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Wahbeh JM, Hookasian E, Lama J, Alam L, Park S, Sangiorgio SN, Ebramzadeh E. An additively manufactured model for preclinical testing of cervical devices. JOR Spine 2024; 7:e1285. [PMID: 38222806 PMCID: PMC10782067 DOI: 10.1002/jsp2.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Composite models have become commonplace for the assessment of fixation and stability of total joint replacements; however, there are no comparable models for the cervical spine to evaluate fixation. The goal of this study was to create the framework for a tunable non-homogeneous model of cervical vertebral body by identifying the relationships between strength, in-fill density, and lattice structure and creating a final architectural framework for specific strengths to be applied to the model. Methods The range of material properties for cervical spine were identified from literature. Using additive manufacturing software, rectangular prints with three lattice structures, gyroid, triangle, zig-zag, and a range of in-fill densities were 3D-printed. The compressive and shear strengths for all combinations were calculated in the axial and coronal planes. Eleven unique vertebral regions were selected to represent the distribution of density. Each bone density was converted to strength and subsequently correlated to the lattice structure and in-fill density with the desired material properties. Finally, a complete cervical vertebra model was 3D-printed to ensure sufficient print quality. Results Materials testing identified a relationship between in-fill densities and strength for all lattice structures. The axial compressive strength of the gyroid specimens ranged from 1.5 MPa at 10% infill to 31.3 MPa at 100% infill and the triangle structure ranged from 2.7 MPa at 10% infill to 58.4 MPa at 100% infill. Based on these results, a cervical vertebra model was created utilizing cervical cancellous strength values and the corresponding in-fill density and lattice structure combination. This model was then printed with 11 different in-fill densities ranging from 33% gyroid to 84% triangle to ensure successful integration of the non-homogeneous in-fill densities and lattice structures. Conclusions The findings from this study introduced a framework for using additive manufacturing to create a tunable, customizable biomimetic model of a cervical vertebra.
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Affiliation(s)
- Jenna M. Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of BioengineeringUCLALos AngelesCaliforniaUSA
| | - Erika Hookasian
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of BioengineeringUCLALos AngelesCaliforniaUSA
| | - John Lama
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of BioengineeringUCLALos AngelesCaliforniaUSA
| | - Labiba Alam
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of BioengineeringUCLALos AngelesCaliforniaUSA
| | - Sang‐Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of Orthopaedic SurgeryUCLALos AngelesCaliforniaUSA
| | - Sophia N. Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of BioengineeringUCLALos AngelesCaliforniaUSA
- Department of Orthopaedic SurgeryUCLALos AngelesCaliforniaUSA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research CenterLuskin Orthopaedic Institute for ChildrenLos AngelesCaliforniaUSA
- Department of Orthopaedic SurgeryUCLALos AngelesCaliforniaUSA
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Patel N, Abdelmalek G, Coban D, Changoor S, Sinha K, Hwang K, Emami A. Should patient eligibility criteria for cervical disc arthroplasty (CDA) be expanded? A retrospective cohort analysis of relatively contraindicated patients undergoing CDA. Spine J 2024; 24:210-218. [PMID: 37774985 DOI: 10.1016/j.spinee.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is a safe and effective alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of various degenerative pathologies with advantages of motion preservation and lower rates of adjacent segment degeneration (ASD). Absolute contraindications for CDA have been well outlined in order to prevent adverse outcomes in patients. However, in cases of patients with relative contraindications (kyphotic deformity, prior cervical surgery, etc.), there remains controversy. There is minimal literature evaluating long-term outcomes in this patient population. PURPOSE To compare long-term clinical and functional outcomes of CDA in typical patients versus those with relative contraindications. DESIGN Retrospective cohort review. PATIENT SAMPLE Eighty-nine patients were included in the study: 55 (no contraindications) in Group 1 and 34 (relatively contraindicated) in Group 2 and 26 (preoperative segmental kyphosis) in Group 3. OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS), and neck disability index (NDI) scores. METHODS Patients were placed in the relatively contraindicated cohort if they possessed at least one of the following: (1) segmental kyphosis of 5° to 10°, (2) significant loss of disc height (between 50% and 75% of initial measurements or 1.5-3mm), (3) bridging osteophytes, and (4) prior cervical spine surgery based on preoperative cervical radiographs. The other cohort included patients without any relative contraindication who underwent CDA over the same time frame. Additionally, a subgroup analysis was used to compare those without any contraindications to those with only preoperative segmental kyphosis. Patients were included in this study if they met the following criteria: over 18 years of age, minimum follow-up of 24 months, and availability of complete medical records. Patient demographics, levels operated on, and perioperative outcomes were assessed between the two groups. Revision and complication rates were recorded. Functional outcomes scores were compared using VAS and NDI scores at 6-months, 12-months and final follow-up. RESULTS Mean follow-up was 40.8 months in Group 1 and 38.3 months in Group 2 (p=.569). Complication rates were 21.8% in Group 1 and 26.4% in Group 2 (p=.615). Complication rates in a comparison between Groups 1 and 3 were statistically insignificant (p=.383). The most common complication was transient approach-related postoperative dysphagia (Group 1: 20% vs Group 2: 23.5%, p=.693). No significant differences were observed in the rates of transient dysphonia (Group 1: 0.0% vs Group 2: 2.9%, p=.201), adjacent segment degeneration (ASD) (Group 1: 1.8% vs Group 2: 0.0%, p=.429), infection (Group 1: 1.8% vs Group 2: 2.9%, p=.712), heterotopic ossification (Group 1: 49.1% vs Group 2: 50.0%, p=.934) or spontaneous fusion (Group 1: 1.8% vs Group 2: 2.9%, p=.728). No revision surgeries were observed in either cohort. All three groups demonstrated significant improvements in their VAS and NDI scores compared with preoperative measurements (p<.001), but no significant differences were found in the degree of improvement between groups at any point in time. CONCLUSIONS Our study found no significant differences in clinical and functional outcomes between patients undergoing 1- and 2-level CDA with relative contraindications versus typical patients. These findings suggest that patient eligibility criteria for CDA may warrant expansion. However, future prospective studies over a longer period of follow-up are necessary to corroborate our results.
