Back pain is a common complaint and the origin of this frequently attributed to degenerative disc disease. In the most severe cases, the integrity of the disc and surrounding tissue is lost to such an extent that surgical intervention is necessary. Fusion procedures are commonly used to treat severely degenerated discs. Yet this is known to alter the biomechanics of the operated level, and may create a progression of degenerative decline. Total disc replacement has emerged as a viable treatment but the complexity of the spine is reflected in the clinical results, which trail far behind the success of hip and knee arthroplasty. This may be due to a failure of total disc replacement procedures to restore the natural biomechanics of the spine. The present study has led to the development of a dynamic pre-clinical testing protocol to quantitatively assess the efficacy of disc replacement devices. A six-axis spine simulator was designed and built, and the stiffness matrix testing of porcine lumbar specimens was completed, both with and without an axial preload. Intact specimens were tested, and the testing repeated after a total disc replacement procedure with a DePuy In Motion artificial disc. This is the first study to complete dynamic six-axis spinal testing of this kind. The testing demonstrated the disc replacement device compared favourably with the intact porcine disc both in shear and axial stiffness. However, the low-friction, double ball and socket design of the In Motion device lacks stiffness in the three rotational axes, and it is unstable in lateral bending. Rotations are the primary movements in the spine, and it is crucial if the natural biomechanics are to be restored, that a disc replacement device should replicate the stiffnesses of these axes. The next generation of disc replacement devices feature elastomeric materials that may more closely replicate the natural intervertebral disc. From patents registered with DePuy, this may also be true of the next generation of In Motion disc. This research provides a means to complete standardised performance tests of new spinal devices and lays the foundations for future comparison studies. Additionally, the spine simulator and testing protocol would provide valuable data during the design stage of new total disc replacements, aiding the development of the next generation of artificial discs.

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