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Fusion vs motion preservation Solid fusion stops pain related o the motion segment Adjacent motion segment degenerates faster- 25% symptomatic at.

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Presentation on theme: "Fusion vs motion preservation Solid fusion stops pain related o the motion segment Adjacent motion segment degenerates faster- 25% symptomatic at."— Presentation transcript:

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5 Fusion vs motion preservation Solid fusion stops pain related o the motion segment Adjacent motion segment degenerates faster- 25% symptomatic at 20 years

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9 PRESTIGE Formerly Bristol disc (Cummins) 2-nd generation modified as 2-piece all metal prosthesis (ball- and-socket) Secured vertebral bodies anterior screws 100 implantations

10 Prestige titanium

11 BRYAN DISC Two anatomically shaped metal plates Low friction, low wear rates 4000 implantations RCT with fusion 2002 20 centres >500 pt

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14 Prodisc C

15 Cobalt - Chrome Alloy (CoCr) MATERIALS

16 Primary: Central Keel Secondary: Titanium Plasma Spray surface FIXATION

17 MIDLINE MARKING

18 RETAINER SCREW INSERTION

19 VERTEBRAL BODY RETAINER

20 DISTRACTION

21 DISCECTOMY AND DECOMPRESSION

22 KEEL CUTTING

23 BOX CUTTING

24 ADJUSTMENT DEPTH TRIAL

25 TRIAL IMPLANT INSERTION

26 IMPLANT INSERTION

27 Final result

28 Surgical approaches C1/2 anterior: trans oral C1/2 posterior: midline sub-occipital Sub-axial anterior: anterior cervical decompression Sub-axial posterior: cervical laminectomy, laminoplasty, foramenotomy

29 Posterior Approaches Occiput C1 C2 Subaxial C2-7

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33 Posterior cervical fixation C1/2 with or without occipital fixation C3-7 cervicothoracic

34 Atlantoaxial instability

35 C1 articular mass screw

36 C1/C2 articular mass screws

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39 Incision

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47 First steps

48 Exposure of the spines and laminae 2

49 Exposure of lateral masses

50 Exposure of the laminae and lateral masses

51 Removal of the laminae

52 Spectrum of pathology Prolapsed discs, osteophytic compression: wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts Infection: discitis, osteomyelitis, epidural abscess

53 Spectrum of pathology Prolapsed discs and osteophytic compression; wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts


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