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Phillips FM, Coric D, Sasso R, Lanman T, Lavelle W, Lauryssen C, Albert T, Cammisa F, Milam RA. Prospective, multicenter clinical trial comparing the M6-C compressible cervical disc with anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical radiculopathy: 5-year results of an FDA investigational device exemption study. Spine J 2024; 24:219-230. [PMID: 37951477 DOI: 10.1016/j.spinee.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND CONTEXT Various total disc replacement (TDR) designs have been compared to anterior cervical discectomy and fusion (ACDF) with favorable short and long-term outcomes in FDA-approved investigational device exemption (IDE) trials. The unique design of M6-C, with a compressible viscoelastic nuclear core and an annular structure, has previously demonstrated favorable clinical outcomes through 24 months. PURPOSE To evaluate the long-term safety and effectiveness of the M6-C compressible artificial cervical disc and compare to ACDF at 5 years. STUDY DESIGN Prospective, multicenter, concurrently and historically controlled, FDA-approved IDE clinical trial. PATIENT SAMPLE Subjects with one-level symptomatic degenerative cervical radiculopathy were enrolled and received M6-C (n=160) or ACDF (n=189) treatment as part of the IDE study. Safety outcomes were evaluated at 5 years for all subjects. The primary effectiveness endpoint was available at 5 years for 113 M6-C subjects and 106 ACDF controls. OUTCOME MEASURES The primary endpoint of this analysis was composite clinical success (CCS) at 60 months. Secondary endpoints were function and pain (neck disability index, VAS), physical quality of life (SF-36, SF-12), safety, neurologic, and radiographic assessments. METHODS Propensity score subclassification was used to control for selection bias and match baseline covariates of the control group to the M6-C subjects. Sixty-month CCS rates were estimated for each treatment group using a generalized linear model controlling for propensity score. RESULTS At 5 years postoperatively, the M6-C treatment resulted in 82.3% CCS while the ACDF group showed 67.0% CCS (superiority p=.013). Secondary endpoints indicated that significantly more M6-C subjects achieved VAS neck and arm pain improvements and showed maintained or improved physical functioning on quality-of-life measures compared to baseline assessments. The M6-C group-maintained flexion-extension motion, with significantly greater increases from baseline disc height and disc angle than observed in the control group. The rates of M6-C subsequent surgical interventions (SSI; 3.1%) and definitely device- or procedure-related serious adverse events (SAE failure; 3.1%) were similar to ACDF rates (SSI=5.3%, SAE failure=4.8%; p>.05 for both). CONCLUSIONS Subjects treated with the M6-C artificial disc demonstrated superior 5-year achievement of clinical success when compared to ACDF controls. In addition, significantly more subjects in the M6-C group showed improved pain and physical functioning scores than observed in ACDF subjects, with no difference in reoperation rates or safety outcomes.
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Affiliation(s)
- Frank M Phillips
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St # 300, Chicago, IL 60612, USA.
| | - Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Atruim Health Musculoskeletal Institute, 225 Baldwin Ave, Charlotte, NC 28204, USA
| | - Rick Sasso
- Indiana Spine Group. 13225 N Meridian St, Carmel, IN 46032, USA
| | - Todd Lanman
- Lanman Spinal Neurosurgery, 450 N Roxbury Dr, Beverly Hills, CA 90210, USA
| | - William Lavelle
- Upstate Bone and Joint Center, 6620 Fly Rd, East Syracuse, NY 13057, USA
| | - Carl Lauryssen
- Central Texas Brain and Spine, PLLC, 2217 Park Bend Dr, Unit 400, Austin, TX 78758, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Frank Cammisa
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
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Clohisy JCF, Abjornson C, Bauer TW, Baral E, Albert TJ. Delayed Failure of M6-C Cervical Disc Arthroplasty After Conversion of Adjacent Cervical Disc Arthroplasty to Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00013. [PMID: 37071739 DOI: 10.2106/jbjs.cc.22.00788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CASE We present a delayed failure of an M6-C cervical disc arthroplasty after conversion of a subjacent failed cervical disc arthroplasty to fusion. The annular component had failed, and the core had been ejected. Histology demonstrated a giant cell reaction to polyethylene debris, and tissue cultures were positive for Cutibacterium acnes. CONCLUSION This is the first report of M6-C failure after conversion of an adjacent arthroplasty to fusion. A growing number of reports surrounding the M6-C failure rate and mechanisms raise concern about the device's durability and underscore the importance of routine clinical and radiographic surveillance for these patients.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Celeste Abjornson
- Integrated Spine Research Program, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Elexis Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Todd J Albert
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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Carrera DA, Ricks CB. Catastrophic delayed cervical arthroplasty failure: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21731. [PMID: 36209405 PMCID: PMC9379625 DOI: 10.3171/case21731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease. While more studies have suggested favorability of CDR over fusion procedures, limited data exist regarding implant fatigability. Here, the authors present a unique and previously unreported failure of the M6-C prosthesis causing spinal cord injury. OBSERVATIONS A 49-year-old female with history of cervical degenerative disease and prior C4–7 M6-C arthroplasty presented 9 years later after a minor fall from standing. She endorsed bilateral hand numbness ascending to forearms and shoulders, with dysesthesias and weakness. Imaging showed fractured arthroplasty penetrating the spinal cord. Revision surgery found a ruptured arthroplasty annulus with metal piece piercing the spinal cord. Partial C4 and C5 corpectomy was performed to remove the integrated fins of the arthroplasty and inspect the cord and dura. This was reconstructed with a corpectomy cage and plate. The patient made an excellent recovery, with improvement in her weakness and resolution of her sensory symptoms. LESSONS Possibility of fatigue-related failures presenting years after implantation have only been infrequently reported but can be catastrophic for patients. The authors encourage further discussions in this area, increased counseling with patients, and recommend a patient registry to better document adverse events.
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Affiliation(s)
- Diego A. Carrera
- Department of Neurological Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Christian B. Ricks
- Department of Neurological Surgery, University of New Mexico, Albuquerque, New Mexico
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Lin H, Chang N, Mobbs R, Hui N. Comparison of in vivo kinematic and radiological parameters of three cervical disc prostheses. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:55-61. [PMID: 35386247 PMCID: PMC8978856 DOI: 10.4103/jcvjs.jcvjs_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cervical total disc replacement (CTDR) is an alternative to anterior cervical discectomy and fusion for select patients that may preserve range of motion and reduce adjacent segment disease. Various CTDR prostheses are available; however, comparative data are limited. This study aimed to compare the short-term kinematic and radiological parameters of the M6-C, Mobi-C, and the CP-ESP prostheses. Methods: This retrospective cohort study included patients treated with CTDR between March 2005 and October 2020 at a single institution. Patients were included if their follow-up assessment included lateral erect and flexion/extension radiographs. The primary outcome assessed at 3-months postoperatively was range of motion, measured by the difference in functional spinal unit angle between flexion and extension. Results: A total of 131 CTDR levels (120 patients, 46.2 ± 10.1 years, 57% male) were included. Prostheses implanted included the M6-C (n = 52), Mobi-C (n = 54), and CP-ESP (n = 25). Range of motion varied significantly (8.2° ± 4.4° vs. 10.9° ± 4.7° vs. 6.1° ± 2.7°, P < 0.001). On post hoc analysis, the Mobi-C prosthesis demonstrated a significantly greater range of motion than either the M6-C prosthesis (P = 0.003) or CP-ESP (P < 0.001). Conclusion: Although the optimal range of motion for CTDR has not been established, short-term differences in the range of motion may guide the selection of CTDR prosthesis. Further studies with longer follow-up and consideration of clinical outcome measures are necessary.
