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European Spine Journal

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01-07-2016 | Original Article

In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement

Authors: Bastian Welke, Michael Schwarze, Christof Hurschler, Thorsten Book, Stephan Magdu, Dorothea Daentzer

Published in: European Spine Journal | Issue 7/2016

Abstract

Purpose and methods

For the treatment of degenerative disc diseases of the cervical spine, anterior cervical discectomy and fusion (ACDF) still represents the standard procedure. However, long term clinical studies have shown a higher incidence of pathologies in the adjacent segments. As an alternative to spinal fusion, cervical total disc replacement (cTDR) or dynamically implants were increasingly used. This in vitro study analyzed the kinematics and intradiscal pressures in seven multi-segmental human cervical spine using hybrid multidirectional test method. The aim of our study was to compare the intact condition with a single-level dynamic stabilization with DCI^®, with cTDR (activC^®) and with simulated ACDF (CeSPACE^® cage and CASPAR plate).

Results

No significant changes in the kinematics and pressures were observed in all segments after arthroplasty. The DCI^® significantly decreased the motion of the treated segment in flexion/extension and lateral bending with some remaining residual mobility. Thereby the motion of the upper segment was increased significantly in flexion/extension. No significant changes of the intradiscal pressures were observed. With simulated fusion the motion of the indexed level was significantly decreased in flexion/extension and axial rotation with the greatest changes in the adjacent levels and the highest pressures.

Conclusion

Based on our biomechanical study the DCI^® can pose an alternative to fusion, which has a lesser effect on adjacent levels. This might reduce the risk of long-term degeneration in those levels. In particular, the facet joint arthritis and kyphotic deformity, as a contraindication to the arthroplasty, could be a clinical application of the dynamic implant.

Chang U-K, Kim DH, Lee MC et al (2007) Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 7:33–39. doi:10.3171/SPI-07/07/033 CrossRefPubMed

DiAngelo DJ, Foley KT, Morrow BR et al (2004) In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant. Neurosurg Focus 17:E7PubMed

Ragab AA, Escarcega AJ, Zdeblick TA (2006) A quantitative analysis of strain at adjacent segments after segmental immobilization of the cervical spine. J Spinal Disord Tech 19:407–410CrossRefPubMed

Galbusera F, Bellini CM, Raimondi MT et al (2008) Cervical spine biomechanics following implantation of a disc prosthesis. Med Eng Phys 30:1127–1133. doi:10.1016/j.medengphy.2008.02.002 CrossRefPubMed

Goffin J, Geusens E, Vantomme N et al (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17:79–85CrossRefPubMed

Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to site of a previous anterior cervical arthrodesis. J Bone Jt Surg Br 81-A:519–528

Delamarter RB, Zigler J (2013) Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine 38:711–717. doi:10.1097/BRS.0b013e3182797592 (Phila Pa 1976) CrossRefPubMed

Blumenthal SL, Ohnmeiss DD, Guyer RD, Zigler JE (2013) Reoperations in cervical total disc replacement compared with anterior cervical fusion: results compiled from multiple prospective food and drug administration investigational device exemption trials conducted at a single site. Spine 38:1177–1182. doi:10.1097/BRS.0b013e31828ce774 (Phila Pa 1976) CrossRefPubMed

Auerbach JD, Jones KJ, Fras CI et al (2008) The prevalence of indications and contraindications to cervical total disc replacement. Spine J 8:711–716. doi:10.1016/j.spinee.2007.06.018 CrossRefPubMed

10.

Patwardhan AG, Havey RM, Ghanayem AJ et al (2000) Load-carrying capacity of the human cervical spine in compression is increased under a follower load. Spine 25:1548–1554 (Phila Pa 1976) CrossRefPubMed

11.

Panjabi MM (2007) Hybrid multidirectional test method to evaluate spinal adjacent-level effects. Clin Biomech 22:257–265. doi:10.1016/j.clinbiomech.2006.08.006 CrossRef

12.

Hurschler C, Pott LS, Gossé F, Wirth C (2005) Sensor-guided robot. Spine motion-segment. Biomech. Test. Valid. against pure moment Appar. In: Transactions of the 51st annual meeting of the Orthopedic Research Society

13.

Wilke H, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7:148–154CrossRefPubMedPubMedCentral

14.

Crawford N, Dickman C (1997) Construction of local vertebral coordinate systems using a digitizing probe: technical note. Spine 22:559–563 (Phila Pa 1976) CrossRefPubMed

15.

White AA III, Panjabi M (1990) Clinical biomechanics of the spine, 2nd edn. J.B. Lippincott Comp, Philadelphia

16.

Patwardhan AG, Tzermiadianos MN, Tsitsopoulos PP et al (2012) Primary and coupled motions after cervical total disc replacement using a compressible six-degree-of-freedom prosthesis. Eur Spine J 21:618–629. doi:10.1007/s00586-010-1575-7 CrossRef

17.

Chang U-K, Kim DH, Lee MC et al (2007) Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine 7:40–46. doi:10.3171/SPI-07/07/040 CrossRefPubMed

18.

McAfee PC, Cunningham B, Dmitriev A et al (2003) Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 28:S176–S185. doi:10.1097/01.BRS.0000092219.28382.0C (Phila Pa 1976) CrossRefPubMed

19.

Suchomel P, Jurák L, Antinheimo J et al (2014) Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis. Eur Spine J 23:1124–1134. doi:10.1007/s00586-014-3223-0 CrossRefPubMed

20.

Mo ZJ, Bin Zhao Y, Wang LZ et al (2014) Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue. Eur Spine J 23:613–621. doi:10.1007/s00586-013-3070-4 CrossRefPubMed

21.

Wang L, Song YM, Liu LM et al (2014) Clinical and radiographic outcomes of dynamic cervical implant replacement for treatment of single-level degenerative cervical disc disease: a 24-month follow-up. Eur Spine J 23:1680–1687. doi:10.1007/s00586-014-3180-7 CrossRefPubMed

22.

Matgé G, Berthold C, Gunness VRN et al (2015) Stabilization with the dynamic cervical implant: a novel treatment approach following cervical discectomy and decompression. J Neurosurg Spine 22:237–245. doi:10.3171/2014.10.SPINE131089 CrossRefPubMed

23.

Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine 13:1129–1134 (Phila Pa 1976) CrossRefPubMed

24.

Crawford NR (2007) Does the “hybrid multidirectional test method” generate quality data or paradoxical data? Clin Biomech (Bristol, Avon) 22:861–2; author reply 863–4. doi: 10.1016/j.clinbiomech.2007.04.005

25.

Panjabi M (2007) Reply. Clin Biomech 22:863–864. doi:10.1016/j.clinbiomech.2007.04.001 CrossRef

26.

Dreischarf M, Zander T, Bergmann G, Rohlmann A (2010) A non-optimized follower load path may cause considerable intervertebral rotations. J Biomech 43:2625–2628. doi:10.1016/j.jbiomech.2010.05.033 CrossRefPubMed

27.

Herdmann J, Buddenberg P, Pilz A et al (2011) Life quality after cervical reconstruction with dynamic cervical implant. Eur Spine J, Springer, p 2026

28.

Li Z, Yu S, Zhao Y et al (2014) Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease. J Clin Neurosci 21:942–948. doi:10.1016/j.jocn.2013.09.007 CrossRefPubMed

Title: In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement
Authors: Bastian Welke
Michael Schwarze
Christof Hurschler
Thorsten Book
Stephan Magdu
Dorothea Daentzer
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 7/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4361-8

At a glance: The STEP trials

Springer Medicine

In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement

Abstract

Purpose and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose and methods

Results

Conclusion

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