Cervical Disc Arthroplasty ORSI 2024.pptx
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The document discusses cervical disc arthroplasty, comparing cervical fusion and disc prosthesis options, emphasizing the importance of maintaining sagittal balance and neurological function. It highlights various prosthesis designs, their long-term outcomes, and surgical techniques, particularly focusing on the ProDisc C Vivo as a preferred option due to its stability and motion characteristics. Additionally, the document addresses surgical risks and complications associated with both approaches and the significance of minimizing wear and mechanical stresses in disc prostheses.
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This document summarizes surgical treatments for low back pain and sciatica presented by Dr. Jean-Louis Leflot. It discusses various procedures including discectomy, DIAM, disc arthroplasty, ALIF, and AXIALIF. Key advantages noted are reduced fibrosis, restored disc height and lordosis, decreased adjacent level degeneration, and avoidance of intracanalicular intrusion. Surgical goals are listed as pain relief, improved function, and longevity. The retroperitoneal approach for disc arthroplasty is highlighted for preserving lumbar muscles and avoiding intraspinal fibrosis with a good intervertebral view.Surgical Treatment of Low Back Pain & Sciatics
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1. The document discusses various surgical treatments for low back pain and sciatica resulting from disc herniation, including discectomy, DIAM, and disc arthroplasty.
2. DIAM and disc arthroplasty aim to relieve pain, improve function, restore sagittal balance, and avoid adjacent level breakdown after discectomy by maintaining disc height and foramenal space.
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The document discusses alternatives to spinal fusion for lumbar re-stabilization, including total disc arthroplasty (TDA) and dynamic intervertebral stabilization devices like DIAM. It presents the DIAM device as a minimally invasive, dynamic stabilization option that restores segment mobility and the posterior tension band without the risks of fusion. Clinical cases demonstrate that DIAM provides stabilization in flexion-extension and can reduce pain, avoiding the need for more invasive fusion procedures.PCM
PCMLEFLOT Jean-Louis
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Jean-Louis Leflot, MD, is a surgeon at the Military Hospital Queen Astrid in Brussels and the University Hospital Mont-Godinne in Yvoir, Belgium. He has extensive experience performing cervical arthroplasty procedures. In this document, Dr. Leflot likely discusses the details and outcomes of cervical arthroplasty, a surgical procedure to replace a damaged disc in the neck with an artificial disc.DIAMLEFLOT Jean-Louis
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Cervical Disc Arthroplasty ORSI 2024.pptx
- 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
- 6. SAGITTAL DISBALANCE Analgesic position ?Decrease the pressure on the back of the disc ?Open the foramens Degenerative ?Intersomatic height loss
- 8. OUR SURGICAL CHALLENGES ? Neurological release ? Sagittal balance ? Preserve the function
- 9. SURGICAL APPROACH 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. SURGICAL APPROACH The right approach is easier for the right-handed and for better centering of a prosthesis (position of the esophagus) For low cervical levels : visualize the recurrent laryngeal nerve to avoid voice disorder Horizontal is more aesthetic Vertical for more than 3 levels, but scar more visible and less flexible
- 12. SURGICAL APPROACH Pre-vascular anterolateral approach ?Smith-Robinson? Atraumatic Finger and "Peanut" tampon dissection
- 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. CERVICAL FUSION Neurological release Stability and sagittal balance Loss of function and adjacent overload
- 16. CERVICAL FUSION DECOMPENSATION OF ADJACENT LEVELS DECO
- 17. CERVICAL FUSION DECOMPENSATION OF ADJACENT LEVELS DE
- 18. CERVICAL DISC PROSTHESIS Preserve the function to reduce constraints on adjacent segments
- 19. CERVICAL DISC PROSTHESIS Neurological release Stability and sagittal balance Restore the Function
- 20. CERVICAL DISC PROSTHESIS PRODISC C VIVO (Centinel Spine) The choice of the PRODISC C VIVO is a long journey in my experience
- 21. CERVICAL DISC PROSTHESIS WHICH ONE TO USE ? ? Design ?Range of Motion ?Materials ?Heights (mm) ?Footprints ?Shape ?Fixation ?Regulatory
- 22. CERVICAL DISC PROSTHESIS 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. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC) Control at 10 years
- 24. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC) 14Y
- 25. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC) 15Y
- 26. CERVICAL DISC PROSTHESIS 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. CERVICAL DISC PROSTHESIS PCM (CERVITECH LINK)
- 28. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) Motion occurs within polymer & provides compression Mimics properties of natural disc
- 29. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
- 30. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 1Y
- 31. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 5Y
- 32. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 4Y
- 33. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) PROBLEM OF WEAR DEBRIS-5Y
- 34. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) PROBLEM OF WEAR DEBRIS-6Y
- 35. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) PROBLEM OF WEAR DEBRIS Journal of Neurosurgery : Spine 2019
- 36. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
- 37. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
- 38. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE) M 48y Corporectomy Fusion C4-C7 Mobi-C C3C4 Controle 4y
- 39. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE) MOBI-C Risk Dislocation described including one case in my experience with very important osteolysis !
- 40. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE) 2018 2018 2024
- 41. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE) Very severe osteolysis with metallosis candles in adjacent vertebral bodies
- 42. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE) Need for corpectomy and reconstruction with arthrodesis
- 43. CERVICAL DISC PROSTHESIS PRODISC C VIVO (Centinel Spine) Primary stability thanks to : - a design perfectly suited to the shape of the vertebral trays
- 44. PRODISC 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. PRODISC C VIVO (Centinel Spine) Surgical technique
- 46. PRODISC 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. PRODISC C VIVO (Centinel Spine) Surgical technique
- 48. PRODISC C VIVO (Centinel Spine) Surgical technique Test implant with Adaptation of the stop Control of the perfect adaptation of the test implant
- 49. PRODISC C VIVO (Centinel Spine) Surgical technique
- 50. PRODISC C VIVO (Centinel Spine) Surgical technique
- 51. PRODISC C VIVO (Centinel Spine) Surgical technique
- 52. PRODISC C VIVO (Centinel Spine)
- 53. PRODISC 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