1
|
Häckel S, Gaff J, Pabbruwe M, Celenza A, Kern M, Taylor P, Miles A, Cunningham G. Heterotopic ossification, osteolysis and implant failure following cervical total disc replacement with the M6-C™ artificial disc. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1292-1299. [PMID: 38363365 DOI: 10.1007/s00586-024-08129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION A recent study reported a 34% mid-term revision rate after M6-C™ cervical total disc replacement (CTDR) for wear-related osteolysis. Here, we aim to investigate the prevalence, risk factors, and radiographic characteristics of periprosthetic bony changes and implant failure of the M6-C™ artificial disc. METHODS We retrospectively analysed radiographic (conventional X-ray, CT scan) and clinical outcomes (EQ-5D-5L, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck and arm pain) data collected during routine follow-up of patients who underwent CTDR with the M6-C™ between 2011 and 2015. RESULTS In total, 85 patients underwent CTDR with the M6-C™. Follow-up data were available for 43 patients (54% female, mean age 44 years) with 50 implants and a mean follow-up of 8.1 years (6.5-11 years). Implant failure with the presence of severe osteolysis was identified in 5 (12%) patients who were all male (p = 0.016) and implanted at the C5/6 level (p = 0.11). All failed implants required revision surgery. The overall prevalence of osteolysis was 44% (22/50 implants) and 34% (17/50 implants) for significant heterotopic ossification. Patients with high-grade osteolysis showed higher VAS arm pain (p = 0.05) and lower EQ-5D-VAS health VAS (p = 0.03). CONCLUSION We report a lower reoperation rate for failed M6-C™ implants than previously published, but confirmed that osteolysis and heterotopic ossification are common following CTDR with the M6-C™ and may be asymptomatic. Therefore, we strongly recommend ongoing clinical and radiographic monitoring after CTDR with the M6-C™, particularly for male patients implanted at the C5/6 level.
Collapse
Affiliation(s)
- Sonja Häckel
- Neurospine Institute, Murdoch, Australia
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Jessica Gaff
- Neurospine Institute, Murdoch, Australia.
- Curtin Medical School, Curtin University, Bentley, Australia.
| | - Moreica Pabbruwe
- Department of Medical Engineering and Physics, Centre for Implant Technology and Retrieval Analysis, Royal Perth Hospital, Perth, Australia
| | | | - Michael Kern
- Neurospine Institute, Murdoch, Australia
- Department of Neurosurgery, St. John of God Hospital, Murdoch, Australia
| | - Paul Taylor
- Neurospine Institute, Murdoch, Australia
- Department of Orthopaedic Surgery, St. John of God Hospital, Murdoch, Australia
- Department of Orthopaedic Surgery, Mount Hospital, Perth, Australia
| | - Andrew Miles
- Neurospine Institute, Murdoch, Australia
- Department of Neurosurgery, St. John of God Hospital, Murdoch, Australia
| | - Greg Cunningham
- Neurospine Institute, Murdoch, Australia
- Curtin Medical School, Curtin University, Bentley, Australia
- Department of Orthopaedic Surgery, St. John of God Hospital, Murdoch, Australia
- Department of Orthopaedic Surgery, Mount Hospital, Perth, Australia
| |
Collapse
|
2
|
Patel N, Abdelmalek G, Coban D, Changoor S, Sinha K, Hwang K, Emami A. Should patient eligibility criteria for cervical disc arthroplasty (CDA) be expanded? A retrospective cohort analysis of relatively contraindicated patients undergoing CDA. Spine J 2024; 24:210-218. [PMID: 37774985 DOI: 10.1016/j.spinee.