1
|
Huang K, Wu T, Lou J, Wang B, Ding C, Gong Q, Rong X, Liu H. Impact of bone-implant gap size on the interfacial osseointegration: an in vivo study. BMC Musculoskelet Disord 2023; 24:115. [PMID: 36765314 PMCID: PMC9921072 DOI: 10.1186/s12891-023-06215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The bone-implant gap resulted from morphological mismatch between cervical bony endplates and implant footprint may have adverse impact on bone-implant interfacial osseointegration of cervical disc arthroplasty (CDA). The purpose of the study was to evaluate the impact of bone-implant gap size on the interfacial osseointegration in a rabbit animal model. METHODS A series of round-plate implants with different teeth depth (0.5 mm, 1.0 mm, 1.5 mm and 2.0 mm) was specifically designed. A total of 48 New Zealand white rabbits were randomly categorized into four groups by the implants they received (0.5 mm: group A, 1.0 mm: group B, 1.5 mm: group C, 2.0 mm: group D). At 4th and 12th week after surgery, animals were sacrificed. Micro-CT, acid fuchsin and methylene blue staining and hematoxylin and eosin (HE) staining were conducted. RESULTS At 4th week and 12th week after surgery, both micro-CT and HE staining showed more new bone formation and larger bone coverage in group A and group B than that in group C and group D. At 12th week, the bone biometric parameters were significantly superior in group C when compared with group D (p < 0.05). At 12th week, hard tissue slicing demonstrated larger portion of direct contact of new bone to the HA coating in group A and group B. CONCLUSIONS Bone-implant gap size larger than 1.0 mm negatively affected bone-implant osseointegration between compact bone and HA coated implant surface.
Collapse
Affiliation(s)
- Kangkang Huang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041 China
| | - Tingkui Wu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041 China
| | - Jigang Lou
- grid.412633.10000 0004 1799 0733Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052 China
| | - Beiyu Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041 China
| | - Chen Ding
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041 China
| | - Quan Gong
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041 China
| | - Xin Rong
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041, China.
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu Sichuan, 610041, China.
| |
Collapse
|
2
|
Gao X, Meng Y, Hao D, Liu H. Parathyroid hormone enhances gap healing and osseointegration in orthopedic porous coated titanium implants: a correlative micro-computed tomographic, histomorphometric and biomechanical analysis. BMC Musculoskelet Disord 2022; 23:17. [PMID: 34980060 PMCID: PMC8725270 DOI: 10.1186/s12891-021-04917-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background Parathyroid hormone, with its anabolic effect on bone formation, has shown excellent outcomes of curing postmenopausal osteoporosis as well as enhancing osseointegration around orthopaedic and stomatologic implants.The purpose of the present study is to test if low-dose intermittent PTH (1–34) treatment could achieve a satisfactory osseointegration in 2-mm peri-implant gaps, as to provide a new idea for improving the stability of such prosthesis, which will be of great clinical value. Methods A custom-made titanium implant was implanted on the calvarium of New Zealand White rabbits. 48 male rabbits were randomly divided into control and PTH group. PTH group received subcutaneous injection of PTH (20 μg/day, 5 days/week). Animals were sacrificed at 4 and 8 weeks after surgery. Quantitative micro-computed tomography, histology and biomechanical pull-out testing were performed to evaluate the gap healing at implantation site. Results Analysis of micro-computed tomography demonstrated that PTH group achieved more new bone formation in 2-mm gaps and on bone-implant interface. Quantitatively, significant differences were observed between two groups in regard to BIC and BV/TV at each time-point. Histological staining revealed that PTH group had a superiority in trabecular number, thickness, separation and better osseointegration compared to control group. As for biomechanical pull-out testing, PTH group also showed significant improvement of ultimate force than control group. Conclusions Low-dose intermittent administration of PTH for 4 and 8 weeks enhances early osseointegration and fixation of orthopedic implants surrounded by a 2-mm gap in terms of increased bone regeneration and mechanical stability. These findings suggest PTH a potential for reducing the postoperative complications of implants by improving bone healing at peri-implant gaps.
