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Published byDiego Sutton
Modified over 4 years ago
Fusion vs motion preservationSolid fusion stops pain related o the motion segment Adjacent motion segment degenerates faster- 25% symptomatic at 20 years
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
BRYAN DISC Two anatomically shaped metal platesLow friction, low wear rates 4000 implantations RCT with fusion centres >500 pt
MATERIALS Cobalt - Chrome Alloy (CoCr)
Titanium Plasma Spray surfaceFIXATION Primary: Central Keel Secondary: Titanium Plasma Spray surface
RETAINER SCREW INSERTION
VERTEBRAL BODY RETAINER
DISCECTOMY AND DECOMPRESSION
ADJUSTMENT DEPTH TRIAL
TRIAL IMPLANT INSERTION
Surgical approaches C1/2 anterior: trans oralC1/2 posterior: midline sub-occipital Sub-axial anterior: anterior cervical decompression Sub-axial posterior: cervical laminectomy, laminoplasty, foramenotomy
Posterior Approaches Occiput C1 C2 Subaxial C2-7
Posterior cervical fixationC1/2 with or without occipital fixation C3-7 cervicothoracic
C1 articular mass screw
C1/C2 articular mass screws
Exposure of the spines and laminae 2
Exposure of lateral masses
Exposure of the laminae and lateral masses
Removal of the laminae
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, Down’s, enterogenous cysts Infection: discitis, osteomyelitis, epidural abscess
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, Down’s, enterogenous cysts
Spectrum of pathology Prolapsed discs and osteophytic compression; wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory.
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