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Affiliation(s)
- Neil Patel
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - George Abdelmalek
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Daniel Coban
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Stuart Changoor
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Kumar Sinha
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Ki Hwang
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Arash Emami
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA.
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Mai E, Shahi P, Lee R, Shinn DJ, Vaishnav A, Araghi K, Singh N, Maayan O, Tuma OC, Pajak A, Asada T, Korsun MK, Singh S, Kim YE, Louie PK, Huang RC, Albert TJ, Dowdell J, Sheha ED, Iyer S, Qureshi SA. Risk factors for failure to achieve minimal clinically important difference following cervical disc replacement. Spine J 2023; 23:1808-1816. [PMID: 37660897 DOI: 10.1016/j.spinee.2023.08.017] [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: 03/27/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT While cervical disc replacement (CDR) has been emerging as a reliable and efficacious treatment option for degenerative cervical spine pathology, not all patients undergoing CDR will achieve minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) postoperatively-risk factors for failure to achieve MCID in PROMs following CDR have not been established. PURPOSE To identify risk factors for failure to achieve MCID in Neck Disability Index (NDI, Visual Analog Scale (VAS) neck and arm following primary 1- or 2-level CDRs in the early and late postoperative periods. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who had undergone primary 1- or 2-level CDR for the treatment of degenerative cervical pathology at a single institution with a minimum follow-up of 6 weeks between 2017 and 2022. OUTCOME MEASURES Patient-reported outcomes: Neck disability index (NDI), Visual analog scale (VAS) neck and arm, MCID. METHODS Minimal clinically important difference achievement rates for NDI, VAS-Neck, and VAS-Arm within early (within 3 months) and late (6 months to 2 years) postoperative periods were assessed based on previously established thresholds. Multivariate logistic regressions were performed for each PROM and evaluation period, with failure to achieve MCID assigned as the outcome variable, to establish models to identify risk factors for failure to achieve MCID and predictors for achievement of MCID. Predictor variables included in the analyses featured demographics, comorbidities, diagnoses/symptoms, and perioperative characteristics. RESULTS A total of 154 patients met the inclusion criteria. The majority of patients achieved MCID for NDI, VAS-Neck, and VAS-Arm for both early and late postoperative periods-79% achieved MCID for at least one of the PROMs in the early postoperative period, while 80% achieved MCID for at least one of the PROMs in the late postoperative period. Predominant neck pain was identified as a risk factor for failure to achieve MCID for NDI in the early (OR: 3.13 [1.10-8.87], p-value: .032) and late (OR: 5.01 [1.31-19.12], p-value: .018) postoperative periods, and VAS-Arm for the late postoperative period (OR: 36.63 [3.78-354.56], p-value: .002). Myelopathy was identified as a risk factor for failure to achieve MCID for VAS-Neck in the early postoperative period (OR: 3.40 [1.08-10.66], p-value: .036). Anxiety was identified as a risk factor for failure to achieve MCID for VAS-Neck in the late postoperative period (OR: 6.51 [1.91-22.18], p-value: .003). CDR at levels C5C7 was identified as a risk factor for failure to achieve MCID in NDI for the late postoperative period (OR: 9.74 [1.43-66.34], p-value: .020). CONCLUSIONS Our study identified several risk factors for failure to achieve MCID in common PROMs following CDR including predominant neck pain, myelopathy, anxiety, and CDR at levels C5-C7. These findings may help inform the approach to counseling patients on outcomes of CDR as the evidence suggests that those with the risk factors above may not improve as reliably after CDR.
