Neurosurg Focus
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The goal of this study was to evaluate and compare load sharing of the facet and uncovertebral joints after total cervical disc arthroplasty using 3 different implant designs. ⋯ In unconstrained/semiconstrained prostheses with different core rigidity, the shared loads at the joints differ, and greater flexibility may result in greater joint loads. With respect to the 3 artificial discs studied, load sharing of the Bryan disc was highest and was closest to normal load sharing with the facet and uncovertebral joints. The Prestige LP and ProDisc-C carried more load through their rigid core, resulting in decreased load transmission to the facet and uncovertebral joints.
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Comparative Study
Effect of arthroplasty design on cervical spine kinematics: analysis of the Bryan Disc, ProDisc-C, and Synergy disc.
Cervical total disc replacement has emerged as a surgical option to preserve motion and potentially avoid adjacent-segment disease after anterior cervical discectomy and fusion. Recently, much attention has been directed at the ability of a given device to maintain and/or restore normal segmental alignment. Nonphysiological disc and segmental angulation could result in increased stresses transmitted to the facet joints and posterior elements, conflicting with the essence of arthroplasty and potentially leading to adjacent-segment disease. The goal of this study was to contrast device alignment and segmental kinematics provided by 3 different cervical disc prostheses. ⋯ The goal for motion preservation at the implanted level was achieved using all 3 devices. The Synergy disc was unique in its ability to alter device angulation by 6 degrees. The Bryan disc demonstrated device endplate kyphosis. Both the Synergy disc and ProDisc-C increased disc space height.
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The X-Stop interspinous device is designed for the treatment of patients with neurogenic intermittent claudication due to lumbar spinal stenosis. It distracts the posterior elements of adjacent vertebral bodies, unloading the intervertebral disc, limiting spinal extension, and improving central canal and neuroforaminal stenosis. In this paper, the authors reviewed the complications and failure/reoperation rates in a small series of patients and compared their results with other reported complication and failure/reoperation rates. ⋯ Overdistraction, poor bone density, poor patient selection, and preexistent adjacent foraminal stenosis may all be factors in the development of the aforementioned complications. Thus, careful attention should be paid preoperatively to adjacent-level disease, bone density, appropriate implant size, and optimal patient selection.
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The authors report the use and preliminary results of a novel hybrid dynamic stabilization and fusion construct for the surgical treatment of degenerative lumbar spine pathology. ⋯ The DTO system represents a novel hybrid dynamic stabilization and fusion construct. The technique holds promise as an alternative to multilevel lumbar arthrodesis while potentially decreasing the risk of adjacent-segment disease following lumbar arthrodesis. The technology is still in its infancy and therefore follow-up, when available, remains short. The authors report their preliminary experience using a hybrid system in 24 patients, along with short-interval clinical and radiographic follow-up.
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To review the cost effectiveness for the management of a unilateral cervical radiculopathy with either posterior cervical foraminotomy (PCF) or anterior cervical discectomy and fusion (ACDF) in military personnel, with a particular focus on time required to return to active-duty service. ⋯ In the management of unilateral posterior cervical radiculopathy for military active-duty personnel, PCF offers a benefit relative to ACDF in immediate short-term direct and long-term indirect costs. The indirect cost of a service member away from full, unrestricted active duty 14.8 weeks longer in the ACDF group was the main contributor to this difference.