"key":"b11-spine14217","series-title":"J Anat","first-page":"115","article-title":"Sagittal evaluation of elemental geometrical dimensions of human vertebrae","volume":"143","author":"Gilad","year":"1985"},{"key":"b12-spine14217","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1016\/j.jbiomech.2010.03.003","article-title":"Cross-shear implementation in sliding-distance-coupled finite element analysis of wear in metal-on-polyethylene total joint arthroplasty: intervertebral total disc replacement as an illustrative application","volume":"43","author":"Goreham-Voss","year":"2010"},{"key":"b13-spine14217","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/S0021-9290(99)00072-X","article-title":"An improved method for measuring tibiofemoral contact areas in total knee arthroplasty: a comparison of K-scan sensor and Fuji film","volume":"32","author":"Harris","year":"1999"},{"key":"b14-spine14217","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1097\/00007632-199907150-00004","article-title":"Static and fatigue biomechanical properties of anterior thoracolumbar instrumentation systems. A synthetic testing model","volume":"24","author":"Kotani","year":"1999"},{"key":"b15-spine14217","series-title":"J Anat","first-page":"189","article-title":"The role of zygapophysial joint orientation and uncinate processes in controlling motion in the cervical spine","volume":"178","author":"Milne","year":"1991"},{"issue":"Suppl 3","key":"b16-spine14217","series-title":"Surg Neurol Int","doi-asserted-by":"publisher","first-page":"S216","DOI":"10.4103\/2152-7806.98582","article-title":"Cervical disc arthroplasty: pros and cons","volume":"3","author":"Moatz","year":"2012"},{"key":"b17-spine14217","series-title":"J Orthop Res","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1002\/jor.1100060514","article-title":"Analysis and measurement of neck loads","volume":"6","author":"Moroney","year":"1988"},{"key":"b18-spine14217","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.jbiomech.2004.05.013","article-title":"Trabecular bone microdamage and microstructural stresses under uniaxial compression","volume":"38","author":"Nagaraja","year":"2005"},{"key":"b19-spine14217","series-title":"Nat Mater","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1038\/nmat832","article-title":"Mechanistic fracture criteria for the failure of human cortical bone","volume":"2","author":"Nalla","year":"2003"},{"key":"b20-spine14217","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1097\/00007632-200007010-00007","article-title":"The effect of kyphosis on the mechanical strength of a long-segment posterior construct using a synthetic model","volume":"25","author":"Orchowski","year":"2000"},{"key":"b21-spine14217","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3171\/spi.2005.2.3.0377","article-title":"Cervical arthroplasty complicated by delayed spontaneous fusion. Case report","volume":"2","author":"Parkinson","year":"2005"},{"key":"b22-spine14217","series-title":"Med Eng Phys","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.medengphy.2005.06.003","article-title":"Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions","volume":"28","author":"Peng","year":"2006"},{"key":"b23-spine14217","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E867","DOI":"10.1097\/01.brs.0000244658.35865.59","article-title":"A comparison of pullout strength for pedicle screws of different designs: a study using tapped and untapped pilot holes","volume":"31","author":"Pfeiffer","year":"2006"},{"key":"b24-spine14217","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00586-002-0505-8","article-title":"Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis","volume":"12","author":"Polikeit","year":"2003"},{"key":"b25-spine14217","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/BF02427846","article-title":"Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine","volume":"8","author":"Pooni","year":"1986"},{"key":"b26-spine14217","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1097\/01.bsd.0000159035.35365.df","article-title":"Vertical split fracture of the vertebral body following total disc replacement using ProDisc: report of two cases","volume":"18","author":"Shim","year":"2005"},{"key":"b27-spine14217","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/BSD.0b013e31803b95db","article-title":"Posterior avulsion fracture at adjacent vertebral body during cervical disc replacement with ProDisc-C: a case report","volume":"20","author":"Shim","year":"2007"},{"key":"b28-spine14217","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ijsp.2011.12.004","article-title":"Prevention of vertebral body\u2013splitting fractures after multilevel ProDisc-L implantation","volume":"6","author":"Sullivan","year":"2012"},{"key":"b29-spine14217","series-title":"J Appl Biomater","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1002\/jab.770040309","article-title":"Characterization of a synthetic foam as a model for human cancellous bone","volume":"4","author":"Szivek","year":"1993"},{"key":"b30-spine14217","series-title":"J Orthop Sci","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1007\/s007760050127","article-title":"Biomechanical study of the development of scoliosis, using a thoracolumbar spine model","volume":"4","author":"Takemura","year":"1999"},{"key":"b31-spine14217","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1302\/0301-620X.79B2.0790181","article-title":"Fatigue failure of cancellous bone: a possible cause of implant migration and loosening","volume":"79","author":"Taylor","year":"1997"},{"key":"b32-spine14217","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1097\/01.BRS.0000084881.11695.50","article-title":"Failure of human cervical endplates: a cadaveric experimental model","volume":"28","author":"Truumees","year":"2003"},{"key":"b33-spine14217","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"231","DOI":"10.3171\/2011.11.SPINE11210","article-title":"Vertebral body split fracture after a single-level cervical total disc replacement","volume":"16","author":"Tu","year":"2012"},{"key":"b34-spine14217","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3171\/2010.11.SPINE10444","article-title":"Heterotopic ossification after cervical total disc replacement: determination by CT and effects on clinical outcomes","volume":"14","author":"Tu","year":"2011"},{"key":"b35-spine14217","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/S0021-9290(00)00069-5","article-title":"Critical evaluation of known bone material properties to realize anisotropic FE-simulation of the proximal femur","volume":"33","author":"Wirtz","year":"2000"},{"key":"b36-spine14217","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1097\/BSD.0b013e318157d382","article-title":"Correlation of ProDisc-C failure strength with cervical bone mineral content and endplate strength","volume":"21","author":"Zhang","year":"2008"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/6\/article-p639.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/6\/article-p639.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/6\/article-p639.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:24:15Z","timestamp":1681593855000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/6\/article-p639.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6]]},"references-count":36,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.spine14217","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2015,6]]}}}