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Affiliation(s)
- Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Ryan Lee
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Daniel J Shinn
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Avani Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Maximilian K Korsun
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Philip K Louie
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Russel C Huang
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - James Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
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Huang CW, Tsou HK, Chen WH, Tsai JC, Chung KC, Lin RH, Chen TY, Tzeng CY. The residual exposed endplate ratio is predictive of posterior heterotopic ossification after cervical Bryan disc arthroplasty. J Clin Neurosci 2023; 114:97-103. [PMID: 37352684 DOI: 10.1016/j.jocn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES Heterotopic ossification (HO), a major cause of dysfunction after disc arthroplasty (CDA). The aim of this study was to determine the cut value of the residual exposed endplate (REE) ratio and to predict the development of posterior HO after Bryan CDA. METHODS This retrospective study investigated the relationship between the REE ratio and posterior HO formation after Bryan CDA. Consecutive adult patients who underwent 1- or 2-level Bryan CDA by a single neurosurgeon between 2006 and 2016 with at least two years follow-up were included. Postoperative radiographic analysis and measurement were performed to obtain the REE ratio and the HO grade. RESULTS Of 249 patients with 384 surgical levels who underwent Bryan CDA during the study period, 114 (45.8 %) received 1-level CDA and 135 (54.2 %) received 2-level CDA. Lateral radiographs showed that 169 implants (44 %) had posterior HOs in all grades after two years or more of follow up and 14 implants (3.64 %) had severe HO (McAfee grades 3 and 4). In 329 implants (85.7 %), a comparison of radiographs to CT examination of HO grading showed a substantial relationship. Using area under the curve (AUC) analysis, a REE ratio >9 %, with 65.1 % sensitivity and 86.5 % specificity, was the cut point for posterior HO formation. CONCLUSIONS REE is highly correlated with the development of postoperative posterior HO after Bryan CDA, regardless of the level of implantation. An undersized implant causing a REE ratio >9 % is a predictor of postoperative posterior HO formation after cervical Bryan CDA.
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Affiliation(s)
- Chih-Wei Huang
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, ROC; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, ROC
| | - Wen-Hsien Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC; Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Jen-Chieh Tsai
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC
| | - Kai-Chen Chung
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tse-Yu Chen
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, ROC; Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC; Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC.
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Perna A, Velluto C, Smakaj A, Caredda M, Proietti L, Santagada DA, Candura D, Meluzio MC, Tamburrelli FC, Genitiempo M. Long-Term Clinical and Radiographic Outcomes After Bryan Cervical Disk Arthroplasty: A Systematic Literature Review. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:321-329. [PMID: 38153488 DOI: 10.1007/978-3-031-36084-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Introductionː Cervical disk arthroplasty is a potential alternative procedure to anterior cervical decompression and fusion for the treatment of cervical disk disease. The aim of the study was to perform a systematic literature review on long-term clinical and radiological outcomes after Bryan cervical disk arthroplasty.Material and Methodsː A systematic literature review was performed according to PRISMA guidelines via PubMed and Embase, Scopus, and the Cochrane Library database by using the following keywords: "Bryan prosthesis"; "cervical disk arthroplasty"; "outcomes"; and "long-term follow-up." Eight articles with at least 10 years of follow-up were considered for eligibility.Resultsː In total, 481 patients were enrolled in the studies. Because of the occurrence of multiple treated levels, 588 arthroplasties were performed, divided as follows: 12 C3/4 cervical disk arthroplasties (2.01%), 63 C4/5 (10.71%), 325 C5/6 (55.27%), and 188 C6/7 (31.97%). The mean preoperative cervical lordosis was 13.6 ± 9.3°, whereas the last follow-up value was 12.8 ± 8.7°. In the last follow-up, the mean segmental range of motion was 8.2 ± 3.3°.Discussion: Recent studies have suggested that cervical disk arthroplasty should be safely performed in healthy young patients with disk degeneration who may need future revision surgery. The results suggest that this procedure preserves native cervical spinal biomechanics at long-term follow-up with acceptable adjacent segments disease and periprosthetic ossifications.Conclusionsː Cervical disk arthroplasty has good long-term device survival, motility, adjacent segment degeneration, and clinical outcomes. Therefore, it represents a valid alternative for the treatment of cervical spine degenerative pathologies, especially in young patients.
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Affiliation(s)
- Andrea Perna
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopedics, Fondazione Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Caredda
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Alessandro Santagada
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dario Candura
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Concetta Meluzio
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genitiempo
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Tao ZS, Wang HS, Li TL, Wei S. Silibinin-modified Hydroxyapatite coating promotes the osseointegration of titanium rods by activation SIRT1/SOD2 signaling pathway in diabetic rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:62. [PMID: 36057883 PMCID: PMC9441422 DOI: 10.1007/s10856-022-06684-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/01/2022] [Indexed: 05/06/2023]
Abstract
The purpose of this study is to investigate the role of Silibinin (SIL)-modified Hydroxyapatite coating on osseointegration in diabetes in vivo and in vitro and explore the mechanism of osteogenic differentiation of MC3T3-E1. RT-qPCR, Immunofluorescence, and Western blot were used to measure the expression level of oxidative Stress Indicators and osteogenic markers proteins. Moreover, CCK-8 assay was conducted to detect cell viability in hyperglycemia. Alizarin red staining and alkaline phosphatase staining were used to examine osteogenic function and calcium deposits. The diabetic rat model receive titanium rod implantation was set up successfully and Von-Gieson staining was used to examine femoral bone tissue around titanium rod. Our results showed that intracellular oxidative stress in hyperglycemia was overexpressed, while FoxO1, SIRT1, GPX1, and SOD2 were downregulated. SIL suppressed oxidative stress to promote osteogenic differentiation. Additionally, it was confirmed that SIL promoted osteogenic differentiation of MC3T3-E1 and obviously restored the osseointegration ability of diabetic rats. Further study indicated that SIL exerted its beneficial function through activation SIRT1/SOD2 signaling pathway to restore osteoblast function, and improved the osseointegration and stability of titanium rods in vivo. Our research suggested that the SIL-modulated oxidative Stress inhibition is responsible for the activation of the process of osteogenic differentiation through activation SIRT1/SOD2 signaling pathway in hyperglycemia, providing a novel insight into improving prosthetic osseointegration in diabetic patients. Hyperglycemia impaired the activity and function of MC3T3-E1 and inhibits bone formation by up-regulating intracellular ROS levels through inhibition of SIRT1/SOD2 signaling pathway. Local administrator SIL can improve the activity and function of osteoblasts and enhance osseointegration by reducing intracellular ROS through activation of SIRT1/SOD2 signaling pathway in DM rat models.