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is a safe and effective alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of various degenerative pathologies with advantages of motion preservation and lower rates of adjacent segment degeneration (ASD). Absolute contraindications for CDA have been well outlined in order to prevent adverse outcomes in patients. However, in cases of patients with relative contraindications (kyphotic deformity, prior cervical surgery, etc.), there remains controversy. There is minimal literature evaluating long-term outcomes in this patient population. PURPOSE To compare long-term clinical and functional outcomes of CDA in typical patients versus those with relative contraindications. DESIGN Retrospective cohort review. PATIENT SAMPLE Eighty-nine patients were included in the study: 55 (no contraindications) in Group 1 and 34 (relatively contraindicated) in Group 2 and 26 (preoperative segmental kyphosis) in Group 3. OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS), and neck disability index (NDI) scores. METHODS Patients were placed in the relatively contraindicated cohort if they possessed at least one of the following: (1) segmental kyphosis of 5° to 10°, (2) significant loss of disc height (between 50% and 75% of initial measurements or 1.5-3mm), (3) bridging osteophytes, and (4) prior cervical spine surgery based on preoperative cervical radiographs. The other cohort included patients without any relative contraindication who underwent CDA over the same time frame. Additionally, a subgroup analysis was used to compare those without any contraindications to those with only preoperative segmental kyphosis. Patients were included in this study if they met the following criteria: over 18 years of age, minimum follow-up of 24 months, and availability of complete medical records. Patient demographics, levels operated on, and perioperative outcomes were assessed between the two groups. Revision and complication rates were recorded. Functional outcomes scores were compared using VAS and NDI scores at 6-months, 12-months and final follow-up. RESULTS Mean follow-up was 40.8 months in Group 1 and 38.3 months in Group 2 (p=.569). Complication rates were 21.8% in Group 1 and 26.4% in Group 2 (p=.615). Complication rates in a comparison between Groups 1 and 3 were statistically insignificant (p=.383). The most common complication was transient approach-related postoperative dysphagia (Group 1: 20% vs Group 2: 23.5%, p=.693). No significant differences were observed in the rates of transient dysphonia (Group 1: 0.0% vs Group 2: 2.9%, p=.201), adjacent segment degeneration (ASD) (Group 1: 1.8% vs Group 2: 0.0%, p=.429), infection (Group 1: 1.8% vs Group 2: 2.9%, p=.712), heterotopic ossification (Group 1: 49.1% vs Group 2: 50.0%, p=.934) or spontaneous fusion (Group 1: 1.8% vs Group 2: 2.9%, p=.728). No revision surgeries were observed in either cohort. All three groups demonstrated significant improvements in their VAS and NDI scores compared with preoperative measurements (p<.001), but no significant differences were found in the degree of improvement between groups at any point in time. CONCLUSIONS Our study found no significant differences in clinical and functional outcomes between patients undergoing 1- and 2-level CDA with relative contraindications versus typical patients. These findings suggest that patient eligibility criteria for CDA may warrant expansion. However, future prospective studies over a longer period of follow-up are necessary to corroborate our results.
Collapse
Affiliation(s)
- Neil Patel
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - George Abdelmalek
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Daniel Coban
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Stuart Changoor
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Kumar Sinha
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Ki Hwang
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Arash Emami
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA.
| |
Collapse
|
3
|
Shen YW, Yang Y, Liu H, Wang BY, Ding C, Meng Y, Rong X, Hong Y. The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement. Global Spine J 2024; 14:56-66. [PMID: 35403474 PMCID: PMC10676169 DOI: 10.1177/21925682221094265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). METHODS The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. RESULTS 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up (P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group (P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO (P = .009). No significant degenerative factors related to the formation of AHO were found. CONCLUSIONS Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.
