anterior cervical fusion cervical total disc …€¦ · sagittal static disorder. cervical fusion...

ANTERIOR CERVICAL FUSIONCERVICAL TOTAL DISC ARTHROPLASTY

LEFLOT JEAN-LOUIS M.D.

UH BRUGMANN BRUSSELS

WHAT INTERESTS US?

ANATOMY (R.LOUIS)

ANATOMY

PATHOLOGICAL ANATOMY

PATHOLOGICAL ANATOMY

SAGITTAL DISBALANCE

Analgesic position

Decrease the pressure on the back of the discOpen the foramens

Degenerative

Intersomatic height loss

SAGITTAL DISBALANCE

SAGITTAL DISBALANCE

OUR SURGICAL CHALLENGES

Neurological release

Sagittal balance

Preserve the function

SURGICAL APPROACH

Positioning of the Head!

At the zenith (better centering of the prosthesis)or slight left rotation for a right anterolateralapproach

Neutral position

AVOID HYPEREXTENSION !!!

Risk of aggravation of cervical myelopathy

SURGICAL APPROACH

The right approach is easier for the right-handed and for bettercentering of a prosthesis (position of the esophagus)For low cervical levels : visualize the recurrent laryngeal nerve to avoidvoice disorder

Horizontal is more aesthetic

Vertical for more than 2 levels, but scar more visible and less flexible

SURGICAL APPROACH

Pre-vascular anterolateral approach«Smith-Robinson»

• Atraumatic• Finger dissection, "Peanut" tampon and dissectionscissors

SURGICAL APPROACH

Low incidence of complicationsmost often minor but some very serious

Dysphagia

Hematoma

Paralysis n. Recurrent laryngeal

Dural injury

Esophageal perforation

Aggravation myelopathy

Syndrome of Claude Bernard Horner

CERVICAL FUSION

F 38y

Cervical discopathies C4C5 and C5C6

Sagittal Static Disorder

CERVICAL FUSION

F42y

Cervical spondylosis (C5C6, C6C7)

Cervical disc herniationand canal narrowing C5C6

Anterolisthesis C4/C5

CERVICAL FUSIONDECOMPENSATION OF ADJACENT LEVELS

DECO

CERVICAL FUSION

CDP CHALLENGE

Preserve the functionto reduce constraintson adjacent segments

CDP WHY?

Trend ?Research of equivalents to other joint prostheses

Hilibrand (1999): Decompensation of segments adjacent to cervicalarthrodesis (25% to 10 years)Preserve the function to reduce constraints on adjacent segments

CDP INDICATIONS

Ideal indication

• Cervicobrachial neuralgia with neurological deficit or resistant to conservative treatment, due to a softdisc 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 mostmobile and least degenerative level(s)

ABSENCE OF ZYGAPOPHYSARY DEGENERATIVE LESIONS

CDP WHICH ONE TO USE ?

Design

Range of Motion

Materials

Heights (mm)

Footprints

Shape

Fixation

Regulatory

CDP WHICH ONE TO USE ?

No compression

Fail to closely replicatephysiologic stability & motion

Complex surgical technique (multi-piece design)

CDP WHICH ONE TO USE ?

Motion occurs within polymer & provides compression

Mimics properties of natural disc

BRYAN (MEDTRONIC)

BRYAN (MEDTRONIC) - 10Y

BRYAN (MEDTRONIC) - 14Y

BRYAN (MEDTRONIC) - 15Y

PCM CERVITECH LINK

PCM CERVITECH LINK

M-47y

mult-stage lesions with moreosteophytosis at levels C3C4 and C5C6

Hybrid stabilization to reduce the rigidityof the treated segment, with excellentrestitution of cervical lordosis

PCM CERVITECH LINK

M6C SPINAL KINETICS

M6C SPINAL KINETICS

M6C SPINAL KINETICS

M6C SPINAL KINETICS 1Y

M6C SPINAL KINETICS 5Y

M6C SPINAL KINETICS 1Y

M6C SPINAL KINETICS 4Y

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMETCORE WITH CONTROLLED MOBILITY

MOBI-C LDR ZIMMER BIOMETCORE WITH CONTROLLED MOBILITY

Classical «Ball & Socket» Controlled mobility of the core : Mobi-C

MOBI-C LDR ZIMMER BIOMET

M 48y

Control3y

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMET

M 48y

CorporectomyFusion C4-C7

Mobi-C C3C4

Controle4y

MOBI-C LDR ZIMMER BIOMET

MOBI-C LDR ZIMMER BIOMETMEAN NDI SCORE (NECK DISABILITY INDEX)

MOBI-C LDR ZIMMER BIOMETMEAN ROM AT INDEX LEVEL

MOBI-C LDR ZIMMER BIOMETRADIOGRAPHIC ADJACENT SEGMENT DEGENERATION

MOBI-C LDR ZIMMER BIOMETRADIOGRAPHIC ADJACENT SEGMENT DEGENERATION

MOBI-C LDR ZIMMER BIOMETADJACENT SEGMENT SUBSEQUENT SURGERIES

CONCLUSIONS

- Return to work faster

- Results at 7 years as good and even better

- Less surgical revision at adjacent levels

- Problem of wear debris ?

PROBLEM OF WEAR DEBRIS ?

PROBLEM OF WEAR DEBRIS ?

PROBLEM OF WEAR DEBRIS ?

RHINE K2M

To avoid wear debris

RHINE K2M

Metal plates manufactured with holes

Over molding process through metal endplates

Manufacture & plasma spray endplates

Manufacture & plasma spray endplates

RHINE K2M

RHINE K2M

RHINE K2M

RHINE K2M

RHINE K2M

C4-C5 C6-C7

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