Cervical Total Disk Replacement

Guyer, Richard D.; Coric, Domagoj; Nunley, Pierce D.; Ohnmeiss, Donna D.

doi:10.1097/bsd.0000000000001314

Clinical Spine Surgery: A Spine Publication

2022

DOI: 10.1097/bsd.0000000000001314

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Cervical Total Disk Replacement

Richard D. Guyer

Domagoj Coric

Pierce D. Nunley

et al.

Abstract: Study Design: This study was a post hoc analysis of data collected from 2 Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials. Objective: The purposes of this study were to: (1) measure disk space heights adjacent to the level to be treated with a total disk replacement (TDR); (2) analyze cervical disk space heights to be replaced with TDR; and (3) investigate the frequency of use of a smaller height TDR when available. Summary of Background Data: Cervical TDR produces outcomes… Show more

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Cited by 3 publications

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Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy

Blumenthal,

Ohnmeiss,

Courtois

et al. 2024

Eur Spine J

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Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy

Blumenthal,

Ohnmeiss,

Courtois

et al. 2024

Eur Spine J

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Optimal Implant Sizing Using Machine Learning Is Associated With Increased Range of Motion After Cervical Disk Arthroplasty

Lakomkin,

Pennington,

Bhandarkar

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Cervical disk arthroplasty (CDA) offers the advantage of motion preservation in the treatment of focal cervical pathology. At present, implant sizing is performed using subjective tactile feedback and imaging of trial cages. This study aims to construct interpretable machine learning (IML) models to accurately predict postoperative range of motion (ROM) and identify the optimal implant sizes that maximize ROM in patients undergoing CDA. METHODS: Adult patients who underwent CDA for single-level disease from 2012 to 2020 were identified. Patient demographics, comorbidities, and outcomes were collected, including symptoms, examination findings, subsidence, and reoperation. Affected disk height, healthy rostral disk height, and implant height were collected at sequential time points. Linear regression and IML models, including bagged regression tree, bagged multivariate adaptive regression spline, and k-nearest neighbors, were used to predict ROM change. Model performance was assessed by calculating the root mean square error (RMSE) between predicted and actual changes in ROM in the validation cohort. Variable importance was assessed using RMSE loss. Area under the curve analyses were performed to identify the ideal implant size cutoffs in predicting improved ROM. RESULTS: Forty-seven patients were included. The average RMSE between predicted and actual ROM was 7.6° (range: 5.8-10.1) in the k-nearest neighbors model, 7.8° (range: 6.5-10.0) in the bagged regression tree model, 7.8° (range: 6.2-10.0) in the bagged multivariate adaptive regression spline model, and 15.8° (range: 14.3-17.5°) in a linear regression model. In the highest-performing IML model, graft size was the most important predictor with RMSE loss of 6.2, followed by age (RMSE loss = 5.9) and preoperative caudal disk height (RMSE loss = 5.8). Implant size at 110% of the normal adjacent disk height was the optimal cutoff associated with improved ROM. CONCLUSION: IML models can reliably predict change in ROM after CDA within an average of 7.6 degrees of error. Implants sized comparably with the healthy adjacent disk may maximize ROM.

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Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study

Tan¹,

Patwardhan²,

Thani³

2023

J Spine Surg

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Background The quality of flexion-extension motion after cervical disc arthroplasty has been a subject of interest due to the number of available devices with different designs and kinematics. Previous studies of motion quality have been limited to measuring the range of motion using two radiographs taken at the extremes of flexion and extension. This is the first study evaluating the in vivo quality of index segment motion using fluoroscopic images collected over the arc of flexion-extension after M6-C cervical disc arthroplasty surgery. Methods Eligible participants had previously undergone a single-level cervical disc arthroplasty surgery for degenerative cervical spine disease performed by the senior author. Study participants underwent dynamic lateral fluoroscopic imaging to capture the C2-C7 motion between maximal flexion and extension. The amount of motion contribution by individual segments to the C2-C7 motion (termed segmental motion fraction) and its variation throughout the arc of flexion-extension were compared between the index and adjacent segments. The shift of centre of rotation during the arc of motion was also assessed. Results Ten subjects with a mean age of 43.8 years old were recruited, with an average follow-up of 16.2 months at the time of fluoroscopy. The C2-C7 cervical spine had an average flexion-extension range of 66.7 degrees. The contribution of the index segment averaged over the flexion-extension arc of motion was 18.9% (peak contribution 24.4%) for the C5-C6 group; and 15.5% (peak contribution 25.5%) for the C6-C7 group. The mean cranial-caudal location of the centre of rotation progressively shifted in the cranial direction from C2-C3 to C6-C7 motion segment. Conclusions Our results demonstrated physiologic quality of motion at the index segment and harmony among its neighbouring segments following cervical disc arthroplasty, without gearshift-like intermittent locking of the prosthesis during the arc of flexion-extension motion. This pilot study provides a basis for the design of future long-term studies with larger sample size to compare the quality of motion between different cervical disc prostheses using the concept of segmental motion fraction as a motion-quality metric.

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Cervical Total Disk Replacement

Cited by 3 publications

References 18 publications

Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy

Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy

Optimal Implant Sizing Using Machine Learning Is Associated With Increased Range of Motion After Cervical Disk Arthroplasty

Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study

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