Collapse
Affiliation(s)
- Xinlin Gao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.,Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Meng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Gornet MF, Lanman TH, Burkus JK, Dryer RF, McConnell JR, Hodges SD, Schranck FW. Two-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: 10-year outcomes of a prospective, randomized investigational device exemption clinical trial. J Neurosurg Spine 2019; 31:508-518. [PMID: 31226684 DOI: 10.3171/2019.4.spine19157] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/09/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The authors assessed the 10-year clinical safety and effectiveness of cervical disc arthroplasty (CDA) to treat degenerative cervical spine disease at 2 adjacent levels compared to anterior cervical discectomy and fusion (ACDF). METHODS A prospective, randomized, controlled, multicenter FDA-approved clinical trial was conducted comparing the low-profile titanium ceramic composite-based Prestige LP Cervical Disc (n = 209) at two levels with ACDF (n = 188). Ten-year follow-up data from a postapproval study were available on 148 CDA and 118 ACDF patients and are reported here. Clinical and radiographic evaluations were completed preoperatively, intraoperatively, and at regular postoperative follow-up intervals for up to 10 years. The primary endpoint was overall success, a composite variable that included key safety and efficacy considerations. Ten-year follow-up rates were 86.0% for CDA and 84.9% for ACDF. RESULTS From 2 to 10 years, CDA demonstrated statistical superiority over ACDF for overall success, with rates at 10 years of 80.4% versus 62.2%, respectively (posterior probability of superiority [PPS] = 99.9%). Neck Disability Index (NDI) success was also superior, with rates at 10 years of 88.4% versus 76.5% (PPS = 99.5%), as was neurological success (92.6% vs 86.1%; PPS = 95.6%). Improvements from preoperative results in NDI and neck pain scores were consistently statistically superior for CDA compared to ACDF. All other study effectiveness measures were at least noninferior for CDA compared to ACDF through the 10-year follow-up period, including disc height. Mean angular ranges of motion at treated levels were maintained in the CDA group for up to 10 years. The rates of grade IV heterotopic ossification (HO) at the superior and inferior levels were 8.2% and 10.3%, respectively. The rate of severe HO (grade III or IV) did not increase significantly from 7 years (42.4%) to 10 years (39.0%). The CDA group had fewer serious (grade 3-4) implant-related or implant/surgical procedure-related adverse events (3.8% vs 8.1%; posterior mean 95% Bayesian credible interval [BCI] of the log hazard ratio [LHR] -0.92 [-1.88, -0.01]). The CDA group also had statistically fewer secondary surgical procedures at the index levels (4.7%) than the ACDF group (17.6%) (LHR [95% BCI] -1.39 [-2.15, -0.61]) as well as at adjacent levels (9.0% vs 17.9%). CONCLUSIONS The Prestige LP Cervical Disc, implanted at two adjacent levels, maintains improved clinical outcomes and segmental motion 10 years after surgery and is a safe and effective alternative to fusion.Clinical trial registration no.: NCT00637156 (clinicaltrials.gov).
