Reducing facet joint overload with a Kevlar-augmented lumbar disc replacement: An ex vivo investigation

Facet joint overload often causes persistent low back pain after lumbar total disc replacement (TDR). This study is the first to test whether adding an anterior Kevlar band (K) can restore normal facet joint loading after lumbar TDR. We tested six human lumbosacral spines under four conditions: inta...

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Published in:Clinical biomechanics (Bristol) Vol. 130; p. 106672
Main Authors: Vanaclocha, V., Atienza, C., Vanaclocha, A., Jorda-Gomez, P., Peñuelas, A., Medina-Ripoll, E., Gómez-Pérez, A., Saiz-Sapena, N., Vanaclocha, L.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.12.2025
Subjects:
Adjacent segment disease
Aged
Annulus reinforcement
Biomechanical Phenomena
Biomechanics
Diskectomy
Facet joint pressure
Female
Humans
Intervertebral Disc - surgery
Lumbar total disc replacement
Lumbar Vertebrae - physiopathology
Lumbar Vertebrae - surgery
Male
Middle Aged
Physical Medicine and Rehabilitation
Pressure
Prostheses and Implants
Prosthesis Design
Range of Motion, Articular
Spinal prosthesis
Total Disc Replacement - instrumentation
Total Disc Replacement - methods
Weight-Bearing
Zygapophyseal Joint - physiopathology
Zygapophyseal Joint - surgery
Biomechanics
Adjacent segment disease
Facet joint pressure
Lumbar total disc replacement
Annulus reinforcement
Spinal prosthesis
ISSN:0268-0033, 1879-1271, 1879-1271
Online Access:Get full text
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Summary:Facet joint overload often causes persistent low back pain after lumbar total disc replacement (TDR). This study is the first to test whether adding an anterior Kevlar band (K) can restore normal facet joint loading after lumbar TDR. We tested six human lumbosacral spines under four conditions: intact, after discectomy, with the ADDISC prosthesis, and with ADDISC plus Kevlar reinforcement. Facet joint pressures were measured at L3–L4, L4–L5, and L5–S1 during flexion, extension, lateral bending, and axial rotation. Discectomy caused a significant rise in facet pressures, especially during extension and axial rotation (p < 0.01). The ADDISC prosthesis lowered facet pressures but did not fully return them to baseline. Kevlar reinforcement lowered pressures by up to 35 % compared to the prosthesis alone, nearing intact spine levels, especially in flexion and extension. Kevlar reinforcement improves load distribution more than the prosthesis alone. It may help prevent facet degeneration and adjacent segment disease, offering a better biomechanical option for motion-preserving spine surgery. The combination of the ADDISC prosthesis and Kevlar reinforcement may help prevent facet joint degeneration and adjacent segment disease, potentially enhancing long-term outcomes in lumbar disc arthroplasty. [Display omitted] •Kevlar band reinforcement reduces facet joint pressure after lumbar disc replacement•ADDISC prosthesis improves pressure profiles vs. discectomy alone in cadaveric testing•Combined prosthesis and Kevlar band closely restore physiological facet load sharing•Highest joint pressures occurred in extension and axial rotation post-discectomy•Reinforcement may lower the risk of facet degeneration and adjacent segment disease
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ISSN:0268-0033
1879-1271
1879-1271
DOI:10.1016/j.clinbiomech.2025.106672