anterior cervical fusion cervical total disc …€¦ · sagittal static disorder. cervical fusion...
TRANSCRIPT
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
www.spinesurgery.be
sealand.spine.community
www.ortholef.com