Collapse
Affiliation(s)
| | - Todd H Lanman
- 2Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Scott D Hodges
- 6Center for Sports Medicine & Orthopaedics, Chattanooga, Tennessee; and
| | | |
Collapse
|
4
|
Broekema AEH, Molenberg R, Kuijlen JMA, Groen RJM, Reneman MF, Soer R. The Odom Criteria: Validated at Last: A Clinimetric Evaluation in Cervical Spine Surgery. J Bone Joint Surg Am 2019; 101:1301-1308. [PMID: 31318810 DOI: 10.2106/jbjs.18.00370] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Odom criteria, established in 1958, are a widely used, 4-point rating scale for assessing the clinical outcome after cervical spine surgery. Surprisingly, the Odom criteria have never been validated, to our knowledge. The aim of this study was to investigate the reliability and validity of the Odom criteria for the evaluation of surgical procedures of the cervical spine. METHODS Patients with degenerative cervical spine disease were included in the study and divided into 2 subgroups on the basis of their most predominant symptom: myelopathy or radiculopathy. Reliability was assessed with interrater and test-retest design using quadratic weighted kappa coefficients. Construct validity was assessed by means of hypotheses testing. To evaluate whether the Odom criteria could act as a global perceived effect (GPE) scale, we assessed concurrent validity by comparing area under the curve (AUC) values of receiver operating characteristic (ROC) curves for the set of questionnaires. RESULTS A total of 110 patients were included in the study; 19 were excluded, leaving 91 in our analysis. Reliability assessments showed κ = 0.77 for overall interrater reliability and κ = 0.93 for overall test-retest reliability. Interrater reliability was κ = 0.81 for the radiculopathy subgroup and κ = 0.68 for the myelopathy subgroup. At least 75% of the hypotheses were met. The AUCs showed similar characteristics between the Odom criteria and GPE scale. CONCLUSIONS The Odom criteria met the predefined criteria for reliability and validity. Therefore, the Odom criteria may be used to assess surgical outcome after a cervical spine procedure, specifically for patients presenting with radicular symptoms. The results of previous studies that have been deemed less trustworthy because of the use of the Odom criteria should be reconsidered.
Collapse
Affiliation(s)
- Anne E H Broekema
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, the Netherlands
| | - Rob Molenberg
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, the Netherlands
| | - Jos M A Kuijlen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, the Netherlands
| | - Rob J M Groen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, the Netherlands
| | - Michiel F Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation, the Netherlands
| | - Remko Soer
- University of Groningen, University Medical Center Groningen, Groningen Spine Center, the Netherlands.,Saxion University of Applied Sciences, Enschede, the Netherlands
| |
Collapse
|
5
|
Xu S, Liang Y, Zhu Z, Wang K, Liu H. [Effectiveness evaluation of Prodisc-C prosthesis for more than 10 years follow-up after total cervical disc replacement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:393-402. [PMID: 30983184 PMCID: PMC8337169 DOI: 10.7507/1002-1892.201810109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/01/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate long-term radiographic and clinical effectiveness of total cervical disc replacement (TDR) with Prodisc-C prosthesis at a minimum of 10 years follow-up. METHODS The clinical data of 118 patients with cervical disc degeneration disease (CDDD) treated with TDR by using Prodisc-C prosthesis between December 2005 and April 2008 were retrospectively analyzed. There were 66 males and 52 females, with the age of 25-62 years (mean, 46.8 years). There were 38 cases of cervical spondylotic radiculopathy, 28 cases of cervical spondylotic myelopathy, and 52 cases of mixed cervical spondylotic myelopathy. The operative segments were C 3-7, including 90 cases of single segment, 20 cases of continuous double segments, and 8 cases of continuous three segments. A total of 154 Prodisc-C prostheses were used during the operation. The clinical effectiveness was evaluated by pain visual analogue scale (VAS) score, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, and Odom grade before and after operation. Imaging evaluation indicators included range of motion (ROM), sagittal lordosis angle, intervertebral disc height (IDH), and prosthesis displacement, subsidence, loosening, locking, and heterotopic ossification (HO), adjacent segment degeneration (ASD), and other complications. Patients were grouped according to whether HO or ASD occurred or not, the ROM of surgical segment was compared. RESULTS All patients were followed up 121-150 months (mean, 135.8 months). No revision operation was performed during the follow-up period. The VAS, NDI, JOA scores and Odom grades were significantly improved at 1 week after operation and last follow-up when compared with preoperative ones ( P<0.05); VAS and NDI scores were further improved at last follow-up than those at 1 week after operation ( P<0.05); there was no significant difference in JOA scores and improvement rates between at 1 week after operation and at last follow-up ( P>0.05). The ROM of the whole cervical