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Affiliation(s)
- Zhou-Shan Tao
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, No. 2, Zhe Shan Xi Road, Wuhu, 241001, Anhui, P.R. China.
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (Wannan Medical College), No. 2, Zhe Shan Xi Road, Wuhu, China.
| | - Hai-Sheng Wang
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, No. 2, Zhe Shan Xi Road, Wuhu, 241001, Anhui, P.R. China
| | - Tian-Lin Li
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, No. 2, Zhe Shan Xi Road, Wuhu, 241001, Anhui, P.R. China
| | - Shan Wei
- School of Mechanical Engineering, Anhui Polytechnic University, Wuhu, 241000, P.R. China
- Additive Manufacturing Institute of Anhui Polytechnic University, Anhui Polytechnic University, Wuhu, 241000, P.R. China
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Alluri RK, Vaishnav AS, Sivaganesan A, Albert TJ, Huang RC, Qureshi SA. Cervical Disc Replacement for Radiculopathy Versus Myeloradiculopathy: An MCID Analysis. Clin Spine Surg 2022; 35:170-175. [PMID: 35507951 DOI: 10.1097/bsd.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The aim was to compare the minimally clinically important difference (MCID) across multiple patient-reported outcomes (PROs) in patients undergoing cervical disc replacement (CDR) for cervical spondylotic radiculopathy versus myeloradiculopathy. SUMMARY OF BACKGROUND DATA To date, a limited number of studies have demonstrated mostly similar results in patients with cervical spondylotic radiculopathy or myeloradiculopathy undergoing CDR. However, each of these previous studies have focused on statistically significant differences, which may not correlate with patient perceived improvements in outcomes or success. METHODS Patients who underwent 1 or 2-level CDR with radiculopathy versus myeloradiculopathy were identified, and prospectively collected data was retrospectively reviewed. Demographic variables, preoperative diagnosis, and operative variables were collected for each patient. The following PROs were prospectively collected: Neck Disability Index (NDI), visual analog scale (VAS)-Neck, VAS-Arm, Short Form-12 Health Survey (SF-12) Physical Component Score (PCS), SF-12 Mental Component Score (MCS), PROMIS Physical Function (PF). An MCID analysis of PROs for each diagnosis group was performed and the percentage of patients achieving the MCID was compared between the two diagnosis groups. RESULTS Eight-five patients, of which 56% had radiculopathy and 44% had myeloradiculopathy. MCID analysis demonstrated that at 6-week, 12-week, and final postoperative follow-up there was no significant difference in the percentage of patients with radiculopathy or myeloradiculopathy achieving the MCID for each PRO assessed. In both diagnosis groups the percentage of patients achieving the MCID for each PRO continued to increase from the 6-week to final postoperative follow-up except for the SF-12 MCS in patients with myeloradiculopathy. CONCLUSIONS The percentage of patients achieving the MCID was not significantly different at each postoperative period assessed in the radiculopathy and myeloradiculopathy groups treated with CDR. In addition, the percentage of patients achieving the MCID continued to increase from 6 weeks to final follow-up in both groups for almost all PROs assessed.
