In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement
Bastian Welke, Michael Schwarze, Christof Hurschler, Thorsten Book, Stephan Magdu, Dorothea Daentzer
June 2016, Volume 25, Issue 7, pp 2247 - 2254 Original Article Read Full Article 10.1007/s00586-015-4361-8
First Online: 18 December 2015
Purpose and methods
For the treatment of degenerative disc diseases of the cervical spine, anterior cervical discectomy and fusion (ACDF) still represents the standard procedure. However, long term clinical studies have shown a higher incidence of pathologies in the adjacent segments. As an alternative to spinal fusion, cervical total disc replacement (cTDR) or dynamically implants were increasingly used. This in vitro study analyzed the kinematics and intradiscal pressures in seven multi-segmental human cervical spine using hybrid multidirectional test method. The aim of our study was to compare the intact condition with a single-level dynamic stabilization with DCI®, with cTDR (activC®) and with simulated ACDF (CeSPACE® cage and CASPAR plate).
No significant changes in the kinematics and pressures were observed in all segments after arthroplasty. The DCI® significantly decreased the motion of the treated segment in flexion/extension and lateral bending with some remaining residual mobility. Thereby the motion of the upper segment was increased significantly in flexion/extension. No significant changes of the intradiscal pressures were observed. With simulated fusion the motion of the indexed level was significantly decreased in flexion/extension and axial rotation with the greatest changes in the adjacent levels and the highest pressures.
Based on our biomechanical study the DCI® can pose an alternative to fusion, which has a lesser effect on adjacent levels. This might reduce the risk of long-term degeneration in those levels. In particular, the facet joint arthritis and kyphotic deformity, as a contraindication to the arthroplasty, could be a clinical application of the dynamic implant.
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