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Abstract
The first US Food and Drug Administration (FDA) approval for cervical total disc replacement (CTDR) was issued in 2007. Since then, 8 more artificial discs have been granted FDA approval for single-level CTDR. Two of these have also been approved for 2-level CTDR. All devices are indicated for levels C3 to C7 for symptomatic patients with radiculopathy or myelopathy caused by disc herniation or spondylosis unresponsive to conservative management. Trials have shown noninferiority of CTDR compared with anterior cervical decompression and fusion in their overall success. Hybrid surgery and CTDR of 3 or more levels are not FDA approved.
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Guyer RD, Albano JL, Ohnmeiss DD. Cervical Total Disc Replacement: Novel Devices. Neurosurg Clin N Am 2021; 32:449-460. [PMID: 34538471 DOI: 10.1016/j.nec.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article reviews the available literature for novel cervical total disc replacement devices, including ones which are available inside and outside of the United States. It includes biomechanical consideration as well as design characteristics and clinical data when available.
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Affiliation(s)
- Richard D Guyer
- Center for Disc Replacement at Texas Back Institute, 6020 W. Parker Rd. #200, Plano, TX 75093, USA.
| | - Joseph L Albano
- Texas Back Institute, 6020 W. Parker Rd. #200, Plano, TX 75093, USA
| | - Donna D Ohnmeiss
- Texas Back Institute Research Foundation, 6020 W. Parker Rd. #200, Plano, TX 75093, USA
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Roschke E, von der Höh NH, Dietz A, Stingu CS, Gradistanac T, Henkelmann J, Heyde CE. A Rare Case of Wear Induced Complications after Cervical Disc Replacement. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:324-328. [PMID: 33601460 DOI: 10.1055/a-1340-0643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Wear-induced complications after cervical disc replacement (CDR) are rare. A literature review on this topic found only a few case reports. We present a case of late complications after implantation of two cervical disc replacements, which resulted in infectious/abrasion-induced mixed-type inflammation with extensive osteolysis. The diagnostic workup, surgical therapy and outcome are presented and discussed with a review of the recent literature.
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Affiliation(s)
- Elisabeth Roschke
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University Medical Centre, Germany
| | - Nicolas H von der Höh
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University Medical Centre, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Leipzig University Medical Centre, Leipzig, Germany
| | - Catalina Suzana Stingu
- Institute of Medical Microbiology and Infection Epidemiology, Leipzig University Medical Centre, Leipzig, Germany
| | - Tanja Gradistanac
- Institute of Pathology, Leipzig University Medical Centre, Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Centre, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University Medical Centre, Germany
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Schroeder GD, Vaccaro AR, Divi SN, Reyes AA, Goyal DKC, Phillips FM, Zigler J. 2021 Position Statement From the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement. Int J Spine Surg 2021; 15:37-46. [PMID: 33900955 DOI: 10.14444/8004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ariana A Reyes
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dhruv K C Goyal
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Frank M Phillips
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Phillips FM, Coric D, Sasso R, Lanman T, Lavelle W, Blumenthal S, Lauryssen C, Guyer R, Albert T, Zigler J, Cammisa F, Milam RA. Prospective, multicenter clinical trial comparing M6-C compressible six degrees of freedom cervical disc with anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical radiculopathy: 2-year results of an FDA investigational device exemption study. Spine J 2021; 21:239-252. [PMID: 33096243 DOI: 10.1016/j.spinee.