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Affiliation(s)
| | | | | | - Todd J Albert
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Russel C Huang
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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Zavras AG, Sullivan TB, Singh K, Phillips FM, Colman MW. Failure in cervical total disc arthroplasty: single institution experience, systematic review of the literature, and proposal of the RUSH TDA failure classification system. Spine J 2022; 22:353-369. [PMID: 34419625 DOI: 10.1016/j.spinee.2021.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving motion of the spinal unit and decreasing the risk for degenerative changes at adjacent segments. However, due to its more recent introduction in clinical practice and low complication rates, the modes by which TDA may fail remain to be described. PURPOSE This study sought to identify the modes and frequencies of cervical TDA failure in order to propose a novel classification system. STUDY DESIGN Retrospective cohort and systematic review. PATIENT SAMPLE Patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution and in the literature of medium and large prospective studies. OUTCOME MEASURES Cervical TDA failure, defined as subsequent surgical intervention at the index segment. METHODS This study retrospectively reviewed patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution to identify the potential implant failure modes. A systematic review and meta-analysis of prospective data in the literature was then performed to further supplement failure mode identification and to describe the rates at which the various failure types occurred. Statistical analysis included between-group comparisons of Non-Failed and Failed patients and frequencies of each failure type among Failed patients. RESULTS A retrospective review at our institution of 169 patients (201 levels) identified eight failures, for a failure rate of 4.7%. Additionally, seven patients were revised who had the primary surgery at an outside institution. The systematic review of 3976 patients (4525 levels) identified 165 (4.1%) additional failures. Using this data, six primary failure types were classified, with several subtypes. These include recurrent or persistent index-level stenosis (Type I); migration (Type II) presenting as gross extrusion (A) or endplate failure with subsidence/acute fracture (B); instability (Type III) due to mechanical loosening (A), septic loosening (B), or device fracture (C); device motion loss (Type IV) such as "locking" of the device in kyphosis; implantation error (Type V) due to malposition (A) or improper sizing (B); and wear (Type VI) either without osteolysis (A) or with wear-particle-induced osteolysis (B). Stenosis (Type I) was the most common mode of failure found both through retrospective review and in the literature. CONCLUSIONS Cervical TDA fails through six primary mechanisms. While rates of certain failures requiring subsequent surgical intervention are low, it is possible that these complications may become more prevalent upon further longitudinal observation. Thus, future application and validation of this classification system is warranted to evaluate how failure frequencies change over time and with larger patient samples.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Thomas Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA.
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Guo Y, Liu H, Xu J, Deng Y, Tao X, Meng Y, Wang X, Hong Y, Wang B, Ding C, Wu W. Pretic-I was a safe and effective artificial cervical disc prosthesis--a retrospective and comparative study with 5-year follow-up. BMC Musculoskelet Disord 2021; 22:981. [PMID: 34819053 PMCID: PMC8611939 DOI: 10.1186/s12891-021-04813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background The newly designed cervical disc prosthesis, Pretic-I, had been finished its limited clinical use for over 5 years. At a short-term follow-up of 2 years, we obtained satisfactory clinical results. The long-term clinical efficacy and safety of Pretic-I will now be analyzed. Methods Peri-operative parameters included intra-operative blood loss, operation time, off-bed time. Clinical parameters included visual analogue scale (VAS) for arm and neck, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) score. Radiological parameters included C2–7 Cobb angle, Shell angle, and the range of motion (ROM) of C2–7, functional segment unit (FSU), and adjacent FSU. The CDA-related complications included adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), heterotopic ossification (HO), prosthesis subsidence, prosthesis displacement, and dysphagia. Results A total 64 patients from two independent centers received a single-level CDA with Discover (n = 32) and Pretic-I (n = 32), and all of patients finished a 5-year follow-up. There’re no significant differences between two groups in peri-operative parameters. The clinical parameters improved greatly in Pretic-I group (p<0.0001), and there’s no statistical difference from Discover group. Furthermore, Pretic-I could slightly improve the cervical curvature (15.08 ± 11.75 to 18.00 ± 10.61, p = 0.3079) and perfectly maintain the Shell angle (3.03 ± 3.68 to 2.23 ± 4.10, p = 0.1988), cervical ROM (52.48 ± 14.31 to 53.30 ± 11.71, p = 0.8062) and FSU ROM (12.20 ± 4.52 to 10.73 ± 4.45, p = 0.2002). The incidence of high-grade HO (Grade III-IV) at the final follow-up was significantly lower in Pretic-I group than in Discover group (12.50% vs. 34.38%, p = 0.0389, Statistical Power = 95.36%). The incidences of other CDA-related complications in Pretic-I group were also well-accepted, comparable to the Discover group, without significant differences. Conclusion CDA with Pretic-I demonstrated a well-accepted and sustained clinical outcome, with a significantly lower incidence of high-grade HO. This newly designed prosthesis is expected to become an alternative choice for cervical disc prosthesis in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04813-5.
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Affiliation(s)
- Yingjun Guo
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Yuxiao Deng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoliang Tao
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yang Meng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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DiCesare JAT, Tucker AM, Say I, Patel K, Lanman TH, Coufal FJ, Millard J, Deckey JE, Shetgeri S, McBride DQ. Mechanical failure of the Mobi-C implant for artificial cervical disc replacement: report of 4 cases. J Neurosurg Spine 2020; 33:727-733. [PMID: 32736353 DOI: 10.3171/2020.5.spine19442] [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: 05/19/2019] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
Cervical spondylosis is one of the most commonly treated conditions in neurosurgery. Increasingly, cervical disc replacement (CDR) has become an alternative to traditional arthrodesis, particularly when treating younger patients. Thus, surgeons continue to gain a greater understanding of short- and long-term complications of arthroplasty. Here, the authors present a series of 4 patients initially treated with Mobi-C artificial disc implants who developed postoperative neck pain. Dynamic imaging revealed segmental kyphosis at the level of the implant. All implants were locked in the flexion position, and all patients required reoperation. This is the first reported case series of symptomatic segmental kyphosis after CDR.