Collapse
Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Operation Room and Anesthesia Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Coric D. Cervical Arthroplasty Complications and Complication Avoidance. Int J Spine Surg 2023; 17:757-759. [PMID: 38071572 PMCID: PMC10753357 DOI: 10.14444/8537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Affiliation(s)
- Domagoj Coric
- Atrium Health Spine Center of Excellence, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| |
Collapse
|
5
|
Muralidharan A, Gong D, Piche JD, Al-Saidi N, Hey HWD, Aleem I. Multilevel Cervical Disk Arthroplasty: Moving Beyond Two Levels. Clin Spine Surg 2023; 36:363-368. [PMID: 37684714 DOI: 10.1097/bsd.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Abstract
Cervical disk arthroplasty (CDA) is well-studied for 1-level and 2-level cervical pathology. There is an increasing trend towards its utilization for greater than 2-level disease as an alternative to the gold standard, anterior cervical discectomy and fusion (ACDF). The number of high-level, prospective studies or randomized trials regarding multilevel CDA is limited but continues to grow as the procedure gains popularity. In appropriately indicated patients with multilevel disease caused by disk herniations or spondylosis without extensive facet arthropathy, CDA shows promising results. Multilevel CDA should be avoided in patients with prior spinal trauma, significant degenerative spondylolisthesis with translation, arthrodesis without mobility, severely incompetent facet joints, ossification of the posterior longitudinal ligament, or kyphotic deformity. With overall similar risk profiles to ACDF but lower theoretical rates of pseudarthrosis and adjacent segment disease, multilevel CDA has been shown to preserve, or perhaps even increase, preoperative cervical range of motion. There are negligible differences in postoperative neck and arm pain, VAS scores, modified Japanese Orthopaedic Association scores, and Neck Disability Index scores when comparing multilevel CDA and ACDF. Despite current indications for multilevel CDA largely being based on single and 2-level data, careful patient selection is critical. Expansion of indications can be expected as literature continues to emerge regarding outcomes and complications in multilevel CDA, as well as with improvements in prosthesis design.
Collapse
Affiliation(s)
| | - Davin Gong
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Joshua D Piche
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Neil Al-Saidi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | | | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| |
Collapse
|
6
|
Nguyen AQ, Credille K, Saifi C. Short-term and Long-term Complications of Cervical Disc Arthroplasty. Clin Spine Surg 2023; 36:404-410. [PMID: 37752635 DOI: 10.1097/bsd.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
STUDY DESIGN A narrative review. OBJECTIVE This review discusses the short and long-term complications associated with cervical disc arthroplasty (CDA). SUMMARY OF BACKGROUND DATA CDA is a safe and effective motion-sparing alternative to fusion for the treatment of cervical disc pathology in patients with cervical radiculopathy or myelopathy. Although CDA offers advantages over fusion within a narrower set of indications, it introduces new technical challenges and potential complications. METHODS A systematic search of several large databases, including Cochrane Central, PubMed, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry, was conducted from January 2005 to August 2023 to identify published studies and clinical trials evaluating cervical disc replacement complications and outcomes. RESULTS Short-term complications are primarily related to surgical approach and include dysphagia reported as high as ~70%, laryngeal nerve injury ~0%-1.25%, Horner syndrome ~0.06%, hematoma ~0.01%, gross device extrusion ~0.3%, whereas long-term complications include adjacent segment disease reported at ~3.8%, osteolysis ~44%-64%, heterotopic ossification ~7.3%-69.2%, implant failure ~3.3%-3.7%, and implant wear, which varies depending on design. CONCLUSIONS Approaches for mitigating complications broadly include meticulous dissection, intraoperative techniques, and diligent postoperative follow-up. This review emphasizes the need for a comprehensive understanding and management of complications to enhance the safety, reproducibility, and success of CDA. As CDA continues to evolve, there remains a critical need for ongoing research to delve deeper into evaluating risk for complications and long-term patient outcomes.
Collapse
Affiliation(s)
- Austin Q Nguyen
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | | | | |
Collapse
|
7
|
Divi SN, Plantz MA, Tegethoff J, Su BW. Current and Expanded Indications for Cervical Disc Arthroplasty: Beyond the FDA IDE Studies. Clin Spine Surg 2023; 36:375-385. [PMID: 37691166 DOI: 10.1097/bsd.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.