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Various designs of total disc replacement (TDR) devices have been compared to anterior cervical discectomy and fusion (ACDF) with favorable outcomes in FDA-approved investigational device exemption trials. The design of M6-C with a compressible viscoelastic nuclear core and an annular structure is substantially different than prior designs and has previously demonstrated favorable kinematics and clinical outcomes in small case series. PURPOSE To evaluate the safety and effectiveness of the novel M6-C compressible artificial cervical disc compared with ACDF for subjects with single-level degenerative cervical radiculopathy. STUDY DESIGN/SETTING Prospective, multicenter, concurrently and historically controlled, FDA-approved investigational device exemption clinical trial. PATIENT SAMPLE Subjects with one-level symptomatic degenerative cervical radiculopathy were enrolled and assigned to receive M6-C or ACDF. OUTCOME MEASURES Pain and function (Neck Disability Index, VAS), quality of life (SF-36), safety, neurologic, and radiographic assessments of motion (both flexion extension and lateral bending) were performed. The primary clinical endpoint was composite clinical success (CCS) at 24 months. METHODS Using propensity score subclassification to control for selection bias, 160 M6-C subjects were compared to a matched subset of 189 ACDF controls (46 concurrent and 143 historical controls). RESULTS Both ACDF and M6-C subjects reported significant improvements in patient-reported outcomes at all time points over baseline. Overall SF-36 Physical Component Score and neck and arm pain scores were significantly improved for M6-C as compared to ACDF treatment. CCS and mean Neck Disability Index improvements were similar between M6-C and ACDF. Correspondingly, there were significantly fewer subjects that utilized pain medication or opioids following M6-C treatment at 24 months relative to baseline. Range of motion was maintained in subjects treated with M6-C. Subsequent surgical interventions, dysphagia rates, and serious adverse events were comparable between groups. CONCLUSIONS M6-C treatment demonstrated both safety and effectiveness for the treatment of degenerative cervical radiculopathy. Treatment with M6-C demonstrated noninferiority for the primary endpoint, indicating a similar ability to achieve CCS at 24 months. However, for the secondary endpoints, M6-C subjects demonstrated significantly improved pain and function compared to ACDF subjects, while maintaining range of motion, improving quality of life, and decreasing analgesic and opioid usage at 2 years postoperatively relative to baseline.
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Affiliation(s)
- Frank M Phillips
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St # 300, Chicago, IL 60612, USA.
| | - Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Atruim Health Musculoskeletal Institute, 225 Baldwin Ave, Charlotte, NC 28204, USA
| | - Rick Sasso
- Indiana Spine Group, 13225 N Meridian St, Carmel, IN 46032, USA
| | - Todd Lanman
- Lanman Spinal Neurosurgery, 450 N Roxbury Dr, Beverly Hills, CA 90210, USA
| | - William Lavelle
- Upstate Bone and Joint Center, 6620 Fly Rd, East Syracuse, NY 13057, USA
| | - Scott Blumenthal
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Carl Lauryssen
- Central Texas Brain and Spine, PLLC, 2217 Park Bend Dr, Unit 400, Austin TX 78758, USA
| | - Richard Guyer
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Jack Zigler
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Frank Cammisa
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
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10
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Pingel A, Hoffmann CH, Scholz M, Kandziora F. Late Implant Failure in Cervical Disc Arthroplasty (M6-C, Spinal Kinetics) Causing Radiculopathy and Myelopathy. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:207-212. [PMID: 33296944 DOI: 10.1055/a-1286-5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cervical disc arthroplasty (CDA) is an approved surgical treatment option in selected patients with cervical spinal disc degeneration. Even though CDA is a standard procedure since 20 years, there is a lack of information about long term performance. The published reoperation rates after CDA are low and comparable to anterior cervical fusion. The authors describe a severe failure and dysfunction with a partial core dislocation of a cervical prosthesis into the spinal canal (M6-C, Spinal Kinetics, Sunnyvale, CA, USA). Six years after implantation of a cTDR (cervical Total Disk Replacement) of the M6 type at C4/5 level, a 52 year-old women presented herself with new clinical signs of cervical myelopathy and radicular pain. Complete posterior dislocation of the central core of the implant into the spinal canal was identified as a cause. The failed device was removed completely and an ACCF (anterior cervical corpectomy and fusion) was performed. Intraoperatively, rupture of the posterior portion of the mesh tissue with posterior dislocation of the whole prosthesis core was detected. This is the second described case of a severe implant failure with core dislocation in this type of cTDR device. Even though there are thousands of successful implantations and middle term outcomes, it seems to be necessary to continue with long term radiological follow up to exclude similar failure in this type of prosthesis.