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Affiliation(s)
| | | | - Irene Say
- 1Department of Neurosurgery, University of California, Los Angeles
| | - Kunal Patel
- 1Department of Neurosurgery, University of California, Los Angeles
| | - Todd H Lanman
- 1Department of Neurosurgery, University of California, Los Angeles
| | - Frank J Coufal
- 2Department of Neurosurgery, Scripps Memorial Hospital, La Jolla
| | | | - Jeffrey E Deckey
- 4Department of Orthopedic Surgery, Orthopedic Specialty Institute, Medical Group of Orange County, Orange, California
| | | | - Duncan Q McBride
- 1Department of Neurosurgery, University of California, Los Angeles
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Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to analyze risk factors of heterotopic ossification (HO) after cervical disk replacement (CDR) and evaluate the effect of footprint mismatch on HO. SUMMARY OF BACKGROUND DATA Incidence of HO after CDR is high, but the exact related factors have not been fully elucidated. MATERIALS AND METHODS Radiographic data of patients who had undergone CDR with Prestige LP or Discover prosthesis in Tongji Hospital from July 2012 to December 2015 were reviewed. HO was graded according to McAfee classification and classified according to Jin morphologic classification. Footprint matching degree was evaluated using 3-dimensional computed tomographic images. Cervical sagittal alignment, functional spinal unit height, and range of motion were measured on radiographs. Preexisting degeneration was scored using Walraevens scoring system. Postulated risk factors including general factors, cervical sagittal alignment, functional spinal unit height, range of motion, postoperative biomechanical changes, preexisting degeneration, number of surgical levels, prosthesis type, use of nonsteroid anti-inflammatory drugs, and footprint matching degree were analyzed by first univariate tests, and then multivariate logistic regression was done to examine the relation with HO occurrence. Effect of footprint mismatch on type 1 HO of morphologic classification was evaluated. RESULTS Data of 46 patients were collected; 43 were finally evaluated with a total 57 prostheses implanted, with a mean follow-up duration of 41.16±12.49 months. No significant differences in basic characteristics existed between 2 prosthesis groups, except follow-up time. Incidence of HO was 66.7%. Mean footprint matching degree in sagittal plane was 0.877±0.068 and in coronal plane was 0.852±0.092. Mean overall footprint matching degree was 0.699±0.102 (range: 0.388-0.993). Prosthesis type and footprint matching degree were significantly related with HO among all postulated risk factors in both univariate and multivariate analyses (P<0.05); the latter had larger Exp(B). Type 1 HO occurrence significantly related with footprint mismatch. CONCLUSIONS Incidence of HO after CDR was high, and serious footprint mismatch existed. HO occurrence was significantly related with prosthesis type and footprint matching degree; the latter played a more important role.
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Pitsika M, Nissen J. Spinal cord compression due to nucleus migration from Mobi-C total disc replacement. Br J Neurosurg 2020; 36:520-523. [DOI: 10.1080/02688697.2020.1716942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marina Pitsika
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Justin Nissen
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Heterotopic ossification is related to change in disc space angle after Prestige-LP cervical disc arthroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2359-2370. [DOI: 10.1007/s00586-019-06053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
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Feng H, Fang X, Huang D, Yu C, Zhao S, Hao D. Quantitative morphometric study of the subaxial cervical vertebrae end plate. Spine J 2017; 17:269-276. [PMID: 27713104 DOI: 10.1016/j.spinee.2016.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty has been gradually adopted as an alternative for the treatment of cervical degenerative disease. However, there is a large discrepancy between footprints of currently available cervical disc prostheses and anatomic dimensions of cervical end plates. PURPOSE This study aimed to accurately and comprehensively quantify the three-dimensional (3D) anatomic morphology of the cervical vertebral end plate and provide a theoretical basis for designing appropriate disc prostheses. Moreover, we introduced a novel geometric and mechanical model for 3D reconstruction techniques of the cervical end plate. STUDY DESIGN A descriptive study of the geometry of the middle and lower cervical vertebral end plates in cadaveric spines was carried out. METHODS A total of 138 cervical vertebral end plates were digitized using an optical 3D range scanning system, and then each end plate was reconstructed using the digitized image. For each end plate, the morphologic characteristics of six surface curves and the end plate concavity depth were symmetrically chosen and depicted. RESULTS The cranial end plates (relative to the disc) were concave and the caudal end plates were relatively flat at all disc levels, with mean concavity depths of 2.04 and 0.69 mm, respectively. For the caudal end plates, the end plate concavity apex was most often (81.42%) located in the posterior portion, whereas in the cranial end plates, the distribution was relatively even. For the sagittal curves, the foremost point and the rearmost point on the middle curve had a more forward position than those in the left curve and the right curve. Regarding the frontal plane curves, the length of the middle curve was longer than that of the anterior curve and posterior curve. For the cranial end plate, the maximal mean depth was the middle curve, whereas for the caudal end plate, the maximum depth was the posterior curve. CONCLUSIONS There is marked morphologic asymmetry, in that the cranial end plate is more concave than the corresponding caudal end plate. In the sagittal plane, the caudal end plates are aerofoil-shaped, whereas the cranial end plates are arc-shaped. In the transverse plane, the end plates are kidney-shaped. These morphologic characteristics of cervical vertebral end plates should be taken into consideration when designing cervical devices, such as artificial discs.
