Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty

There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.

Download Full-text

Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine141217 ◽

2016 ◽

Vol 24 (5) ◽

pp. 752-759 ◽

Cited By ~ 14

Author(s):

Peng-Yuan Chang ◽

Hsuan-Kan Chang ◽

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Li-Yu Fay ◽

...

Keyword(s):

Cervical Spine ◽

Heterotopic Ossification ◽

Clinical Outcomes ◽

Large Scale ◽

Japanese Orthopaedic Association ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

Download Full-text

Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/2019.5.spine19257 ◽

2019 ◽

Vol 31 (5) ◽

pp. 660-669 ◽

Cited By ~ 1

Author(s):

Michael M. H. Yang ◽

Won Hyung A. Ryu ◽

Steven Casha ◽

Stephan DuPlessis ◽

W. Bradley Jacobs ◽

...

Keyword(s):

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Adjacent Segment ◽

Low Grade ◽

High Grade ◽

Artificial Disc ◽

Disc Arthroplasty ◽

The Mean ◽

Index Level

OBJECTIVECervical disc arthroplasty (CDA) is an accepted motion-sparing technique associated with favorable patient outcomes. However, heterotopic ossification (HO) and adjacent-segment degeneration are poorly understood adverse events that can be observed after CDA. The purpose of this study was to retrospectively examine 1) the effect of the residual exposed endplate (REE) on HO, and 2) identify risk factors predicting radiographic adjacent-segment disease (rASD) in a consecutive cohort of CDA patients.METHODSA retrospective cohort study was performed on consecutive adult patients (≥ 18 years) who underwent 1- or 2-level CDA at the University of Calgary between 2002 and 2015 with > 1-year follow-up. REE was calculated by subtracting the anteroposterior (AP) diameter of the arthroplasty device from the native AP endplate diameter measured on lateral radiographs. HO was graded using the McAfee classification (low grade, 0–2; high grade, 3 and 4). Change in AP endplate diameter over time was measured at the index and adjacent levels to indicate progressive rASD.RESULTSForty-five patients (58 levels) underwent CDA during the study period. The mean age was 46 years (SD 10 years). Twenty-six patients (58%) were male. The median follow-up was 29 months (IQR 42 months). Thirty-three patients (73%) underwent 1-level CDA. High-grade HO developed at 19 levels (33%). The mean REE was 2.4 mm in the high-grade HO group and 1.6 mm in the low-grade HO group (p = 0.02). On multivariable analysis, patients with REE > 2 mm had a 4.5-times-higher odds of developing high-grade HO (p = 0.02) than patients with REE ≤ 2 mm. No significant relationship was observed between the type of artificial disc and the development of high-grade HO (p = 0.1). RASD was more likely to develop in the lower cervical spine (p = 0.001) and increased with time (p < 0.001). The presence of an artificial disc was highly protective against degenerative changes at the index level of operation (p < 0.001) but did not influence degeneration in the adjacent segments.CONCLUSIONSIn patients undergoing CDA, high-grade HO was predicted by REE. Therefore, maximizing the implant-endplate interface may help to reduce high-grade HO and preserve motion. RASD increases in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6–7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.

Download Full-text

Radiological and clinical outcomes of 3-level cervical disc arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19545 ◽

2020 ◽

Vol 32 (2) ◽

pp. 174-181 ◽

Cited By ~ 2

Author(s):

Hsuan-Kan Chang ◽

Wen-Cheng Huang ◽

Tsung-Hsi Tu ◽

Li-Yu Fay ◽

Chao-Hung Kuo ◽

...

Keyword(s):

Clinical Outcomes ◽

Large Scale ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain ◽

Estimated Blood Loss

OBJECTIVEOne- and two-level cervical disc arthroplasty (CDA) has been compared to anterior cervical discectomy and fusion (ACDF) in several large-scale, prospective, randomized trials that have demonstrated similar clinical outcomes. However, whether these results would be similar when treating 3-level disc herniation and/or spondylosis has remained unanswered. This study aimed to investigate the differences between 3-level CDA and ACDF.METHODSA series of 50 patients who underwent 3-level CDA at C3–7 was retrospectively reviewed and compared with another series of 50 patients (age- and sex-matched controls) who underwent ACDF at C3–7. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain, the modified Japanese Orthopaedic Association (mJOA) scale, and the Neck Disability Index (NDI). Radiological outcomes included range of motion (ROM) at the index levels. Every patient was evaluated by CT for the presence of fusion in the ACDF group. Also, complication profiles were investigated.RESULTSThe demographics and levels of distribution in both groups were very similar. During the follow-up period of 24 months, clinical outcomes improved (overall and respectively in each group) for both the CDA and ACDF patients when compared with the patients’ preoperative condition. There were essentially few differences between the two groups in terms of neck and arm pain VAS scores, mJOA scores, and NDI scores preoperatively and at 3, 6, 12, and 24 months postoperatively. After the 3-level surgery, the CDA group had an increased mean ROM of approximately 3.4°, at 25.2° ± 8.84°, compared to their preoperative ROM (21.8° ± 7.20°) (p = 0.001), whereas the ACDF group had little mobility (22.8° ± 5.90° before and 1.0° ± 1.28° after surgery; p < 0.001). The mean operative time, estimated blood loss, and complication profiles were similar for both groups.CONCLUSIONSIn this selectively matched retrospective study, clinical outcomes after 3-level CDA and ACDF were similar during the 2-year follow-up period. CDA not only successfully preserved but slightly increased the mobility at the 3 index levels. However, the safety and efficacy of 3-level CDA requires more long-term data for validatation.

