In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant

DiAngelo, Denis J.; Foley, Kevin T.; Morrow, Brian R; Schwab, John S.; Song, Jung Suk; German, John W.; Blair, Eve

doi:10.3171/foc.2004.17.3.7

Cited by 113 publications

(76 citation statements)

References 28 publications

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“…1,10,16 With the option of arthroplasty, there is a theoretical assumption that reconstructing normal or near normal spinal biomechanics should diminish chances of further spinal degeneration and thus the development of ASD. 2,3,[6][7][8]11,15,18,19,21,23 Our study provides evidence supporting the hypothesis that arthroplasty may indeed be an alternative solution in a certain carefully selected cohort of ASD patients in whom conservative therapy has failed. Our results show that adequate decompression can be achieved along with improvement in the overall sagittal profile (as seen by an increase in cervical lordosis) due to an increase in the disc space angle and ROM at the treated level.…”

Section: Discussionsupporting

confidence: 69%

Adjacent-level arthroplasty following cervical fusion

Rajakumar¹,

Hari²,

Krishna³

et al. 2017

FOC

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OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1–3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2–7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow-up period. CONCLUSIONS Artificial cervical disc replacement in patients who have previously undergone cervical fusion surgery appears to be safe, with encouraging early clinical results based on this small case series, but more data from larger numbers of patients with long-term follow-up are needed. Arthroplasty may provide an additional tool for the management of post-fusion adjacent-level cervical disc disease in carefully selected patients.

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Section: Discussionsupporting

confidence: 69%

Adjacent-level arthroplasty following cervical fusion

Rajakumar¹,

Hari²,

Krishna³

et al. 2017

FOC

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“…Despite the promising accumulating clinical experience with disk replacements of varying designs, little work has been done to characterize the in vitro biomechanical features of varying replacements. DiAngelo et al [11] provided a biomechanical analysis of the ProDisc-C and demonstrated maintenance of normal motion at the treated and adjacent levels in all conditions except extension when compared with intact spines. Dmitriev et al [12] showed that the PCM implant maintained normal ROM at the treated and adjacent segments as well as maintaining normal intradiscal pressure at adjacent segments, parameters that are both increased in a fusion construct.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the implant is engineered to have a low profile without protrusion from the disk space and is secured via one midline keel in the superior level and two laterally placed keels in the inferior level to avoid conflict when multiple levels are instrumented. Despite the promising early clinical results and obvious theoretical benefits, there is a paucity of in vitro biomechanical data characterizing cervical arthroplasty devices in the literature [11,12,22]. In this study, we detail the kinematics of the entire subaxial cervical spine from C2 to C7 with the middle segment intact, treated by fusion, or replaced with an artificial disc implant.…”

Section: Introductionmentioning

confidence: 99%

Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty

et al. 2009

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An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4-C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI TM ,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2-C7) were tested in flexion/extension, lateral bending, and axial rotation under a ± 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4-C5 and tested. Then, a fusion using lateral mass fixation and an anterior plate was simulated and tested. Stiffness and range of motion (ROM) data were calculated. The ROM of the C4-C5 motion segment with the arthroplasty device was similar to that of the intact spine in flexion/extension and slightly less in lateral bending and rotation, while the fusion construct allowed significantly less motion in all directions. The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting.

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“…The development of adjacent segment degeneration (ASD) following anterior cervical decompression and fusion (ACDF) is well reported in the literature [4][5][6][7][8][9][10][11][12][13][14][15]. Within the past few decades, both in vivo and in vitro biomechanical evidence suggest that arthrodesis may augment stress on the unfused adjacent levels [16][17][18][19][20][21]. Hilibrand et al [7] reported an annualized incidence of 2.9 % per year for developing symptomatic ASD after singlelevel ACDF and estimated that about 25.6 % of patients would have symptomatic ASD within 10 years of their index surgery.…”

Section: Introductionmentioning

confidence: 99%

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

et al. 2015

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Purpose Adjacent segment degeneration (ASD) is known to occur after anterior cervical arthrodesis. However, it is not known whether cervical canal stenosis enhances the risk of ASD. The purpose of this study was to explore whether congenital stenosis could be used as a predictor of ASD after anterior cervical decompression and fusion (ACDF). Methods We enrolled 141 patients who had undergone ACDF for cervical myelopathy and/or radiculopathy, and had at least 6 years of follow-up. In standard radiographs of cervical spine in lateral view, bony congenital stenosis was evaluated and all patients were divided into two groups: stenosis (n = 63) and non-stenosis (n = 78). Radiographic ASD was assessed according to the criteria of Kellgren and Lawrence and correlated with symptomatic ASD. Clinical and radiological parameters were compared between the groups. The primary outcome was the rate of radiographic ASD after initial ACDF. The incidence of symptomatic ASD was assessed by Kaplan-Meier method. Results Radiographic ASD and symptomatic ASD developed in 46.8 % and 18.4 % of all patients, respectively. There was a significant association between congenital stenosis and radiographic ASD. The area under the receiver operating characteristic curve of preoperative anteroposterior (AP) diameter of cervical canal for predicting radiographic ASD was 0.756. 13.0 mm was the cutoff value of preoperative AP diameter of cervical canal predicting radiographic ASD. Kaplan-Meier analysis predicted a disease-free survival rate of symptomatic ASD in 97.2 % of patients at 5 years and 78.0 % at 10 years after ACDF. There was no significant difference in survival rates of the adjacent segment between the two groups via log-rank analysis (P = 0.102). Conclusion Congenital stenosis can increase the rate of radiographic ASD after initial ACDF. The cutoff value of 13.0 mm for preoperative AP diameter of cervical canal had the highest validity for predicting radiographic ASD.

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In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant

Cited by 113 publications

References 28 publications

Adjacent-level arthroplasty following cervical fusion

Adjacent-level arthroplasty following cervical fusion

Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

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