Artificial Disc Versus Fusion: Effect on Three-Dimensional Dynamic In Vivo Cervical Spine Motion

2011 ◽  
Author(s):  
Colin P. McDonald ◽  
Michael J. McDonald ◽  
Nicole L. Ramo ◽  
Stephen W. Bartol ◽  
Michael J. Bey
Keyword(s):  
Cervical Spine ◽  
Three Dimensional ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Artificial Disc ◽  
Disc Disease ◽  
Adjacent Disc ◽  
Spine Motion

Intervertebral disc degeneration in the cervical spine is a common condition that often manifests as cervical disc disease, resulting in pain, motor weakness and sensory deficits. The most common surgical treatment strategy involves removal of the diseased disc and fusion of the adjacent vertebrae. Although fusion typically relieves symptoms at the surgical site, evidence of degeneration in the adjacent disc has been reported in 25–92% of patients [1,2]. It has been hypothesized that the progression of adjacent segment degeneration is a result of increased motion at the segments adjacent to the site of fusion [3]. As a response to this proposed mechanism of degeneration, artificial discs were designed with the goals of preserving motion at the operative site and maintaining normal motion in the adjacent segments. However, the extent to which normal adjacent segment motion is maintained in artificial disc patients compared to fusion patients remains unknown. Thus, the objective of this study was to compare the dynamic, three-dimensional (3D) motion of the cervical spine in fusion patients and artificial disc replacement patients.

scholarly journals Two-level total disc replacement with Mobi-C(r) over 3-years

2014 ◽  
Vol 13 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Reginald Davis ◽  
Pierce Dalton Nunley ◽  
Kee Kim ◽  
Michael Hisey ◽  
Hyun Bae ◽  
...  
Keyword(s):  
Degenerative Disc Disease ◽  
Total Disc Replacement ◽  
Adjacent Segment Degeneration ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Artificial Disc ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Surgery Rates

Objective: To evaluate the safety and effectiveness of two-level total disc replacement (TDR) using a Mobi-C(r) Cervical Artificial Disc at the 36 month follow-up. Methods: a Prospective, randomized, controlled, multicenter clinical trial of an artificial cervical disc (Mobi-C(r) Cervical Artificial Disc) was conducted under the Investigational Device Exemptions (IDE) and the U.S. Food & Drug Administration (FDA) regulations. A total of 339 patients with degenerative disc disease were enrolled to receive either two-level treatment with TDR, or a two-level anterior cervical discectomy and fusion (ACDF) as control. The 234 TDR patients and 105 ACDF patients were followed up at regular time points for three years after surgery. Results: At 36 months, both groups demonstrated an improvement in clinical outcome measures and a comparable safety profile. NDI scores, SF-12 PCS scores, patient satisfaction, and overall success indicated greater statistically significant improvement from baseline for the TDR group, in comparison to the ACDF group. The TDR patients experienced lower subsequent surgery rates and a lower rate of adjacent segment degeneration. On average, the TDR patients maintained segmental range of motion through 36 months with no device failure. Conclusion: Results at three-years support TDR as a safe, effective and statistically superior alternative to ACDF for the treatment of degenerative disc disease at two contiguous cervical levels.

The future in the care of the cervical spine: interbody fusion and arthroplasty

2004 ◽  
Vol 1 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Regis W. Haid
Keyword(s):  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Cervical Fusion ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Fine Print

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Impact of Cervical Artificial Disc Implantation on the Biomechanical Function of Adjacent Segments

2013 ◽  
Vol 748 ◽  
pp. 358-364
Author(s):  
Wen Zhi Zhao ◽  
Bin Li ◽  
Bing Zhi Chen ◽  
Sheng Wei He ◽  
Jin Su ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Intervertebral Disc ◽  
Interbody Fusion ◽  
Element Model ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Artificial Disc ◽  
Range Of Movement ◽  
Fusion Surgery ◽  
Adjacent Segments

