Place and interests of the cervical disc prosthesis in the cervical spine surgery LEFLOT Jean-Louis M.D.

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
Positioningofthe Head!
Atthe zenith(bettercenteringofthe prosthesis)
orslightleftrotationforarightanterolateral
approach
Neutralposition
AVOID HYPEREXTENSION !!!
Risk ofaggravationofcervicalmyelopathy

12. SURGICAL APPROACH
The rightapproachis easierforthe right-handedandforbetter
centeringofaprosthesis (positionofthe esophagus)
Forlowcervicallevels : visualize the recurrentlaryngealnerve toavoid
voice disorder
Horizontalis more aesthetic
Verticalformore than2 levels, butscarmore visible andless flexible

13. SURGICAL APPROACH
Pre-vascularanterolateralapproach
«Smith-Robinson»
• Atraumatic
• Fingerdissection, "Peanut" tamponanddissection
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?
Researchofequivalents tootherjointprostheses
Hilibrand(1999): Decompensationofsegments adjacenttocervical
arthrodesis (25% to10 years)
Preserve the functiontoreduce constraints onadjacentsegments

21. CDP INDICATIONS
Idealindication
• Cervicobrachialneuralgiawithneurologicaldeficitorresistanttoconservative treatment, due toasoft
discherniationthus affectingastillmobile discondynamicxRay
Relative indication
• Cervicobrachialneuralgiadue toosteophytosis (hardhernia) ifthe discis mobile
• "Hybrid" stabilization(fusionandprosthesis) inmulti-stage lesions withdiscprosthesis forthe most
mobile andleastdegenerative level(s)
ABSENCE OF ZYGAPOPHYSARY DEGENERATIVE LESIONS

22. CDP WHICH ONE TO USE ?
Design
Range ofMotion
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» Controlledmobility ofthe 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
FusionC4-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
- Returntoworkfaster
- Resultsat7 yearsasgoodandevenbetter
- Lesssurgicalrevisionatadjacentlevels
- Problemofweardebris?

55. PROBLEM OF WEAR DEBRIS ?

56. PROBLEM OF WEAR DEBRIS ?

57. PROBLEM OF WEAR DEBRIS ?

58. RHINE K2M
Toavoidweardebris

59. RHINE K2M
Metalplates manufacturedwithholes
Overmoldingprocess throughmetalendplates
Manufacture & plasmaspray endplates
Manufacture & plasmaspray endplates

60. RHINE K2M

61. RHINE K2M

62. RHINE K2M

63. RHINE K2M

64. RHINE K2M
C4-C5 C6-C7

65. www.spinesurgery.be
sealand.spine.community
www.ortholef.com