Collapse
Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Jason Tegethoff
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Brian W Su
- California Orthopedics & Spine, Novato, CA
| |
Collapse
|
8
|
Nigh ED, Finkel RA, Sayari AJ, Lanman TH, Baron EM, Cuellar JM. An Atypical Presentation of Early Periprosthetic Infection After Cervical Disc Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00001. [PMID: 37418554 DOI: 10.2106/jbjs.cc.22.00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
CASE A 22-year-old woman with Klippel-Feil syndrome who underwent cervical disc arthroplasty (CDA) presented 3 months postoperatively with worsening neck pain and radiculopathy. Work-up was negative for infection, but single-photon emission computed tomography revealed increased metabolic activity in the vertebral body below the implant. During revision, the implant was grossly loose and multiple cultures grew Cutibacterium acnes. She was treated with an antibiotic course and conversion to anterior fusion without recurrence. CONCLUSION This report highlights the rare presentation of an early periprosthetic infection after CDA caused by C. acnes.
Collapse
Affiliation(s)
- Evan D Nigh
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ryan A Finkel
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Todd H Lanman
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eli M Baron
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jason M Cuellar
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
9
|
Hsieh MK, Tai CL, Li YD, Lee DM, Lin CY, Tsai TT, Lai PL, Chen WP. Finite element analysis of optimized novel additively manufactured non-articulating prostheses for cervical total disc replacement. Front Bioeng Biotechnol 2023; 11:1182265. [PMID: 37324423 PMCID: PMC10267663 DOI: 10.3389/fbioe.2023.1182265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Ball-and-socket designs of cervical total disc replacement (TDR) have been popular in recent years despite the disadvantages of polyethylene wear, heterotrophic ossification, increased facet contact force, and implant subsidence. In this study, a non-articulating, additively manufactured hybrid TDR with an ultra-high molecular weight polyethylene core and polycarbonate urethane (PCU) fiber jacket, was designed to mimic the motion of normal discs. A finite element (FE) study was conducted to optimize the lattice structure and assess the biomechanical performance of this new generation TDR with an intact disc and a commercial ball-and-socket Baguera®C TDR (Spineart SA, Geneva, Switzerland) on an intact C5-6 cervical spinal model. The lattice structure of the PCU fiber was constructed using the Tesseract or the Cross structures from the IntraLattice model in the Rhino software (McNeel North America, Seattle, WA) to create the hybrid I and hybrid II groups, respectively. The circumferential area of the PCU fiber was divided into three regions (anterior, lateral and posterior), and the cellular structures were adjusted. Optimal cellular distributions and structures were A2L5P2 in the hybrid I and A2L7P3 in the hybrid II groups. All but one of the maximum von Mises stresses were within the yield strength of the PCU material. The range of motions, facet joint stress, C6 vertebral superior endplate stress and path of instantaneous center of rotation of the hybrid I and II groups were closer to those of the intact group than those of the Baguera®C group under 100 N follower load and pure moment of 1.5 Nm in four different planar motions. Restoration of normal cervical spinal kinematics and prevention of implant subsidence could be observed from the FE analysis results. Superior stress distribution in the PCU fiber and core in the hybrid II group revealed that the Cross lattice structure of a PCU fiber jacket could be a choice for a next-generation TDR. This promising outcome suggests the feasibility of implanting an additively manufactured multi-material artificial disc that allows for better physiological motion than the current ball-and-socket design.
Collapse
Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - De-Mei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yi Lin
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Weng-Pin Chen
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| |
Collapse
|
10
|
Wahbeh JM, Park SH, Iyer S, Ebramzadeh E, Sangiorgio SN. Observations of bony ongrowth and clinical fixation in two retrieved disc replacements. J Biomed Mater Res B Appl Biomater 2023. [PMID: 37191359 DOI: 10.1002/jbm.b.35263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Total disc replacements utilize textured coatings to maximize bony ongrowth. However, the contribution of direct bony attachment to overall fixation for total disc replacements has not been reported. The goal of the present study was to document the extent of bony attachment to the surfaces of two clinically functional total disc replacements that were securely fixed at the time of revision. Two metal-and-polymeric disc replacements, one cervical and one lumbar, were evaluated following surgical retrieval. The cervical device was retrieved at 8 months and the lumbar device at 28 months post-operative. Both devices were reported well-fixed at the time of removal, with large bone masses attached to one endplate of each device. Visual inspections, non-destructive gravimetric measurements, and surface metrology were performed to assess fixation. These inspections suggested that both devices had been fixed at the time of removal with little in vivo mechanical damage, as surgical extraction damage was noted on both devices and provided imaging showed a lack of device migration. Devices were then embedded and sectioned to evaluate the bone-implant interface. High resolution photographs and contact microradiographs were taken to assess bony attachment. In contrast to initial analysis, these images revealed radiolucent gaps between the endplates and bone masses. Little direct contact between the bone and endplate surface was identified and the original surgical cuts were still visible. Both devices were clinically fixed at the time of removal and neither had complications associated with loosening. However, osseointegration was minimal in one of the devices and altogether absent from the other. The findings of the present study suggest that other factors may influence overall clinical fixation such as the surgical preparation of the vertebral bone or the surface roughness of the treated endplates. Despite the limitations of the present study, this information is unique to the current total disc replacement literature and the ongrowth and fixation of devices should be considered as a topic for future investigation.