The range of movement(ROM) of adjacent segments and the change of intervertebral disc stress after implanting artificial cervical disc are investigated. The contact problem for bio-modeling is introduced. A normal cervical spine finite element model is proposed. The bone graft and fusion between C5 and C6 and C5/6 artificial disc implantation were simulated. The range of movement on adjacent segment and the change of intervertebral disc’s stress in such two cases are analyzed. Computational results show that the model includes the ligaments, joint capsule and other soft tissue structures, which is real, fine and high accuracy. When the adjacent intervertebral ROM was increased after interbody fusion surgery, the stress of corresponding intervertebral disc was increased obviously and the stress of upper segment of nucleus pulposus and annulus fibrosus were also increased about 70% ,besides the next-bit segments was increased about 40%. There were no differences among cervical spine ROM except extension (p> 0.05) after the implantation of artificial disc, and the stress on adjacent segments was increased less than 10%. The implantation of artificial cervical disc can release the stress on adjacent segments in a certain extent, and resume cervical activities at the same time.

Three-Dimensional In-Vivo Cervical Spine Kinematics: Preliminary Comparison of Fusion Patients and Normal Control Subjects

2009 ◽  
Author(s):  
Colin P. McDonald ◽  
Sukhinder K. Bilkhu ◽  
Victor Chang ◽  
Casey Bachison ◽  
Stephen W. Bartol ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Normal Control ◽  
Three Dimensional ◽  
The United States ◽  
Disc Disease ◽  
Control Subjects ◽  
Spine Kinematics ◽  
Vertebral Bodies

Degenerative disc disease (DDD) of the cervical spine is a common condition that causes significant pain and disability. Treatment for DDD in 2000 exceeded 110,000 patients in the United States alone [1]. A common treatment option for patients involves removal of the degenerated disc and fusion of the adjacent vertebral bodies. However, previous research has shown that as many as 25–92% of patients treated with fusion have disc degeneration at the adjacent levels within 10 years after surgery [2,3]. It has been hypothesized that this is the result of a change in adjacent vertebral segment motion [4]. However, it is unknown if spinal fusion alters motion at these segments. Thus, the objective of this study was to compare the dynamic, three-dimensional (3D) motion of the cervical spine in normal control subjects and spinal fusion patients.

scholarly journals Ranges of Cervical Intervertebral Disc Deformation During an In Vivo Dynamic Flexion–Extension of the Neck

2017 ◽  
Vol 139 (6) ◽  
Author(s):  
Yan Yu ◽  
Haiqing Mao ◽  
Jing-Sheng Li ◽  
Tsung-Yuan Tsai ◽  
Liming Cheng ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Imaging System ◽  
Human Subjects ◽  
Three Dimensional ◽  
Cervical Disc ◽  
Significant Difference ◽  
Flexion Extension ◽  
Fluoroscopic Imaging ◽  
Magnetic Resonance Imaging Mri

While abnormal loading is widely believed to cause cervical spine disc diseases, in vivo cervical disc deformation during dynamic neck motion has not been well delineated. This study investigated the range of cervical disc deformation during an in vivo functional flexion–extension of the neck. Ten asymptomatic human subjects were tested using a combined dual fluoroscopic imaging system (DFIS) and magnetic resonance imaging (MRI)-based three-dimensional (3D) modeling technique. Overall disc deformation was determined using the changes of the space geometry between upper and lower endplates of each intervertebral segment (C3/4, C4/5, C5/6, and C6/7). Five points (anterior, center, posterior, left, and right) of each disc were analyzed to examine the disc deformation distributions. The data indicated that between the functional maximum flexion and extension of the neck, the anterior points of the discs experienced large changes of distraction/compression deformation and shear deformation. The higher level discs experienced higher ranges of disc deformation. No significant difference was found in deformation ranges at posterior points of all the discs. The data indicated that the range of disc deformation is disc level dependent and the anterior region experienced larger changes of deformation than the center and posterior regions, except for the C6/7 disc. The data obtained from this study could serve as baseline knowledge for the understanding of the cervical spine disc biomechanics and for investigation of the biomechanical etiology of disc diseases. These data could also provide insights for development of motion preservation surgeries for cervical spine.

scholarly journals Cervical Total Disc Arthroplasty

2012 ◽  
Vol 2 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Rahul Basho ◽  
Kenneth A. Hood
Keyword(s):  
Cervical Spine ◽  
Surgical Techniques ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Arthroplasty ◽  
Definitive Answer ◽  
Investigational Device Exemption ◽  
Early Results

Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer.

Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study

2005 ◽  
Vol 3 (6) ◽  
pp. 417-423 ◽  
Author(s):  
James T. Robertson ◽  
Stephen M. Papadopoulos ◽  
Vincent C. Traynelis
Keyword(s):  
Cervical Disc ◽  
Adjacent Segment ◽  
Cervical Fusion ◽  
Adjacent Level ◽  
Disc Disease ◽  
Content Type ◽  
Arm Pain ◽  
Adjacent Disc ◽  
Adjacent Disc Disease ◽  
Fine Print

Object. The authors compared the incidence of radiologically documented changes and symptomatic adjacent-level cervical disc disease after single-level discectomy and subsequent cervical fusion or arthroplasty in two independent prospective clinical studies. Methods. The patients were treated with the Affinity Anterior Cervical Cage System or the Bryan Artificial Cervical Disc. In each study the patients were required to undergo serial cervical radiography preoperatively and 24 months postoperatively, as well as serial clinical evaluations including documentation of adverse events, neurological status, and results of the 36-item Short Form Health Survey. All serial radiographs were reviewed prior to evaluating the clinical symptoms for development of increasing or new adjacent degenerative disc disease (DDD). Subsequently, the clinical data were analyzed. For various reasons of exclusion, the cases analyzed in the Bryan disc—treated cohort consisted of 74 patients and in the Affinity system—treated cohort there were 158 patients. New anterior osteophyte formation or enlargement, increased narrowing of an interspace, new DDD, and calcification of the anterior longitudinal ligament were the radiological findings indicative of adjacent-level disease. Fusion was associated with a significant increase in x-ray film—based changes of adjacent-disc disease (p = 0.009, odds ratio [OR] 2.44). In the cage fusion series, the incidence of symptomatic adjacent-level DDD was statistically greater than that in the group treated with the artificial disc (p = 0.018), and the patients required a statistically greater number of medical treatments related to episodic symptoms of neck, shoulder, and arm pain attributed to new disc disease (p = 0.001, OR 35.8). Conclusions. In comparing these prospective studies the authors demonstrated that maintaining motion rather than fusion will prevent symptomatic adjacent-disc disease and will decrease adjacent-level radiological indicators of disease at a 24-month postoperative interval.

scholarly journals Evaluation of Adjacent Segment Degeneration after Cervical Spine Surgery: Arthroplasty versus Fusion

2013 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Saeed Hamidi ◽  
Neda Fahimi ◽  
Ehsan Jangholi ◽  
Mohammad Ali Fahimi ◽  
Ali Farshad ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Increased Risk ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Anterior Cervical Discectomy and Fusion (ACDF) is an effective treatment for disc herniations; but some studies demonstrated that in the untreated levels adjacent to a fusion, increased motion might lead to an increased risk of adjacent segment degeneration (ASD). On the other hand, methods of cervical Disc Arthroplasty (CDA) have improved. The aim of this study is to evaluate and compare the rate of ASD in patients who underwent ACDF or CDA cervical spine surgery.Methods and Materials: This prospective study was performed on 84 patients with cervical radiculopathy due to single-level disc herniation referred to hospitals in Tehran, Iran from June 2011 to December 2012. All subjects were randomly allocated to Group A or Group B to undergo ACDF or CDA, respectively. The validated Neck Disability Index (NDI) questionnaire was used to assess the cervical neck pain.Results: The mean of age in Group A was 51.7 ± 9.1 years and in Group B was 49.3 ±9.2. The differences in cervical radiculopathy in the two groups were not statistically significant. The difference in mean Visual Analogue Scale (VAS) score in the two groups at each assessment time was statistically significant. Mean NDI score before the surgery was 46.9 ± 6.1 in group A, and 41.3 ±4.7 in group B. The mean NDI score improved significantly in group B. Twenty-seven of the patients in Group A experienced ASD at 12 months compared to one patient (2.3%) in Group B (p<0.05).Conclusion: According to the findings of this study, CDA leads to reduced VAS and NDI score compared to ACDF. Also increased ASD in ACDF was demonstrated when compared with CDA after 1-year follow-up.

scholarly journals The future in the care of the cervical spine: interbody fusion and arthroplasty

2004 ◽  
Vol 17 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Regis W. Haid
Keyword(s):  
Adjacent Segment Degeneration ◽  
Long Term Results ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Cervical Fusion ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Large Joint

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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