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Affiliation(s)
- Andreas Pingel
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
| | | | - Matti Scholz
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
| | - Frank Kandziora
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
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Jacobs CAM, Siepe CJ, Ito K. Viscoelastic cervical total disc replacement devices: Design concepts. Spine J 2020; 20:1911-1924. [PMID: 32810609 DOI: 10.1016/j.spinee.2020.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/03/2023]
Abstract
Cervical disc replacement (CDR) is a motion-preserving surgical procedure for treating patients with degenerative disorders. Numerous reports of first generation CDR "ball-and-socket" articulating devices have shown satisfactory clinical results. As a result, CDR devices have been safely implemented in the surgeon's armamentarium on a global scale. However, only minor design improvements have been made over the last few years, as first generation CDRs devices were based on traditional synovial joint arthroplasty designs. As a consequence, these articulating designs have limited resemblance to the complex kinematic behavior of a natural disc. This has driven the development of deformable viscoelastic CDR devices to better mimic the biomechanical behavior of a natural disc. As a result, several viscoelastic CDR devices have been developed in recent years that vary in terms of materials, design and clinical outcomes. Since these viscoelastic CDR devices are fairly new, their weaknesses and strengths, which are related to their design characteristics, have not been well described. Therefore, this literature review discusses design related advantages and disadvantages of deformable viscoelastic CDR devices. As such, this paper can provide insight for surgeons and engineers on specific design characteristics of several viscoelastic devices and could potentially help to develop and design future implants. Eleven viscoelastic CDR devices were identified. An extensive database search on the devices' tradenames in Medline and PubMed was performed next. The devices were categorized based on common design characteristics to give an overview of both category and device specific complications and advantages. Overall, literature shows that most of these viscoelastic CDR devices can provide motion in all six degrees-of-freedom and have a variable center of rotation. Nevertheless, the viscoelastic materials used do not have an extensive history in orthopedics, so the long-term material behavior in vivo is still unknown. Although the viscoelastic devices have common benefits and risks, each specific design and category also has its own design related advantages and drawbacks that are described in this review. Altogether, viscoelastic total disc replacements seem to be a promising option for the future of cervical arthroplasty, but long-term clinical outcome is needed to confirm the advantages of mimicking the viscoelasticity of a natural disc.
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Affiliation(s)
- Celien A M Jacobs
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Rondom 70, 5612 AP Eindhoven, the Netherlands.
| | - Christoph J Siepe
- Schoen Clinic Munich Harlaching, Spine Center, Harlachinger Str. 51, D-81547 Munich, Germany; Spine Research Institute and Academic Teaching Hospital of the Paracelsus University Salzburg (PMU), Strubergasse 21, A-5020 Salzburg, Austria
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Rondom 70, 5612 AP Eindhoven, the Netherlands
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12
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Clark NJ, Francois EL, Freedman BA, Currier B. Early Implant Failure of a 2-Level M6-Cervical Total Disc Replacement: A Case Report. JBJS Case Connect 2020; 10:e1900644. [PMID: 32773711 DOI: 10.2106/jbjs.cc.19.00644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of implant failure after primary 2-level M6-cervical disc replacement (M6-C; Spinal Kinetics) at C4-5 and C5-6. At revision surgery, a full-thickness tear was identified in the sheath of the C5-6 implant. Histology from periprosthetic tissue demonstrated polyethylene particles without acute inflammation. Tissue cultures were positive for Propionibacterium acnes, but ultrasonicate cultures were negative for both prostheses. An independent laboratory test confirmed mechanical failure of the C5-6 prosthesis. CONCLUSION This is the first report of mechanical failure associated with wear-debris osteolysis after M6-C disc arthroplasty. Therefore, continued surveillance after CTDR is necessary.
