Goals of cervical disc replacement

Albert, Todd J.; Eichenbaum, Matthew D.

doi:10.1016/j.spinee.2004.07.023

Cited by 34 publications

(11 citation statements)

References 13 publications

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“…Indeed, it is not clear whether or not ASD is due to the physiological ageing of the spine or to alterations induced by previous fusion [21]. Furthermore, fusion can be associated with other problems like pseudoarthrosis [28], graftdonor site complications and alterations of the adjacent motion segments' biomechanics.…”

Section: Discussionmentioning

confidence: 99%

Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

et al. 2009

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We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion-nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3-15 degrees ) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors' best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

et al. 2009

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“…ACDF is a reliable procedure with a fusion rate of between 85% and 95% [2,26]. Cervical plates are used to stabilize the segment(s), affording solid fusion of the grafted bone, probably due to enhanced compression of the graft [19].…”

Section: Introductionmentioning

confidence: 99%

Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study

Terai

Faizan

Sairyo

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Anterior cervical discectomy and fusion (ACDF) represent the standard treatment for cervical spondylolytic radiculopathy and myelopathy. To achieve solid fusion, appropriate compressive loading of the graft and stability are essential. Fusion may lead to adjacent segment degeneration. Artificial discs have been introduced as motion-preserving devices to reduce the risk of fusion-related complications. Questions/purposes We therefore asked: (1) Does the use of a plate reduce motion at the operated level and bone graft compression compared to fusion with bone graft alone; and (2) is adjacent-segment motion higher after fusion with a plate? Methods Motions and compressive loads in the graft were quantified for intact, C4-C5 ACDF without and with a plate, and total disc arthroplasty in human cadaver spines. Results At the surgery level all motions decreased for ACDF with a plate. The motions were similar to intact motions after total disc arthroplasty. The motions across the adjacent segment increased after fusion in all loading modes except lateral bending and were closer to the intact for the total disc arthroplasty case. The plate maintained a compressive load on the graft with a maximum increase in extension. Conclusions Unlike fusion, the arthroplasty can restore motion to normal at the surgery and adjacent segments, compared to fusion cases. A cervical plate with a precompression of the graft provides enhanced stability and fusion due to improved compression. Clinical Relevance Our findings support the clinical observations that fusion may lead to the degeneration of the adjacent segments. Disc arthroplasty may be able to circumvent the adjacent segment degeneration.

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“…It is not absolute whether or not anterior cervical discectomy is due to the physiological senescence of the spine or changes on the ground that previous fusion (Hilibrand et al, 2004). Fusion may be related with other causes such as pseudoarthrosis (Albert et al, 2004), donor site complications and factors of the neighborhood motion segments' biomechanics. The hybrid, single stage, fusion-nonfusion technique appears to be a promising and viable alternation in the treatment of symptomatic multilevel cervical DDD with prevalent anterior myeloradicular compression and different severity per single level, particularly in younger patients.…”

Section: Surgical Proceduresmentioning

confidence: 99%