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Affiliation(s)
- Hang Feng
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Xiangyi Fang
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Chengcheng Yu
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Songchuan Zhao
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Jiaotong University Health Science Center, No. 76 Nanguo, Rd, Xi'an 710054, Shaanxi, China.
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Karaca S, Akpolat AO, Oztermeli A, Erdem MN, Aydogan M. Discrepancy between cervical disc prostheses and anatomical cervical dimensions. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:544-547. [PMID: 27776930 PMCID: PMC6197307 DOI: 10.1016/j.aott.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/20/2016] [Accepted: 03/02/2016] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. METHODS The anatomic dimensions of the C3-C7 segments were measured on 50 patients (age range 26-47 years) with computerized tomography scan and compared with the sizes of the popular cervical total disc prostheses (CTDP) at the market [Bryan (Medtronic), Prodisc-C (Synthes), Prestige LP (Medtronic), Discover (DePuy)]. The mediolateral and anteriorposterior diameters of the upper and lower endplates were measured with a digital measuring system. RESULTS Overall, 43.7% of the largest implant footprints were smaller in the anterior-posterior diameter and 42.6% in the mediolateral diameter were smaller than cervical endplate measurements. Discrepancy of the level C5/C6 and C6/C7 was calculated as 56.2% at the anteroposterior diameter and 43.8% at the center of mediolateral diameter. CONCLUSION Large disparity has been found between the sizes of devices and cervical anatomic data. Companies that produce CTDP should take care of the anatomical dimensions and generate different sizes of CTDP. Spine surgeon should be familiar with the size mismatch in CTDP that may affect the clinical and radiological outcome of the surgery.
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Morphological studies of cartilage endplates in subaxial cervical region. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2218-22. [PMID: 26611364 DOI: 10.1007/s00586-015-4336-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to provide morphological data of endplates for the redesign of cervical artificial disc for use in the middle and lower cervical spine (C3-C7). METHODS Reformatted CT scans of 73 individuals were analysed. The shapes of superior endplates (SEPs) and inferior endplates (IEPs) were classified as either flat or arced. The curvature radius of the IEP and sagittal disc angle were measured in the mid-sagittal plane. The maximum transverse diameter (MTD) of the SEPs and IEP was measured in the coronal plane. RESULTS The majority of SEPs were flat (79.5 % at C7 and 91.8-95.9 % at C3-C6). Almost all (98.6-100 %) IEPs were arced. The curvature radius has a gradually increasing trend from C3 to C6 (P < 0.05, mean 29.26 mm). There were significant differences at C3-C7 in the average sagittal disc angles (5.80°, 6.92°, 7.51°, and 8.82°, respectively; P < 0.05; mean 7.26°), the average MTDs of the SEPs (13.64, 14.42, 15.03, and 16.74 mm, respectively, P < 0.05; mean 14.96 mm) and the average MTD of the IEPs (16.77, 17.67, 19.15, and 21.66 mm, respectively; P < 0.05; mean 18.81 mm). CONCLUSION The majority of SEPs were flat, while almost all IEPs were curved. The curvature radius of IEPs has a gradually increasing trend from C3 to C6. The average sagittal disc angles, MTDs of the SEPs and IEPs significantly increased from C3 to C7. Based on the above, the current cervical artificial disc design does not sufficiently match the morphology of cervical endplates (CEPs). This mismatch may lead to some postoperative complications of cervical disc arthroplasty.
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Dong L, Tan MS, Yan QH, Yi P, Yang F, Tang XS, Hao QY. Footprint mismatch of cervical disc prostheses with Chinese cervical anatomic dimensions. Chin Med J (Engl) 2015; 128:197-202. [PMID: 25591562 PMCID: PMC4837838 DOI: 10.4103/0366-6999.149200] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The footprint of most prostheses is designed according to Caucasian data. Total disc replacement (TDR) has been performed widely for cervical degenerative diseases in China. It is essential to analyze the match sizes of prostheses footprints and Chinese cervical anatomic dimensions in our study. Methods: The anatomic dimensions of the C4–C7 segments of 138 patients (age range 16–77 years) in a Chinese population were measured by computed tomography scans. We compared the footprints of the most commonly used cervical disc prostheses (Bryan: Medtronic, Minneapolis, MN, USA; Prestige LP: Medtronic, Fridley, Minnesota, USA; Discover: DePuy, Raynham, MA, USA; Prodisc-C: Synthes, West Chester, PA, USA) in China with Chinese cervical anatomic dimensions and assessed the match of their size. Results: The mismatch of available dimensions of prostheses and anatomic data of cervical endplates ranged from 17.03% (C4/C5, Prestige LP, Prodisc-C) to 57.61% (C6/C7, Discover) in the anterior-posterior (AP) diameter, and 35.51% (C4/C5, Prodisc-C, Prestige LP) to 94.93% (C6/C7, Bryan) in the center mediolateral (CML) diameter. About 21.01% of endplates were larger than the largest prostheses in the AP diameter and 57.25% in the CML diameter. All available footprints of prostheses expect the Bryan with an unfixed height, can accommodate the disc height (DH), however, 36.23% of the middle DH was less than the smallest height of the prostheses. The average disc sagittal angles (DSAs) of C4–C7 junctions were 5.04°, 5.15°, and 4.13° respectively. Only the Discover brand had a built-in 7° lordotic angle, roughly matching with the DSA. Conclusions: There is a large discrepancy between footprints of prostheses and Chinese cervical anatomic data. In recent years, possible complications of TDR related with mismatch sizes are increasing, such as subsidence, displacement, and heterotopic ossification. Manufacturers of prostheses should introduce or produce additional footprints of prostheses for Chinese TDR.