spine and the operative segment decreased at 1 week and 10 years after operation when compared with preoperative ones ( P<0.05), but there was no significant difference in the other time points ( P>0.05); there was no significant difference in the ROM between the upper adjacent segment (UAS) and the lower adjacent segment (LAS) at each time point after operation ( P>0.05). There was no significant difference in sagittal lordosis angle of cervical spine before and after operation ( P>0.05); the sagittal lordosis angle of operative segment increased significantly at 1 week, 6 months, 1 year, and 2 years after operation ( P<0.05). The IDH of operative segment was significantly improved at each time point after operation ( P<0.05), but there was no significant difference in IDH between UAS and LAS at each time point after operation ( P>0.05). No prosthesis displacement, subsidence, or loosening occurred at each time point after operation. There was no significant difference of the prosthetic displacement and subsidence distance between all time points after 6 months after operation ( P>0.05). At last follow-up, the incidence of prosthetic locking/fusion was 10.4%, showing no significant difference when compared with 6 months (1.9%) ( P<0.05). The incidence of upper ASD and lower ASD was 1.3% and 2.6% respectively at 1 week after operation. The incidence of upper ASD and lower ASD increased gradually with time prolonging, and there were significant differences between different time points ( P<0.05). The ROM of operative segment in ASD group was lower than that in non-ASD group at each time point after operation, but there was no significant difference ( P>0.05). HO appeared in 58.4% of the segments at 6 months after operation, and the incidence of HO increased significantly with time, which was significantly different from that at 6 months after operation ( P<0.05). The ROM of operative segments in HO group was significantly lower than that in non-HO group at 6 months, 2 years, 5 years, and 10 years after operation ( P<0.05). CONCLUSION TDR has little effect on adjacent segments, although there are some imaging complications, it has no significant effect on the improvement of overall clinical effectiveness. Prodisc-C prosthesis can provide long-term, safe, and definite clinical effectiveness in the treatment of CDDD.
Collapse
Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Kaifeng Wang
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, 100044,
| |
Collapse
|
6
|
Lei T, Tong T, Miao D, Gao X, Xu J, Zhang D, Shen Y. Anterior Migration After Bryan Cervical Disc Arthroplasty: The Relationship Between Hyperlordosis and its Impact on Clinical Outcomes. World Neurosurg 2017; 101:534-539. [DOI: 10.1016/j.wneu.2017.02.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 12/14/2022]
|
7
|
Chen C, Zhang X, Ma X. Durability of cervical disc arthroplasties and its influence factors: A systematic review and a network meta-analysis. Medicine (Baltimore) 2017; 96:e5947. [PMID: 28178135 PMCID: PMC5312992 DOI: 10.1097/md.0000000000005947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The durability of cervical disc arthroplasties (CDA) may vary significantly because of different designs and implanting techniques of the devices. Nevertheless, the comparative durability remains unknown. OBJECTIVES We aimed to assess the durability of CDAs in at least 2-year follow-up. We analyzed the classifications and causes of secondary surgical procedures, as well as the structural designs of the devices that might influence the durability. METHODS PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from the inception of each database to September 2015 using the following Keywords: "cervical disc replacement" OR "cervical disc arthroplasty" AND "randomized controlled trial (RCT)." Publication language was restricted to English. The primary outcome was the rate of secondary surgical procedures following CDA or anterior cervical decompression and fusion (ACDF). Pairwise meta-analysis and a Bayesian network meta-analysis were carried out using Review Manager v5.3.5 and WinBUGS version 1.4.3, respectively. Quality of evidence was appraised by Grading of Recommendations Assessment, Development and Evaluation methodology. RESULTS Twelve RCTs that met the eligibility criteria were included. Follow-up ranged from 2 years to 7 years. A total of 103 secondary surgical procedures were performed. The most frequent classification of secondary surgical procedures was reoperation (48/103) and removal (47/103). Revision (3/103) and supplementary fixation (2/103) were rare. Adjacent-level diseases were the most common cause of reoperations. The rates of secondary surgical procedures were significantly lower in Mobi-C, Prestige, Prodisc-C, Secure-C group than in ACDF group. No significant difference was detected between Bryan, PCM, Kineflex-C, Discover, and ACDF. Mobi-C, Secure-C, and Prodisc-C ranked the best, the second best, the third best, respectively. CONCLUSIONS We concluded that Mobi-C, Secure-C, and Prodisc-C were more durable than ACDF. Precise selection of device size and proper surgical techniques are implicated to be crucial to enhance the perdurability. Device design should concentrate on the imitation of biomechanics of normal cervical disc, and semi-constrained structural device is a better design to make CDA more durable.
