ANTERIOR CERVICAL FUSION CERVICAL TOTAL DISC ARTHROPLASTY

Transcription

1 ANTERIOR CERVICAL FUSION CERVICAL TOTAL DISC ARTHROPLASTY LEFLOT JEAN-LOUIS M.D. UH BRUGMANN BRUSSELS

2 WHAT INTERESTS US?

3 ANATOMY (R.LOUIS)

4 ANATOMY

5 PATHOLOGICAL ANATOMY

6 PATHOLOGICAL ANATOMY

7 SAGITTAL DISBALANCE Analgesic position Decrease the pressure on the back of the disc Open the foramens Degenerative Intersomatic height loss

8 SAGITTAL DISBALANCE

9 SAGITTAL DISBALANCE

10 OUR SURGICAL CHALLENGES Neurological release Sagittal balance Preserve the function

11 SURGICAL APPROACH Positioning of the Head! At the zenith (better centering of the prosthesis) or slight left rotation for a right anterolateral approach Neutral position AVOID HYPEREXTENSION!!! Risk of aggravation of cervical myelopathy

12 SURGICAL APPROACH The right approach is easier for the right-handed and for better centering of a prosthesis (position of the esophagus) For low cervical levels : visualize the recurrent laryngeal nerve to avoid voice disorder Horizontal is more aesthetic Vertical for more than 2 levels, but scar more visible and less flexible

13 SURGICAL APPROACH Pre-vascular anterolateral approach «Smith-Robinson» Atraumatic Finger dissection, "Peanut" tampon and dissection scissors

14 SURGICAL APPROACH Low incidence of complications most often minor but some very serious Dysphagia Hematoma Paralysis n. Recurrent laryngeal Dural injury Esophageal perforation Aggravation myelopathy Syndrome of Claude Bernard Horner

15 CERVICAL FUSION F 38y Cervical discopathies C4C5 and C5C6 Sagittal Static Disorder

16 CERVICAL FUSION F42y Cervical spondylosis (C5C6, C6C7) Cervical disc herniation and canal narrowing C5C6 Anterolisthesis C4/C5

17 CERVICAL FUSION DECOMPENSATION OF ADJACENT LEVELS DECO

18 CERVICAL FUSION

19 CDP CHALLENGE Preserve the function to reduce constraints on adjacent segments

20 CDP WHY? Trend? Research of equivalents to other joint prostheses Hilibrand (1999): Decompensation of segments adjacent to cervical arthrodesis (25% to 10 years) Preserve the function to reduce constraints on adjacent segments

21 CDP INDICATIONS Ideal indication Cervicobrachial neuralgia with neurological deficit or resistant to conservative treatment, due to a soft disc 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 most mobile and least degenerative level(s) ABSENCE OF ZYGAPOPHYSARY DEGENERATIVE LESIONS

22 CDP WHICH ONE TO USE? Design Range of Motion Materials Heights (mm) Footprints Shape Fixation Regulatory

23 CDP WHICH ONE TO USE? No compression Fail to closely replicate physiologic stability & motion Complex surgical technique (multi-piece design)

24 CDP WHICH ONE TO USE? Motion occurs within polymer & provides compression Mimics properties of natural disc

25 BRYAN (MEDTRONIC)

26 BRYAN (MEDTRONIC) - 10Y

27 BRYAN (MEDTRONIC) - 14Y

28 BRYAN (MEDTRONIC) - 15Y

29 PCM CERVITECH LINK

30 PCM CERVITECH LINK M-47y mult-stage lesions with more osteophytosis at levels C3C4 and C5C6 Hybrid stabilization to reduce the rigidity of the treated segment, with excellent restitution of cervical lordosis

31 PCM CERVITECH LINK

32 M6C SPINAL KINETICS

33 M6C SPINAL KINETICS

34 M6C SPINAL KINETICS

35 M6C SPINAL KINETICS 1Y

36 M6C SPINAL KINETICS 5Y

37 M6C SPINAL KINETICS 1Y

38 M6C SPINAL KINETICS 4Y

39 MOBI-C LDR ZIMMER BIOMET

40 MOBI-C LDR ZIMMER BIOMET

41 MOBI-C LDR ZIMMER BIOMET

42 CORE WITH CONTROLLED MOBILITY MOBI-C LDR ZIMMER BIOMET

43 CORE WITH CONTROLLED MOBILITY MOBI-C LDR ZIMMER BIOMET Classical «Ball & Socket» Controlled mobility of the core : Mobi-C

44 MOBI-C LDR ZIMMER BIOMET M 48y Control 3y

45 MOBI-C LDR ZIMMER BIOMET

46 MOBI-C LDR ZIMMER BIOMET

47 MOBI-C LDR ZIMMER BIOMET M 48y Corporectomy Fusion C4-C7 Mobi-C C3C4 Controle 4y

48 MOBI-C LDR ZIMMER BIOMET

49 MEAN NDI SCORE (NECK DISABILITY INDEX) MOBI-C LDR ZIMMER BIOMET

50 MEAN ROM AT INDEX LEVEL MOBI-C LDR ZIMMER BIOMET

51 RADIOGRAPHIC ADJACENT SEGMENT DEGENERATION MOBI-C LDR ZIMMER BIOMET

52 RADIOGRAPHIC ADJACENT SEGMENT DEGENERATION MOBI-C LDR ZIMMER BIOMET

53 ADJACENT SEGMENT SUBSEQUENT SURGERIES MOBI-C LDR ZIMMER BIOMET

54 CONCLUSIONS - Return to work faster - Results at7 years as good and even better - Less surgicalrevision atadjacentlevels - Problem of weardebris?

55 PROBLEM OF WEAR DEBRIS?

56 PROBLEM OF WEAR DEBRIS?

57 PROBLEM OF WEAR DEBRIS?

58 RHINE K2M To avoid wear debris

59 RHINE K2M Metal plates manufactured with holes Over molding process through metal endplates Manufacture & plasma spray endplates Manufacture & plasma spray endplates

60 RHINE K2M

61 RHINE K2M

62 RHINE K2M

63 RHINE K2M

64 RHINE K2M C4-C5 C6-C7

65 sealand.spine.community