Subsidence of SB Charit, total disc replacement and the role of undersizing

Ilona Punt*, Marc van Rijsbergen, Bert van Rietbergen, Keita Ito, Lodewijk van Rhijn, Andre van Ooij, Paul Willems

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


A possible complication after total disc replacement (TDR) is subsidence, presumably caused by asymmetric implantation, implant undersizing or reduced bone quality. This study aims to quantify the degree of subsidence of an SB Charit, TDR, and investigate whether undersizing is related to subsidence. A custom developed software package (Mathworks) reconstructed 3D bone-implant geometry. A threshold for subsidence was determined by comparing penetrated bone volume (PBV) and rotation angles. Inter- and intra-observer reproducibilities were calculated. Subsidence was correlated to undersizing. High inter- and intra-observer correlation coefficients were found for the method (R > 0.92). Subsidence was quantified as PBV 700 mm(3) combined with a rotation angle > 7.5A degrees. A reduced risk of subsidence was correlated to > 60 and > 62 % of the bony endplate covered by the TDR endplate for L4 and L5, respectively. A reproducible method to determine undersizing was developed. Thresholds were determined related to a reduced risk of subsidence.
Original languageEnglish
Pages (from-to)2264-2270
JournalEuropean Spine Journal
Issue number10
Publication statusPublished - Oct 2013


  • Total disc replacement
  • Subsidence
  • Undersizing
  • Penetrated bone volume
  • Rotation angle


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