Collapse
Affiliation(s)
| | - Xiaolin Zhang
- Department of spinal surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | | |
Collapse
|
8
|
Application of a stand-alone anchored spacer in noncontiguous anterior cervical arthrodesis with radiologic analysis of the intermediate segment. J Clin Neurosci 2016; 25:69-74. [DOI: 10.1016/j.jocn.2015.05.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/06/2015] [Accepted: 05/09/2015] [Indexed: 10/22/2022]
|
9
|
Janssen ME, Zigler JE, Spivak JM, Delamarter RB, Darden BV, Kopjar B. ProDisc-C Total Disc Replacement Versus Anterior Cervical Discectomy and Fusion for Single-Level Symptomatic Cervical Disc Disease: Seven-Year Follow-up of the Prospective Randomized U.S. Food and Drug Administration Investigational Device Exemption Study. J Bone Joint Surg Am 2015; 97:1738-47. [PMID: 26537161 DOI: 10.2106/jbjs.n.01186] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with single-level cervical degenerative disc disease, total disc arthroplasty can relieve radicular pain and preserve functional motion between two vertebrae. We compared the efficacy and safety of cervical total disc arthroplasty with that of anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease between C3-C4 and C6-C7. METHODS Two hundred and nine patients at thirteen sites were randomly treated with either total disc arthroplasty with ProDisc-C (n = 103) or with ACDF (n = 106). Patients were assessed preoperatively; at six weeks and three, six, twelve, eighteen, and twenty-four months postoperatively; and then annually until seven years postoperatively. Outcome measures included the Neck Disability Index (NDI), the Short Form-36 (SF-36), postoperative neurologic parameters, secondary surgical procedures, adverse events, neck and arm pain, and satisfaction scores. RESULTS At seven years, the overall follow-up rate was 92% (152 of 165). There were no significant differences in demographic factors, follow-up rate, or patient-reported outcomes between groups. Both procedures were effective in reducing neck and arm pain and improving and maintaining function and health-related quality of life. Neurologic status was improved or maintained in 88% and 89% of the patients in the ProDisc-C and ACDF groups, respectively. After seven years of follow-up, thirty secondary surgical procedures had been performed in nineteen (18%) of 106 patients in the ACDF group compared with seven secondary surgical procedures in seven (7%) of 103 patients in the ProDisc-C group (p = 0.0099). There were no significant differences in the rates of any device-related adverse events between the groups. CONCLUSIONS Total disc arthroplasty with ProDisc-C is a safe and effective surgical treatment of single-level symptomatic cervical degenerative disc disease. Clinical outcomes after total disc arthroplasty with ProDisc-C were similar to those after ACDF. Patients treated with ProDisc-C had a lower probability of subsequent surgery, suggesting that total disc arthroplasty provides durable results and has the potential to slow the rate of adjacent-level disease. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michael E Janssen
- Center for Spinal Disorders/Scientific Education and Research Institute, 9005 Grant Street, Suite 200, Thornton, CO 80229
| | - Jack E Zigler
- Texas Back Institute, 6020 West Parker Road, Suite 200, Plano, TX 75093
| | - Jeffrey M Spivak
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003
| | - Rick B Delamarter
- The Spine Institute, 2811 Wilshire Boulevard, Suite 850, Santa Monica, CA 90403
| | - Bruce V Darden
- OrthoCarolina Spine Center, 2001 Randolph Road, Charlotte, NC 28207
| | - Branko Kopjar
- Department of Health Services, University of Washington, 4333 Brooklyn Avenue N.E., Room 14-315, Seattle, WA 98195-9455. E-mail address:
| |
Collapse
|
10
|
Chang PY, Chang HK, Wu JC. Cervical disc arthroplasty: nonconstrained versus semiconstrained. J Neurosurg Spine 2015; 23:394-5. [PMID: 26047343 DOI: 10.3171/2015.1.spine141313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Peng-Yuan Chang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|