PRESTIGE Cervical Arthroplasty: Past, Present, and Future

Numerical Shape Optimization of Cervical Spine Disc Prosthesis Prodisc-C

Various ball and socket-type designs of cervical artificial discs are in use or under investigation. All these disc designs claim to restore the normal kinematics of the cervical spine. In this study, we are interested in the cervical prosthesis, which concerns the most sensitive part of the human body, given the movements generated by the head. The goal of this work is to minimize the constraints by numerical shape optimization in the prodisc-C cervical spine prosthesis in order to improve performance and bio-functionality as well as patient relief. Prodisc-C cervical spine prosthesis consists of two cobalt chromium alloy plates and a fixed nucleus. Ultra-high molecular weight polyethylene, on each plate there is a keel to stabilize the prosthesis; this prosthesis allows thee degrees of freedom in rotation. To achieve this goal, a static study was carried out to determine the constraint concentrations on the different components of the prosthesis. Based on the biomechanical behaviour of the spine discs, we totally fixed the lower metal plate; a vertical load of 73.6 N to simulate the weight of the head was applied to the superior metallic endplate. After a static study on this prosthesis, using a finite element model, we noticed that the concentration of the Von-Mises stress is concentrated on the peripheral edge core and the concave articulating surface of the superior metallic endplate the numerical. We use the module optimization for 3D SolidWorks for optimize our design, based on the criteria of minimizing stress value. Shape optimization concluded to minimize the equivalent stress value on both joint surface (concave and convex) from 11.3 MPa to 9.1MPa corresponding to a percentage decrease of 19.4% from the original geometry. We conclude that despite the fact that maximum Von Mises stresses are higher in the case of the dynamic load, remains that they are weak. Which is an advantage for the durability of the prosthesis and-also for the bone, because a low stress concentration on the prosthesis will reduce stress concentration generated by the implant on the bone, therefore its risk of fracture reduces.

Differences between C3-4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4-5 and C5-6 discs account for more motion than the C3-4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3-4 and non-C3-4 CDA groups (i.e., those including C4-5, C5-6, and C6-7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3-4 CDA group and 77 in the non-C3-4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3-4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3-4 was infrequent, the improved clinical outcomes of CDA were similar at C3-4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3-4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

Cervical Arthroplasty for Traumatic Disc Herniation: An Age- and Sex-matched Comparison with Anterior Cervical Discectomy and Fusion

BACKGROUND

The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been demonstrated by prospective, randomized and controlled clinical trials. However, there are scant data on using cervical arthroplasty for traumatic disc herniation. Therefore, this study aimed to investigate the outcomes of patients who underwent cervical arthroplasty for traumatic disc herniation.

METHODS

This cohort included patients who were admitted through the emergency department for trauma. Only patients who had newly-onset, one- or two-level cervical disc disease causing radiculopathy or myelopathy were identified. None of these patients had previously sought for medical attention for such problems. Those patients who had severe spinal cord injury (i.e. American Spinal Injury Association scale A, B or C) or severe myelopathy (i.e. Nurick scale 4 or 5), bony fracture, dislocation, perched facet, kyphotic deformity, or instability were also excluded. An age- and sex-matched one-to-one comparison was made between patients who underwent cervical arthroplasty, on the one hand, and anterior cervical discectomy and fusion (ACDF).

RESULTS

A total of 30 trauma patients (15 in the arthroplasty group and 15 in the ACDF group) were analyzed, with a mean follow-up of 29.6 months. The demographic data were similar. Post-operation, the arthroplasty group had significant improvement in VAS of neck and arm pain, JOA, and NDI when compared to their pre-operation status. Similarly, the ACDF group also improved significantly after the operation. There were no differences between the two groups in post-operative VAS neck and arm pain, and JOA scores. The arthroplasty group maintained a range of motion in the indexed levels and had better NDI scores at 6-months post-operation than the ACDF group.

CONCLUSIONS

For selected patients (i.e. no spinal cord injury, no fracture, and no instability) with traumatic cervical disc herniation, cervical arthroplasty yields similar improvement in clinical outcomes to ACDF and preserves segmental mobility.