This document discusses anterior cervical fusion and cervical total disc arthroplasty. It begins with an overview of cervical anatomy and pathological anatomy related to degenerative conditions. Surgical challenges like neurological release and maintaining sagittal balance are addressed. Different surgical approaches and their advantages are outlined. Examples of cervical fusion and total disc arthroplasty cases are presented, showing preservation of function with disc arthroplasty. Benefits like reduced adjacent segment degeneration are discussed. Different disc arthroplasty devices like Bryan, Mobi-C, and ProDisc-C are described and outcomes at various follow-up times are summarized. Potential problems with wear debris are acknowledged and new devices like K2M's Rhine plate designed to avoid this are presented.

1. ANTERIOR CERVICAL FUSION
CERVICAL TOTAL DISC ARTHROPLASTY
LEFLOT JEAN-LOUIS M.D.
UH BRUGMANN BRUSSELS

2. WHAT INTERESTS US?

3. ANATOMY (R.LOUIS)

4. ANATOMY

5. PATHOLOGICAL ANATOMY

6. PATHOLOGICAL ANATOMY

7. SAGITTAL DISBALANCE
Analgesic position
Decrease the pressure
on the back of the disc
Open the foramens
Degenerative
Intersomatic height loss

8. SAGITTAL DISBALANCE

9. SAGITTAL DISBALANCE

10. OUR SURGICAL CHALLENGES
 Neurological release
 Sagittal balance
 Preserve the function

11. SURGICAL APPROACH
Positioning of the Head!
At the zenith (better centering of the prosthesis)
or slight left rotation for a right anterolateral
approach
Neutral position
AVOID HYPEREXTENSION !!!
Risk of aggravation of cervical myelopathy

12. SURGICAL APPROACH
The right approach is easier for the right-handed and for better
centering of a prosthesis (position of the esophagus)
For low cervical levels : visualize the recurrent laryngeal nerve to avoid
voice disorder
Horizontal is more aesthetic
Vertical for more than 2 levels, but scar more visible and less flexible

13. SURGICAL APPROACH
Pre-vascular anterolateral approach
«Smith-Robinson»
• Atraumatic
• Finger dissection, "Peanut" tampon and dissection
scissors

14. SURGICAL APPROACH
Low incidence of complications
most often minor but some very serious
 Dysphagia
 Hematoma
 Paralysis n. Recurrent laryngeal
 Dural injury
 Esophageal perforation
 Aggravation myelopathy
 Syndrome of Claude Bernard Horner

15. CERVICAL FUSION
F 38y
Cervical discopathies
C4C5 and C5C6
Sagittal Static Disorder

16. CERVICAL FUSION
F42y
 Cervical spondylosis
(C5C6, C6C7)
 Cervical disc herniation
and canal narrowing C5C6
 Anterolisthesis C4/C5

17. CERVICAL FUSION
DECOMPENSATION OF ADJACENT LEVELS
DECO

18. CERVICAL FUSION

19. CDP CHALLENGE
Preserve the function
to reduce constraints
on adjacent segments

20. CDP WHY?
Trend ?
Research of equivalents to other joint prostheses
Hilibrand (1999): Decompensation of segments adjacent to cervical
arthrodesis (25% to 10 years)
Preserve the function to reduce constraints on adjacent segments

21. CDP INDICATIONS
Ideal indication
• Cervicobrachial neuralgia with neurological deficit or resistant to conservative treatment, due to a soft
disc herniation thus affecting a still mobile disc on dynamic xRay
Relative indication
• Cervicobrachial neuralgia due to osteophytosis (hard hernia) if the disc is mobile
• "Hybrid" stabilization (fusion and prosthesis) in multi-stage lesions with disc prosthesis for the most
mobile and least degenerative level(s)
ABSENCE OF ZYGAPOPHYSARY DEGENERATIVE LESIONS

22. CDP WHICH ONE TO USE ?
 Design
Range of Motion
Materials
Heights (mm)
Footprints
Shape
Fixation
Regulatory

23. CDP WHICH ONE TO USE ?
 No compression
 Fail to closely replicate
physiologic stability & motion
 Complex surgical technique
(multi-piece design)

24. CDP WHICH ONE TO USE ?
 Motion occurs within polymer
& provides compression
 Mimics properties of natural
disc

25. BRYAN (MEDTRONIC)

26. BRYAN (MEDTRONIC) - 10Y

27. BRYAN (MEDTRONIC) - 14Y

28. BRYAN (MEDTRONIC) - 15Y

29. PCM CERVITECH LINK

30. PCM CERVITECH LINK
M-47y
mult-stage lesions with more
osteophytosis at levels C3C4 and C5C6
Hybrid stabilization to reduce the rigidity
of the treated segment, with excellent
restitution of cervical lordosis

31. PCM CERVITECH LINK

32. M6C SPINAL KINETICS

33. M6C SPINAL KINETICS

34. M6C SPINAL KINETICS

35. M6C SPINAL KINETICS 1Y

36. M6C SPINAL KINETICS 5Y

37. M6C SPINAL KINETICS 1Y

38. M6C SPINAL KINETICS 4Y

39. MOBI-C LDR ZIMMER BIOMET

40. MOBI-C LDR ZIMMER BIOMET

41. MOBI-C LDR ZIMMER BIOMET

42. MOBI-C LDR ZIMMER BIOMET
CORE WITH CONTROLLED MOBILITY

43. MOBI-C LDR ZIMMER BIOMET
CORE WITH CONTROLLED MOBILITY
Classical «Ball & Socket» Controlled mobility of the core : Mobi-C

44. MOBI-C LDR ZIMMER BIOMET
M 48y
Control
3y

45. MOBI-C LDR ZIMMER BIOMET

46. MOBI-C LDR ZIMMER BIOMET

47. MOBI-C LDR ZIMMER BIOMET
M 48y
Corporectomy
Fusion C4-C7
Mobi-C C3C4
Controle
4y

48. MOBI-C LDR ZIMMER BIOMET

49. MOBI-C LDR ZIMMER BIOMET
MEAN NDI SCORE (NECK DISABILITY INDEX)

50. MOBI-C LDR ZIMMER BIOMET
MEAN ROM AT INDEX LEVEL

51. MOBI-C LDR ZIMMER BIOMET
RADIOGRAPHIC ADJACENT SEGMENT DEGENERATION

52. MOBI-C LDR ZIMMER BIOMET
RADIOGRAPHIC ADJACENT SEGMENT DEGENERATION

53. MOBI-C LDR ZIMMER BIOMET
ADJACENT SEGMENT SUBSEQUENT SURGERIES

54. CONCLUSIONS
- Return to work faster
- Results at 7 years as good and even better
- Less surgical revision at adjacent levels
- Problem of wear debris ?

55. PROBLEM OF WEAR DEBRIS ?

56. PROBLEM OF WEAR DEBRIS ?

57. PROBLEM OF WEAR DEBRIS ?

58. RHINE K2M
To avoid wear debris

59. RHINE K2M
Metal plates manufactured with holes
Over molding process through metal endplates
Manufacture & plasma spray endplates
Manufacture & plasma spray endplates

60. RHINE K2M

61. RHINE K2M

62. RHINE K2M

63. RHINE K2M