Collapse
Affiliation(s)
- Jenna M Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sumant Iyer
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
11
|
Oezel L, Memtsoudis SG, Moser M, Zhong H, Adl Amini D, Liu J, Poeran J, Shue J, Sama AA. Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006-2019. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:667-681. [PMID: 36542166 DOI: 10.1007/s00586-022-07465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures. METHODS In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor. RESULTS A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034). CONCLUSION PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research.
Collapse
Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stavros G Memtsoudis
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Haoyan Zhong
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jashvant Poeran
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L.Levy Pl, New York, NY, 10029, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
12
|
Takami T, Hara T, Hara M, Inui T, Ito K, Koyanagi I, Mizuno J, Mizuno M, Nakase H, Shimokawa N, Sugawara T, Suzuki S, Takahashi T, Takayasu M, Tani S, Hida K, Kim P, Arai H. Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients. Neurol Med Chir (Tokyo) 2022; 62:489-501. [PMID: 36223947 PMCID: PMC9726179 DOI: 10.2176/jns-nmc.2022-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2023] Open
Abstract
Anterior cervical disc replacement (ACDR) using cervical artificial disc (CAD) has the advantage of maintaining the range of motion (ROM) at the surgical level, subsequently reducing the postoperative risk of adjacent disc disease. Following the approval for the clinical use in Japan, a post-marketing surveillance (PMS) study was conducted for two different types of CAD, namely, Mobi-C (metal-on-plastic design) and Prestige LP (metal-on-metal design). The objective of this prospective observational multicenter study was to analyze the first 2-year surgical results of the PMS study of 1-level ACDR in Japan. A total of 54 patients were registered (Mobi-C, n = 24, MC group; Prestige LP, n = 30, PLP group). Preoperative neurological assessment revealed radiculopathy in 31 patients (57.4%) and myelopathy in 15 patients (27.8%). Preoperative radiological assessment classified the disease category as disc herniation in 15 patients (27.8%), osteophyte in 6 patients (11.1%), and both in 33 patients (61.1%). The postoperative follow-up rates at 6 weeks, 6 months, 1 year, and 2 years after ACDR were 92.6%, 87.0%, 83.3%, and 79.6%, respectively. In both groups, patients' neurological condition improved significantly after surgery. Radiographic assessment revealed loss of mobility at the surgical level in 9.5% of patients in the MC group and in 9.1% of patients in the PLP group. No secondary surgeries at the initial surgical level and no serious adverse events were observed in either group. The present results suggest that 1-level ACDR is safe, although medium- to long-term follow-up is mandatory to further verify the validity of ACDR for Japanese patients.
