Cervical Total Disc Replacement: Novel Devices

Guyer, Richard D.; Albano, Joseph; Ohnmeiss, Donna D.

doi:10.1016/j.nec.2021.05.004

Cited by 3 publications

(5 citation statements)

References 45 publications

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“…Starting in the 2000s, the clinical effectiveness of cTDR has been supported by randomized clinical trials, now with intermediate- and long-term follow-up [ 2 , 4 – 10 ]. Early cTDR designs were often based on traditional orthopaedic biomaterials, including polyethylene, CoCr alloys and Ti alloys [ 3 , 10 ], but the lower biomechanical loading demands of the cervical spine relative to the lumbar spine have also encouraged innovative designers to investigate new bearing materials [ 11 ], incorporating metallic alloys, ceramics, polycarbonate urethane, and/or PEEK, with no previous clinical precedent as bearing materials in large total joint replacements. As cTDR designs and its biomaterials continue to evolve, and as utilization of the procedure increases with longer historical exposure, there has been increased attention on identifying mechanisms of cTDR failure [ 12 ], such as subsidence, migration, and/or wear, along with recommended treatment paradigms for each clinical failure scenario [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Khachatryan,

Phillips,

Lanman

et al. 2024

J Orthop Surg Res

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Background The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR. Methods Aided by serial plain radiographs from recent cTDR cases (34 patients; 44 devices), a panel of experts assembled for the purpose of creating a classification system to aid in reproducibly and accurately identifying bony changes and assessing cTDR radiographic appearance. Subdividing the superior and inferior vertebral bodies into 3 equal sections, observed bone loss such as endplate rounding, cystic erosion adjacent to the endplate, and cystic erosion not adjacent to the endplate, is recorded. Determining if bone loss is progressive, based on serial radiographs, and estimating severity of bone loss (measured by the percentage of end plate involved) is recorded. Additional relevant bony changes and device observations include radiolucent lines, heterotopic ossification, vertebral body olisthesis, loss of core implant height, and presence of device migration, and subsidence. Results Serial radiographs from 19 patients (25 devices) implanted with a variety of cTDR designs were assessed by 6 investigators including clinicians and scientists experienced in cTDR or appendicular skeleton joint replacement. The overall agreement of assessments ranged from 49.9% (95% bootstrap confidence interval 45.1–73.1%) to 94.7% (95% CI 86.9–100.0%). There was reasonable agreement on the presence or absence of bone loss or radiolucencies (range: 58.4% (95% CI 51.5–82.7%) to 94.7% (95% CI 86.9–100.0%), as well as in the progression of radiolucent lines (82.9% (95% CI 74.4–96.5%)). Conclusions The novel classification system proposed demonstrated good concordance among experienced investigators in this field and represents a useful advancement for improving reporting in cTDR studies.

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Section: Introductionmentioning

confidence: 99%

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Khachatryan,

Phillips,

Lanman

et al. 2024

J Orthop Surg Res

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“…The annual number of cervical disc replacements performed is witnessing steady incremental annual increases of approximately 17% [ 10 ]. Many comparative studies, as well as systematic reviews, have extensively evaluated the short- and long-term outcomes of ACDF and CDA for single-level cervical DDD [ 11 , 12 , 13 , 14 , 15 ]. In general, CDA has been shown to produce better results than ACDF, including higher overall success rates, lower pain scores for both arm and neck, and lower reoperation rates for discs replaced at adjacent levels.…”

Section: Introductionmentioning

confidence: 99%

“…In general, CDA has been shown to produce better results than ACDF, including higher overall success rates, lower pain scores for both arm and neck, and lower reoperation rates for discs replaced at adjacent levels. Additionally, CDA provides significant advantages over ACDF by maintaining mobility capability at the injured levels and maximizing the restoration of the biomechanical qualities of an intact cervical spine [ 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis

Chen,

Yang,

2024

JCM

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Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949–3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169–0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.

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“…The acceptance and use of these devices have increased significantly over the past decade 6 . With the increased adoption of CDA, there has been a significant expansion of device options in the market, designed with a variety of materials, articulations, and geometries 7,8 …”

mentioning

confidence: 99%

“…6 With the increased adoption of CDA, there has been a significant expansion of device options in the market, designed with a variety of materials, articulations, and geometries. 7,8 WHAT WE KNOW…”

mentioning

confidence: 99%

Past, Present, and Future of Cervical Disc Arthroplasty

Du,

Gonzalez,

Albert

et al. 2023

Clinical Spine Surgery: A Spine Publication

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T he cervical spine is a sophisticated biomechanical structure that provides for mobility while maintaining horizontal gaze. Unfortunately, due to pathology such as degeneration, trauma, and infection, there is a significant disease burden of the cervical spine resulting in conditions such as radiculopathy and myelopathy. 1,2 In the degenerative population, cervical spine surgery is an option for patients who have exhausted nonoperative management efforts or have progressive neurologic deficits. Over the last century, anterior cervical discectomy and fusion (ACDF) has been shown to be an effective operation for pathologic conditions due to the ability to decompress the neural elements and stabilize the spine at the surgical site. 3 This is following the natural history of cervical degener-

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Cervical Total Disc Replacement: Novel Devices

Cited by 3 publications

References 45 publications

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis

Past, Present, and Future of Cervical Disc Arthroplasty

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