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Affiliation(s)
- Nicholas J Clark
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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13
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Harris L, Dyson E, Elliot M, Peterson D, Ulbricht C, Casey A. Delayed periprosthetic collection after cervical disc arthroplasty. J Neurosurg Spine 2020; 32:584-591. [PMID: 31835247 DOI: 10.3171/2019.9.spine19900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Abstract
Cervical disc arthroplasty is a treatment option for symptomatic cervical disc disease. There is a paucity of literature on long-term safety outcomes, durability, and device-related failure rates. The M6-C artificial cervical disc is a device with titanium alloy endplates and a complex polymeric centerpiece. To date, trials have exhibited acceptable safety profiles.This case series describes the presentation, management, and pathological findings of a delayed prevertebral periprosthetic mass anterior to the M6-C disc. Four patients at 3 different institutions underwent cervical disc replacement with the M6-C disc. Two to seven years postoperatively, they presented with dysphagia secondary to a compressive mass anterior to the disc. Case notes were reviewed to collect data on symptoms, management, and outcomes. The patients were systemically well and presented with progressive dysphagia. They had imaging findings of a mass anterior to the disc. They underwent a decompressive procedure, with 2 patients undergoing device removal and fusion. In 2 cases, a soft-tissue mass was seen intraoperatively, with frank pus. In 3 cases, Propionibacterium acnes was identified and antibiotic treatment given. Histopathology demonstrated mixed inflammatory infiltrates with foreign body-type granulomas. Postoperatively, the dysphagia resolved.The development of delayed dysphagia in a patient with an M6-C disc should prompt investigation to identify a mass lesion. To the authors' knowledge, this is the first report of delayed infection, or suspected delayed-type hypersensitivity reaction, following M6-C disc implantation. It is important for this to be added to the device safety concerns. Further prospective studies are needed to establish the incidence and the long-term safety and failure rates of the M6-C disc.
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Affiliation(s)
- Lauren Harris
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Edward Dyson
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Matthew Elliot
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - David Peterson
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Christian Ulbricht
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Adrian Casey
- 2Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Xia MAM, Winder MJ. M6-C cervical disc replacement failure associated with late onset infection. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:584-588. [PMID: 32043008 PMCID: PMC6989942 DOI: 10.21037/jss.2019.11.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Cervical disc replacements are commonly used to treat degenerative disc disease. We present a case an M6-C disc replacement failure associated with Propionibacterium acnes infection three years post implantation.
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Affiliation(s)
- Mary-Anne M Xia
- Department of Neurosurgery, St Vincent's Private Hospital, Sydney, NSW, Australia
| | - Mark J Winder
- Department of Neurosurgery, St Vincent's Private Hospital, Sydney, NSW, Australia
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Hui N, Phan K, Kerferd J, Lee M, Mobbs RJ. Comparison of M6-C and Mobi-C cervical total disc replacement for cervical degenerative disc disease in adults. JOURNAL OF SPINE SURGERY 2019; 5:393-403. [PMID: 32042989 DOI: 10.21037/jss.2019.09.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Cervical total disc replacement (CTDR) is complicated by adjacent segment degeneration (ASD). Since non-physiological spine kinematics after CTDR was postulated to cause ASD, M6-C prosthesis has been developed to better replicate the natural kinematics of the intervertebral disc. This retrospective cohort study aims to compare the short-term outcomes between patients receiving either the M6-C or Mobi-C prostheses. Methods Patients who had refractory radiculopathy and/or myelopathy secondary to cervical degenerative disc disease and underwent CTDR between March 2004 and April 2017 were included. All CTDRs were performed by a single surgeon at a single institution. Self-reported clinical outcomes and radiological parameters were evaluated at baseline and final follow-up between March 2004 and April 2018. Results Sixty-two patients with greater than 1-year follow-up or who developed HO within 12 months of surgery, were included in the study. The mean radiological follow-up was 29.0 months (3-84 months), which includes 7 patients with less than 12 months follow-up who also developed HO. The changes in clinical and radiological measures were comparable between M6-C and Mobi-C prostheses. Thirty-seven out of 52 spinal segments (71.2%) and 10 out of 16 spinal segments (62.5%) developed HO in M6-C and Mobi-C group respectively. There was no significant difference in the rate of HO between the two groups. Conclusions No short-term differences were found in clinical or radiological outcomes between patients who received either the M6-C or Mobi-C prosthesis. Further randomized trials with a long-term follow-up period are warranted to determine the safety and efficacy of M6-C prosthesis.