Collapse
Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University
| | | | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
| | - Junichi Mizuno
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | | | | | | | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center
| | - Shinsuke Suzuki
- Department of Spinal Surgery, Sendai East Neurosurgical Hospital
| | | | | | - Satoshi Tani
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital
| | - Phyo Kim
- Neurologic Surgery, Symphony Clinic
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University
| |
Collapse
|
13
|
Leonard SE, Song H, Edwards CC. Is C7-T1 cervical disc replacement a viable technique: A case series. Int J Surg Case Rep 2022; 98:107454. [PMID: 35964370 PMCID: PMC9399142 DOI: 10.1016/j.ijscr.2022.107454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Cervical disc replacement (CDR) surgery is well established for the treatment of disc degeneration from C3-C7, but there is little data regarding the safety and efficacy of CDR at the cervicothoracic junction, C7-T1. CDR is an appealing option, in terms of range of motion preservation, symptom relief, and absence of risk for nonunion. Currently, C7-T1 CDR is not approved by the Food and Drug Administration, and the existing literature is limited to two case reports that describe the results of a combined two patients. This series explores whether C7-T1 CDR is a reasonable treatment and alternative to fusion. Methods We present a case series of seven consecutive patients who underwent CDR at C7-T1 by a single surgeon from January to December of 2019. There were five females and two males with an average age of 61.3 ± 6.4 years. Results Average follow up was 18.9 ± 2.5 months. The average postoperative NDI score was 22.6 % ± 14.0. We also recorded qualitative data regarding patient satisfaction and revision surgery status. There was one complication of disc subsidence following three months of complete pain resolution. The six other patients reported being very satisfied with their surgical outcome. Conclusion These seven cases dramatically increase the volume of data in the literature on clinical outcomes and patient satisfaction following CDR at the cervicothoracic junction. Additionally, the heterogeneity of cases shows the effectiveness of this treatment in many real-world cases. A greater volume of cases with longer follow up will be necessary to better establish long-term clinical success. Cervical disc replacement as an emerging treatment option for preserving motion Seven patients with pathology at C7-T1 successfully received disc replacement. All resolved symptoms, measured by NDI and survey of patient satisfaction CDR as viable treatment option at the cervicothoracic junction
Collapse
Affiliation(s)
- Sarah E Leonard
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America
| | - Hyun Song
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America.
| | - Charles C Edwards
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America
| |
Collapse
|
14
|
Coric D, Guyer RD, Bae H, Nunley PD, Strenge KB, Peloza JH, Boltes MO, Ohnmeiss DD. Prospective, multicenter study of 2-level cervical arthroplasty with a PEEK-on-ceramic artificial disc. J Neurosurg Spine 2022; 37:357-367. [PMID: 35364570 DOI: 10.3171/2022.1.spine211264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a PEEK-on-ceramic cervical total disc replacement (cTDR) device for the treatment of 2-level cervical disc disease with radiculopathy and/or myelopathy. METHODS The study was a prospective, nonrandomized, historically controlled FDA investigational device exemption trial evaluating the Simplify Cervical Artificial Disc for use at 2 levels. The anterior cervical discectomy and fusion (ACDF) control group was derived from a propensity score-matched (using subclassification) cohort of patients who participated in an earlier prospective trial in which similar indications were used. The follow-up duration was 24 months. The primary outcome was a 4-point composite success classification. Other validated clinical and radiographic assessments were also evaluated. RESULTS The investigational group (n = 182) was compared with patients who underwent ACDF (n = 170) in a historical control group using propensity score analysis. The overall composite success rate was statistically significantly greater in the cTDR group compared with the ACDF group (86.7% vs 77.1%; p < 0.05). The mean Neck Disability Index scores improved significantly in both groups, with cTDR significantly lower at some follow-up points. At the 24-month follow-up, a minimum 15-point improvement in Neck Disability Index scores was achieved in 92.9% of the cTDR group and 83.5% of the ACDF group (p > 0.05). In both groups, neck and arm pain scores improved significantly (p < 0.05) by 6 weeks and improvement was maintained throughout follow-up. Segmental range of motion was maintained at both treated segments in the cTDR group. MRI performed in the cTDR group at 24 months postoperatively found minimal changes in facet joint degeneration. The rate of subsequent surgical intervention was 2.2% in the cTDR group and 8.8% in the ACDF group. CONCLUSIONS This study adds to the growing body of literature supporting cTDR for 2-level cervical disc disease with radiculopathy or myelopathy. cTDR showed a superior overall success rate compared to ACDF, while maintaining motion. These results support that the Simplify disc is a viable alternative to ACDF in appropriately selected patients with 2-level cervical spondylosis.
