A variety of lumbar total disc replacement (TDR) designs exist for the treatment of disc pathologies and several of which have undergone clinical trials. A key design parameter for a constrained ball and socket type device is a fixed center of rotation (CoR). A previous study  demonstrated that the lumbar motion segment unit (MSU) was highly sensitive to the anatomical location of the sagittal plane rotational axis. Malalignment between the implant CoR and the inherent rotational axis of the MSU may lead to an overloaded or over-constrained condition.
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Robotic Simulation of the Effects of Surgical Placement of the ProDisc-L on Motion Segment Mechanics: An In Vitro Human Cadaveric Lumbar Model
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Dhillon, BK, Wido, DM, DiAngelo, DJ, Bertagnoli, R, & Kelly, BP. "Robotic Simulation of the Effects of Surgical Placement of the ProDisc-L on Motion Segment Mechanics: An In Vitro Human Cadaveric Lumbar Model." Proceedings of the ASME 2010 Summer Bioengineering Conference. ASME 2010 Summer Bioengineering Conference, Parts A and B. Naples, Florida, USA. June 16–19, 2010. pp. 491-492. ASME. https://doi.org/10.1115/SBC2010-19398
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