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group (NSURG), The University of New South Wales, Sydney, NSW, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), The University of New South Wales, Sydney, NSW, Australia
| | - Jack Kerferd
- NeuroSpine Surgery Research Group (NSURG), The University of New South Wales, Sydney, NSW, Australia
| | - Meiyi Lee
- NeuroSpine Surgery Research Group (NSURG), The University of New South Wales, Sydney, NSW, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), The University of New South Wales, Sydney, NSW, Australia
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Galbusera F, Bassani T. The Spine: A Strong, Stable, and Flexible Structure with Biomimetics Potential. Biomimetics (Basel) 2019; 4:E60. [PMID: 31480241 PMCID: PMC6784295 DOI: 10.3390/biomimetics4030060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
From its first appearance in early vertebrates, the spine evolved the function of protecting the spinal cord, avoiding excessive straining during body motion. Its stiffness and strength provided the basis for the development of the axial skeleton as the mechanical support of later animals, especially those which moved to the terrestrial environment where gravity loads are not alleviated by the buoyant force of water. In tetrapods, the functions of the spine can be summarized as follows: protecting the spinal cord; supporting the weight of the body, transmitting it to the ground through the limbs; allowing the motion of the trunk, through to its flexibility; providing robust origins and insertions to the muscles of trunk and limbs. This narrative review provides a brief perspective on the development of the spine in vertebrates, first from an evolutionary, and then from an embryological point of view. The paper describes functions and the shape of the spine throughout the whole evolution of vertebrates and vertebrate embryos, from primordial jawless fish to extant animals such as birds and humans, highlighting its fundamental features such as strength, stability, and flexibility, which gives it huge potential as a basis for bio-inspired technologies.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Oltulu İ, Korkmaz Ö, Sarıoğlu E, Aydoğan M. A Retrospective Review of Radiographic and Clinical Findings from the M6 Cervical Prosthesis. Asian Spine J 2019; 13:913-919. [PMID: 31422645 PMCID: PMC6894978 DOI: 10.31616/asj.2018.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/26/2019] [Indexed: 12/20/2022] Open
Abstract
Study Design Retrospective clinical study. Purpose To evaluate clinical results of the M6 cervical prosthesis. Overview of Literature Cervical disk prostheses have been developed to preserve motion and reduce degeneration in adjacent segments in degenerative disk diseases. Methods A retrospective evaluation was performed on 43 patients who received the M6 cervical disk prosthesis between 2012 and 2016. Standard and dynamic radiographs, computed tomography, and magnetic resonance imaging were used to evaluate all the patients preoperatively and postoperatively. The Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores were examined in evaluating the clinical and functional results of patients with collapsed disk herniation who had received the M6 cervical prosthesis and to evaluate whether the core structure of the prosthesis protects motion. Results The mean follow-up period was 34.12±6.70 months. Radiologically, the preoperative cervical segment ROM was measured as a mean of 5.77°±2.19° preoperatively and 8.49°±2.37° at the inal postoperative follow-up examination. In the patients with a preoperative disk height of <4 mm, the segmental ROM increased from 4.53°±2.79° preoperatively to 7.2°±3.18° postoperatively. In the patients with a preoperative disk height of >4 mm, the cervical segment ROM increased from 6.4°±1.45° preoperatively to 8.6°±2.02° at the inal postoperative follow-up examination. The NDI scores reduced from 53.86±9.77 preoperatively to 22.69±7.26 postoperatively and the VAS scores reduced from 8.74±0.58 to 1.88±1.14. During follow-up in any patient, no collapse of the levels at which surgery was performed was observed. No heterotopic ossiication or implant failure was recorded in any patient during the follow-up period. Conclusions The M6 new-generation cervical disk prosthesis had few complications. No heterotopic ossiication was observed in any patient, and lexion-extension ROM was maintained in all the patients, indicating the M6 prosthesis as a promising alternative.