Download Full-text

Resection of uncovertebral joints and posterior longitudinal ligament for cervical disc arthroplasty

Neurosurgical FOCUS ◽

10.3171/2017.1.focusvid.16380 ◽

2017 ◽

Vol 42 (videosuppl1) ◽

pp. V2 ◽

Cited By ~ 9

Author(s):

Tsung-Hsi Tu ◽

Chih-Chang Chang ◽

Jau-Ching Wu ◽

Li-Yu Fay ◽

Wen-Cheng Huang ◽

...

Keyword(s):

Posterior Longitudinal Ligament ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Artificial Disc ◽

Nerve Roots ◽

Disc Arthroplasty ◽

Flexion Extension ◽

Indirect Decompression ◽

The Us ◽

Vertebral Bodies

The most commonly accepted indications for cervical disc arthroplasty (CDA) are 1- and 2-level cervical disc herniation or spondylosis causing radiculopathy or myelopathy that is refractory to medical management. Unlike anterior cervical discectomy and fusion (ACDF), which eliminates motion, CDA aims to restore the physiological range of motion of the indexed joint. Thus, the effect of indirect decompression gained by the insertion of a sufficiently large interbody graft and incorporation into arthrodesis after ACDF cannot be duplicated for CDA. For patients undergoing CDA, during extreme flexion/extension or rotation, the exiting nerve roots might be impinged by inadequately decompressed foraminal osteophytes. Therefore, the authors advocate generous decompression, including resection of the posterior longitudinal ligament (PLL) and bilateral uncovertebral joints (UVJs), even in the asymptomatic side. This video demonstrates full dural expansion and enlarged neuroforamen after removal of the PLL and UVJs. Venous hemorrhage encountered during foraminotomy can always be controlled by cottonoid packing or hemostatic agents. Also, the endplates of the surrounding vertebral bodies were meticulously prepared for parallel insertion of the ProDisc-C Nova (DePuy Synthes Spine) artificial disc. Please note that the ProDisc-C Nova is currently not available on the US market.The video can be found here: https://youtu.be/XUo34j6WFYs.

Download Full-text

A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

World Neurosurgery ◽

10.1016/j.wneu.2018.10.231 ◽

2019 ◽

Vol 122 ◽

pp. e1083-e1089 ◽

Cited By ~ 5

Author(s):

Xinlin Gao ◽

Yi Yang ◽

Hao Liu ◽

Yang Meng ◽

Junfeng Zeng ◽

...

Keyword(s):

Degenerative Disc Disease ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Disease ◽

Disc Arthroplasty ◽

Cervical Discectomy ◽

Degenerative Disc ◽

Cervical Degenerative Disc Disease

Download Full-text

Adjacent Segment Pathology After Treatment With Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion, Part 1: Radiographic Results at 7-Year Follow-Up

The International Journal of Spine Surgery ◽

10.14444/7036 ◽

2020 ◽

Vol 14 (3) ◽

pp. 269-277 ◽

Cited By ~ 1

Author(s):

PIERCE D. NUNLEY ◽

EUBULUS J. KERR ◽

DAVID A. CAVANAUGH ◽

PHILLIP ANDREW UTTER ◽

PETER G. CAMPBELL ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Adjacent Segment ◽

Disc Arthroplasty ◽

Cervical Discectomy

Download Full-text

Myelopathy after cervical disc arthroplasty due to progression of spondylosis at the index level: case report

Journal of Neurosurgery Spine ◽

10.3171/2017.8.spine161385 ◽

2018 ◽

Vol 28 (5) ◽

pp. 467-471

Author(s):

Anita Bhansali ◽

Michael Musacchio ◽

Noam Stadlan

Keyword(s):

Case Report ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Artificial Disc ◽

Rare Occurrence ◽

Disc Disease ◽

Disc Arthroplasty ◽

Low Incidence ◽

Index Level ◽

Better Than

Cervical disc arthroplasty (CDA) has emerged as a popular alternative to anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disc disease. CDA has been well studied, with efficacy reported to be equivalent to or better than that seen with ACDF, and it is associated with a consistently low incidence of adverse events. The development or progression of myelopathy after CDA is a particularly rare occurrence. In this report, the authors describe the first known case of recurrence of myelopathy at the index level of surgery after CDA implantation due the continuation of the spondylitic process after placement of the artificial disc.

Download Full-text