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Affiliation(s)
| | - Ming-Sheng Tan
- Department of Orthopedics Surgery, China Japan Friendship Hospital, Beijing 100029; Graduate School of Peking Union Medical College, Beijing 100730, China
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Abstract
Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.
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Does heterotopic ossification affect the outcomes of cervical total disc replacement? A meta-analysis. Spine (Phila Pa 1976) 2015; 40:E332-40. [PMID: 25584944 DOI: 10.1097/brs.0000000000000776] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE The purpose of this study was to answer the following questions: (1) Does heterotopic ossification (HO) negatively influence clinical outcomes after cervical total disc replacement (CTDR)? (2) Should patients be classified into HO and non-HO groups? (3) Is there a more rational classification? SUMMARY OF BACKGROUND DATA Heterotopic ossification has emerged as a common complication after CTDR and has been an important reason for reoperation, thus limiting the use of the surgery. However, the influence of HO on clinical outcomes after CTDR has not been well established. METHODS A meta-analysis was conducted with studies identified by searches of MEDLINE, EMBASE, and the Cochrane Library. We calculated the weighted mean differences of the visual analogue scale pain score, Neck Disability Index, and range of motion (ROM). Patients were classified into 2 groups under 3 classifications on the basis of the grade of HO. Results were pooled using a fixed effect model or a random effects model, according to the heterogeneity. RESULTS There were significant differences in ROM under all 3 classifications. The visual analogue scale pain score and the Neck Disability Index between the patients with and without HO showed no significant difference after CTDR. Significant differences in visual analogue scale pain score were observed when patients were classified into a "high-grade HO" group (McAfee grades 3 or 4 HO) and a "low-grade HO" group (McAfee grade 0, 1, or 2 HO). CONCLUSIONS The presence of HO is not associated with clinical outcomes after CTDR. However, the severity of HO actually impacts clinical outcomes in an inverse manner, which needs further investigation. It is inappropriate to classify patients on the basis of the presence of HO; further studies of the classifications (ROM-affecting HO vs. ROM-preserving HO; high-grade HO vs. low-grade HO) and cervical stability after CTDR are needed. LEVEL OF EVIDENCE 2.
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The use of polyurethane materials in the surgery of the spine: a review. Spine J 2014; 14:3038-47. [PMID: 25151132 DOI: 10.1016/j.spinee.2014.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/26/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The spine contains intervertebral discs and the interspinous and longitudinal ligaments. These structures are elastomeric or viscoelastic in their mechanical properties and serve to allow and control the movement of the bony elements of the spine. The use of metallic or hard polymeric devices to replace the intervertebral discs and the creation of fusion masses to replace discs and/or vertebral bodies changes the load transfer characteristics of the spine and the range of motion of segments of the spine. PURPOSE The purpose of the study was to survey the literature, regulatory information available on the Web, and industry-reported device development found on the Web to ascertain the usage and outcomes of the use of polyurethane polymers in the design and clinical use of devices for spine surgery. STUDY DESIGN/SETTING A systematic review of the available information from all sources concerning the subject materials' usage in spinal devices was conducted. METHODS A search of the peer-reviewed literature combining spinal surgery with polyurethane or specific types and trade names of medical polyurethanes was performed. Additionally, information available on the Food and Drug Administration Web site and for corporate Web sites was reviewed in an attempt to identify pertinent information. RESULTS The review captured devices that are in testing or have entered clinical practice that use elastomeric polyurethane polymers as disc replacements, dynamic stabilization of spinal movement, or motion limitation to relieve nerve root compression and pain and as complete a listing as possible of such devices that have been designed or tested but appear to no longer be pursued. This review summarizes the available information about the uses to which polyurethanes have been tested or are being used in spinal surgery. CONCLUSIONS The use of polyurethanes in medicine has expanded as modifications to the stability of the polymers in the physiological environment have been improved. The potential for the use of elastomeric materials to more closely match the mechanical properties of the structures being replaced and to maintain motion between spinal segments appears to hold promise. The published results from the use of the devices that are discussed show early success with these applications of elastomeric materials.
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