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Affiliation(s)
- İsmail Oltulu
- Department of Orthopedics and Traumatology, Emsey Hospital, İstanbul, Turkey
| | - Özgür Korkmaz
- Department of Orthopedics and Traumatology, Medicalpark Pendik Hospital, İstanbul, Turkey
| | - Ender Sarıoğlu
- Department of Orthopedics and Traumatology, Medicalpark Göztepe Hospital, İstanbul, Turkey
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Cervical disc arthroplasty: tips and tricks. INTERNATIONAL ORTHOPAEDICS 2018; 43:777-783. [PMID: 30519869 DOI: 10.1007/s00264-018-4259-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/26/2018] [Indexed: 12/26/2022]
Abstract
Cervical disc arthroplasty (CDA) is a powerful, motion-sparing treatment option for managing cervical radiculopathy or myelopathy. While CDA can be an excellent surgery for properly indicated patients, it is also less forgiving than cervical fusion. Optimally resolving patient symptoms while maintaining range of motion relies on near perfection in the surgical technique. Different CDA options exist on the market, with some having long-term proven success and others in early stages of clinical trials. We discuss the different options available for use, as well as strategies of positioning, approach, disc space preparation, implantation, and fusion prevention that we believe can help improve performance and outcomes of CDA.
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Nunley PD, Coric D, Frank KA, Stone MB. Cervical Disc Arthroplasty: Current Evidence and Real-World Application. Neurosurgery 2018; 83:1087-1106. [DOI: 10.1093/neuros/nyx579] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/07/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | | | - Marcus B Stone
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
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Miller AT, Safranski DL, Smith KE, Sycks DG, Guldberg RE, Gall K. Fatigue of injection molded and 3D printed polycarbonate urethane in solution. POLYMER 2017. [DOI: 10.1016/j.polymer.2016.11.055] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Staudt MD, Das K, Duggal N. Does design matter? Cervical disc replacements under review. Neurosurg Rev 2016; 41:399-407. [PMID: 27465393 DOI: 10.1007/s10143-016-0765-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/30/2016] [Accepted: 06/23/2016] [Indexed: 01/11/2023]
Abstract
The present article reviews the design rationale of currently available cervical disc replacements. Recent prospective randomized control trials comparing cervical disc replacement and anterior fusion have demonstrated safety as well as equal or superior clinical results. Increasingly, more devices are becoming available on the market. Understanding design rationale will provide context for the surgeon to optimize decision making for the most appropriate prosthesis. Cervical arthroplasty is a technique that is undergoing rapid design refinement and development. Further improvements in device design will enable patient-specific device selection. Understanding the design rationale and complication profile of each device will improve clinical and radiographic outcomes.
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Affiliation(s)
- Michael D Staudt
- Department of Clinical Neurological Sciences, Division of Neurosurgery, Western University, London, Ontario, Canada
| | - Kaushik Das
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Neil Duggal
- Department of Clinical Neurological Sciences, Division of Neurosurgery, Western University, London, Ontario, Canada.
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Miller AT, Safranski DL, Smith KE, Guldberg RE, Gall K. Compressive cyclic ratcheting and fatigue of synthetic, soft biomedical polymers in solution. J Mech Behav Biomed Mater 2016; 54:268-82. [DOI: 10.1016/j.jmbbm.2015.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 12/14/2022]
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