Cervical Disc Arthroplasty ORSI 2024.pptx

Indication and installation of a mobile cervical disc prosthesis. Benefits of the PRODISC C VIVO mobile disc prosthesis (Centinel Spine)

1. CERVICAL disc arthroplasty Orsi Academy 5 june 2024 LEFLOT Jean-Louis M.D . UH Brugmann Brussels UH Mont-Godinne Yvoir

2. FUSION versus Disc PROSTHESIS ?

3. ANATOMY

4. Pathological Anatomy

5. Sagittal disbalance

6. Sagittal disbalance Analgesic position Decrease the pressure on the back of the disc Open the foramens Degenerative Intersomatic height loss

7. Sagittal disbalance

8. Our Surgical Challenges Neurological release Sagittal balance Preserve the function

9. S URGICAL A PPROACH Positioning of the Head! Slight left rotation for a right anterolateral approach AVOID HYPEREXTENSION !!! Risk of aggravation of cervical myelopathy Shoulder traction by tensoplast Oblique incision straddling the SCM (3 fingers C3C4, C4C5 and 4 fingers C5C6 and C6C7)

10. S urgical a pproach The right approach is easier for the right-handed and for better centering of a prosthesis (position of the esophagus) For low cervical levels : visualize the recurrent laryngeal nerve to avoid voice disorder Horizontal is more aesthetic Vertical for more than 3 levels, but scar more visible and less flexible

11. S urgical a pproach

12. S urgical a pproach Pre-vascular anterolateral approach «Smith-Robinson» Atraumatic Finger and " Peanut" tampon dissection

13. Surgical approach

14. Surgical approach Low incidence of complications but some very serious Dysphagia Hematoma Paralysis n. Recurrent laryngeal Dural injury Esophageal perforation Aggravation myelopathy Syndrome of Claude Bernard Horner

15. C ervical F usion Neurological release Stability and sagittal balance Loss of function and adjacent overload

16. C ervical F usion decompensation of adjacent levels deco

17. C ervical F usion decompensation of adjacent levels de

18. C ervical D isc P rostHesis Preserve the function to reduce constraints on adjacent segments

19. C ervical D isc P rostHesis Neurological release Stability and sagittal balance Restore the Function

20. C ervical D ISC P Rosthesis P rodisc C VIVO ( Centinel Spine) The choice of the PRODISC C VIVO is a long journey in my experience

21. C ervical D ISC P Rosthesis Which one to use ? Design Range of Motion Materials Heights (mm) Footprints Shape Fixation Regulatory

22. C ervical D ISC P Rosthesis Bryan ( Medtronic) My revelation in 2002 for dynamic surgery of the cervical spine Motion occurs within polymer & provides compression Mimics properties of natural disc

23. C ervical D ISC P Rosthesis Bryan ( Medtronic) Control at 10 years

24. C ervical D ISC P Rosthesis Bryan ( Medtronic) 14y

25. C ervical D ISC P Rosthesis Bryan ( Medtronic) 15y

26. C ervical D ISC P Rosthesis PCM ( cervitech Link) M-47y multistage lesions with more osteophytosis at levels C3C4 and C5C6 Hybrid stabilization to reduce the rigidity of the treated segment, with excellent restitution of cervical lordosis

27. C ervical D ISC P Rosthesis PCM ( cervitech Link)

28. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS) Motion occurs within polymer & provides compression Mimics properties of natural disc

29. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS)

30. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS) 1y

31. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS) 5y

32. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS) 4y

33. C ervical DISC PRosthesis M6C ( SPINALKINETICS) Problem of wear debris-5Y

34. C ervical DISC PRosthesis M6C ( SPINALKINETICS) Problem of wear debris-6Y

35. C ervical D ISC P Rosthesis M6C ( SPINALKINETICS) Problem of wear debris Journal of Neurosurgery : Spine 2019

36. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie)

37. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie)

38. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie) M 48y Corporectomy Fusion C4-C7 Mobi-C C3C4 Controle 4y

39. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie) MOBI-C  Risk Dislocation described including one case in my experience with very important osteolysis !

40. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie) 2018 2018 2024

41. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie) Very severe osteolysis with metallosis “ candles” in adjacent vertebral bodies

42. C ervical D ISC P Rosthesis MOBI-C ( LDR Zimvie) Need for corpectomy and reconstruction with arthrodesis

43. C ervical D ISC P Rosthesis P rodisc C VIVO ( Centinel Spine) Primary stability thanks to : - a design perfectly suited to the shape of the vertebral trays - 6 spikes Secondary stability thanks to b : - bone integration into the 3D coating

44. P rodisc C VIVO ( Centinel Spine) Surgical technique - Level identification ( RX scopy) - Prevascular approach ( right) - Control of the recurring nerve laryngeal - Implementation of the parallel Caspard retractor

45. P rodisc C VIVO ( Centinel Spine) Surgical technique

46. P rodisc C VIVO ( Centinel Spine) Surgical technique - Complete Discectomy - Avivement vertebral trays - Parallel distraction to open the posterior space and the foramens - Bone resection with micromotor (3 mm diam) and Kerisson of 1, 2 and 3 mm posterior osteophytes and cervicale uncarthrosis

47. P rodisc C VIVO ( Centinel Spine) Surgical technique

48. P rodisc C VIVO ( Centinel Spine) Surgical technique Test implant with protective stop Scopic control Adaptation of the stop Control of the perfect adaptation of the test implant

49. P rodisc C VIVO ( Centinel Spine) Surgical technique

50. P Rodisc C VIVO ( Centinel Spine) Surgical technique

51. P Rodisc C VIVO ( Centinel Spine) Surgical technique

52. P Rodisc C VIVO ( Centinel Spine)

53. P Rodisc C VIVO ( Centinel Spine) Chrome-Cobalt alloy trays Fixed Polyethylene Core of specific radius to provides: - Controlled, predictable motion - Controlled translation coupled with flexion-extension

54. PRODISC C VIVO The «  Gold Standard » in my practice PRODISC-C Vivo - Return to work faster - Results at 7 years as good and even better - Less surgical revision at adjacent levels Problem of wear debris ? Cross-linked polyethylene core with minimization of mechanical stresses

55. Clinical Cases

56. Clinical Cases

57. Clinical Cases

58. Clinical Cases

59. Conclusions Prodisc C Vivo My «  Gold Standard » ! - Precise but easy technique - Controlled, predictable motion - Controlled translation coupled with flexion-extension - Excellent primary stability without keel ( interesting for stabilizations on several levels or hybrid stabilizations) - Excellent secondary stability thanks to the 3D coating - No wear problem