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

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 centres >500 pt

14. Prodisc C

15. MATERIALS
Cobalt - Chrome Alloy
(CoCr)

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

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

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

39. Incision

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, Down’s, 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, Down’s, enterogenous cysts