Collapse
Affiliation(s)
- Domagoj Coric
- 1Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 2Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | - Richard D Guyer
- 3Center for Disc Replacement at Texas Back Institute, Plano, Texas
| | - Hyun Bae
- 4Cedars-Sinai, Los Angeles, California
| | | | | | | | - Margaret O Boltes
- 1Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Donna D Ohnmeiss
- 3Center for Disc Replacement at Texas Back Institute, Plano, Texas
- 8Texas Back Institute Research Foundation, Plano, Texas
| |
Collapse
|
15
|
Prod’homme M, Grasset D, Boscherini D. Posterior intraprosthetic dislocation of cervical arthroplasty: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21500. [PMID: 36061081 PMCID: PMC9435578 DOI: 10.3171/case21500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Cervical disc herniation is a common condition usually treated with anterior cervical discectomy and fusion (ACDF) or, more recently, with cervical disc arthroplasty (CDA). Both treatments offer similar clinical results. However, CDA has been found to offer fewer medium- to long-term complications as well as potential reduction of long-term adjacent disc degeneration.
OBSERVATIONS
A 40-year-old man was treated with cervical discectomy and arthroplasty due to a C6–C7 disc herniation with left C7 radiculopathy. After the treatment, his postoperative follow-up appointments were uneventful for 9 months. However, after 9 months, he reported cervical pain and a right C7 radiculopathy after neck extension. Imaging confirmed a posterior intraprosthetic dislocation, the first case reported to date. The patient was received emergency surgery under neuromonitoring, and the prosthesis was replaced by an ACDF and anterior plate. The insert presented a rupture of the anterior horn. The patient presented no preoperative or postoperative neurological deficit, and his follow-up review revealed no issues.
LESSONS
Posterior intraprosthetic dislocation is an extremely rare complication. It may occur with Mobi-C cervical arthroplasty in the case of rupture and oxidation of the polyethylene insert. Spine surgeons should be aware of this potential major complication.
Collapse
Affiliation(s)
- Marc Prod’homme
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
| | - Didier Grasset
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
| | - Duccio Boscherini
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
| |
Collapse
|
16
|
Coric D. Commentary: Risk Factors for High-Grade Heterotopic Ossification After Total Disc Replacement: A Single-Center Experience of 394 Cases. Neurosurgery 2021; 89:E312-E313. [PMID: 34468001 DOI: 10.1093/neuros/nyab330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Domagoj Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA.,Atrium Health Musculoskeletal Institute of Orthopedics & Sports Medicine, Charlotte, North Carolina, USA
| |
Collapse
|
17
|
Price RL, Coric D, Ray WZ. Cervical Total Disc Replacement: Complications and Complication Avoidance. Neurosurg Clin N Am 2021; 32:473-481. [PMID: 34538473 DOI: 10.1016/j.nec.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cervical total disc replacement (CTDR) has gained popularity over the last 2 decades. It is a motion-preserving option to ACDF and is becoming more popular with patients and surgeons alike. Understanding complications that are unique to CTDR is crucial to performing successful, durable surgery. Careful patient selection and meticulous surgical technique are key to reducing complications associated with the surgery. Patient's should be followed closely after surgery with routine flexion/extension x-rays for early detection of any complications that may occur. Most complications can be observed with close follow-up. However, it is incumbent on the surgeon to recognize when revision surgery is necessary.
Collapse
Affiliation(s)
- Richard L Price
- Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St Louis, MO 63110, USA; Swedish Neuroscience Institute, Seattle, WA, USA
| | - Domagoj Coric
- Carolinas Neurosurgical and Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| |
Collapse
|
18
|
Response to a letter to editor regarding "incidence of bone loss after prestige-LP cervical disc arthroplasty: a single-center retrospective study of 396 cases". Spine J 2021; 21:722-723. [PMID: 33896541 DOI: 10.1016/j.spinee.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023]
|