Artificial cervical disc replacement: Principles, types and techniques

Sekhon, Lali H.S.; Ball, Jonathon

doi:10.4103/0028-3886.22611

Cited by 61 publications

(35 citation statements)

References 30 publications

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“…They should also restore the physiologic range of motion, be able to restore disc height, and transmit axial loading forces from the superior vertebral body to the one inferior [68]. Chang et al [69] found that following TDR, the facet loads increased at the index level in all the bending modes, with maximum in extension.…”

Section: Facet Joint Loadingmentioning

confidence: 99%

Parameters that effect spine biomechanics following cervical disc replacement

et al. 2011

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Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long-term clinical data proving the efficacy of the implants is lacking. Limited clinical data suggest somewhat of a disagreement between the in vitro biomechanical studies and in vivo assessments. This conceptual paper presents the potential biomechanical challenges affecting the TDR that should be addressed with a hope to improve the clinical outcomes and our understanding of the devices. Appropriate literature and our own research findings comparing the biomechanics of different disc designs are presented to highlight the need for additional investigations. The biomechanical effects of various surgical procedures are analyzed, reiterating the importance of parameters like preserving uncinate processes, disc placement and its orientation within the cervical spine. Moreover, the need for a 360°dynamic system for disc recipients who may experience whiplash injuries is explored. Probabilistic studies as performed already in the lumbar spine may explore high risk combinations of different parameters and explain the differences between ''standard'' biomechanical investigations and clinical studies. Development of a patient specific optimized finite element model that takes muscle forces into consideration may help resolve the discrepancies between biomechanics of TDR and the clinical studies.Factors affecting long-term performance such as bone remodeling, subsidence, and wear are elaborated. In vivo assessment of segmental spine motion has been, and continues to be, a challenge. In general, clinical studies while reporting the data have placed lesser emphasis on kinematics following intervertebral disc replacements. Evaluation of in vivo kinematics following TDR to analyze the quality and quantity of motion using stereoradiogrammetric technique may be needed.

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Section: Facet Joint Loadingmentioning

confidence: 99%

Parameters that effect spine biomechanics following cervical disc replacement

et al. 2011

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“…Anterior approach includes traditional ACDF, artificial disc replacement, and anterior transcorporeal disc resection [15,16]. Postoperative dysphagia and risks of violation of the esophagus or recurrent laryngeal nerve during operation are well-known complications of anterior cervical approaches, although each method can produce good clinical results.…”

Section: Discussionmentioning

confidence: 99%

Tandem keyhole foraminotomy in the treatment of cervical radiculopathy: retrospective review of 35 cases

et al. 2014

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BackgroundThere has been no report regarding the results of two-level keyhole foraminotomy. The purpose of this study was to detail clinical outcomes following consecutive two-level cervical foraminotomy (tandem keyhole foraminotomy (TKF)) in patients with radiculopathy.MethodsThe authors conducted a retrospective review of 35 cases involving patients treated by a single surgeon using TKF. Clinical symptoms, data of physical examinations, pathology and clinical outcomes were detailed and discussed about this surgical method.ResultsPatients consisted of cervical disc herniation (CDH) (19/35), cervical spondylotic radiculopathy (CSR) (13/35), and cervical spondylotic amyotrophy (CSA) (3/35). TKF was performed from C3 to C5 in 2 patients (6%), from C4 to C6 in 7 patients (20%), from C5 to C7 in 23 patients (66%), and from C6 to T1 in 3 patients (8%). The mean operative duration was 99.2 min (range, 72 to 168 min). The mean estimated blood loss was 55.8 g (range, 0 to 200 g). Radicular pain was relieved within 3 months in 88% (29/32) and in 97% (31/32) at final follow-up. Resolution of muscle weakness was recognized within 6 months after operation in all CSA cases. Sixty-six percent of patients showed a greater than 20% deficit in grip weakness on the affected side compared with the normal side. After pain was relieved, grip strength improved by more than 15%.ConclusionsTKF is a safe and highly effective procedure for patients with cervical radiculopathy and does not require invasive preoperative examinations. Further investigation is required to determine the effects of consecutive facetectomy.

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“…In order to protect the facet joints from abnormal stresses, cervical arthroplasty devices should have an axis of rotation that mimics the kinematics of the normal spine. They should also restore physiologic range of motion, be able to restore disc height, and transmit axial loading forces from the superior vertebral body to the one inferior [14]. …”

Section: Rationale Of Cervical Arthroplastymentioning

confidence: 99%

“…Cobalt–chrome is commonly considered as biocompatible with advantageous mechanical properties. However, this does significantly interfere with potential future imaging studies such as CT and MRI [14, 30]. Stainless steel is similarly biocompatible and less expensive to fabricate but has a high modulus of elasticity which may be related to subsidence.…”

Section: Design Considerationsmentioning

confidence: 99%