Table Of ContentGunzburg et al. (Eds.) Arthroplasty of the Spine
Springer-Verlag Berlin Heidelberg GmbH
R. Gunzburg • H. M. Mayer • M . Szpalski • M. Aebi
(Editors)
Arthroplasty
of the Spine
With 159 Figures and 29 Tables
Springer
Dr. Robert Gunzburg Prof. Dr. Marek Szpalski
Eeuwfeestkliniek Centre Hospitalier Moliere
Harmoniestraat 68 Longchamps
2018 Antwerp Rue Marconi 142
Belgium 1180 Brussels
Belgium
Dr. Heinz Michael Mayer
Orthopädische Klinik Prof. Dr. Max Aebi
München-Harlaching Maurice E. Müller Institute
Wirbelsäulenzentrum for Evaluative Research
Harlachinger Str. 51 and Documentation
81243 München in Orthopaedic Surgery
Germany Murtenstr. 35
3008 Bern
Switzerland
ISBN 978-3-540-20295-0
Also published as Volume 11, Supplement 2, October 2002
of the European Spine Journal
ISSN 0940-6719
Library of Congress Cataloging-in-Publication Data
Arthroplasty of the spine / R. Gunzburg ... [et al.] (eds.).
p. ; cm. - (European spine journal, ISSN 0940-6719 ; v. 11, suppl. 2)
Includes bibliographical references and index.
ISBN 978-3-540-20295-0 ISBN 978-3-642-18508-3 (eBook)
DOI 10.1007/978-3-642-18508-3
1. Spine-Surgery. 2. Arthroplasty. I. Gunzburg, Robert. II. Series
[DNLM: 1. Intervertebral Disk-surgery. 2. Arthroplasty, Replacement-methods.
3. Prostheses and Implants. WE 740 A7866 2002]
RD768.A785 2002 617.4'71-dc22 2003066402
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Contents
INTRODUCTION Arthroplasty of the spine: the long quest for mobility................................ 1
R. Gunzburg, H. M. Mayer, M. Szpalski, and M. Aebi
REVIEWS Spine arthroplasty: a historical review ........................................................ 3
M. Szpalski, R. Gunzburg, and M. Mayer
With 37 Figures
Non-fusion technology in degenerative lumbar spinal disorders:
facts, questions, challenges .......................................................................... 23
H. M. Mayer and A. Korge
With 6 Figures and 7 Tables
DISC REPLACEMENT Cervical motion segment replacement.. ............... ........................................ 30
BY EXCISION V. E. Bryan Jr
With 5 Figures and 3 Tables
History, design and biomechanics of the LINK SB Charite artificial disc... 36
H.D.Link
With 13 Figures and 1 Table
Artificial disc:
preliminary results of a prospective study in the United States .................. 44
S. H. Hochschuler, D. D. Ohnmeiss, R. D. Guyer, and S. L. Blumenthal
With 5 Figures
Optimal minimally traumatic approach for the SB ChariteM Artificial Disc 49
K. Biittner-Janz
With 1 Figure
Maverick total lumbar disk prosthesis:
biomechanics and preliminary clinical results............................................. 53
J. C. Le Huec, S. Aunoble, T. Friesem, H. Mathews, and T. Zdeblick
With 6 Figures and 1 Table
VI
Total disc replacement arthroplasty using the AcroFlex lumbar disc:
a non-human primate model........................................................................ 59
B. W. Cunningham, G. L. Lowery, H. A. Serhan, A. E. Dmitriev,
C.M.Orbegoso, P.C.McAfee, R.D.Fraser, R.E.Ross, and S.S.Kulkarni
With 6 Figures
Minimally invasive total disc replacement:
surgical technique and preliminary clinical results......... ............ ................ 68
H. M. Mayer, K. Wiechert, A. Korge, and 1. Qose
With 9 Figures and 2 Tables
Indications for full prosthetic disc arthroplasty:
a correlation of clinical outcome against a variety of indications............... 75
R. Bertagnoli and S. Kumar
With 5 Figures and 1 Table
DISC REPLACEMENT The PDN@ prosthetic disc-nucleus device................................................... 81
BY MAINTAINING C.D.Ray
THE ANNULUS With 3 Figures
Surgical and clinical results with the PDN@ prosthetic disc-nucleus device 87
R. Bertagnoli and R. ScMnmayr
With 6 Figures
A spiral implant as nucleus prosthesis in the lumbar spine.................... .... 93
A. Korge, Th. Nydegger, J. L. Polard, H. M. Mayer, and J. L. Husson
With 4 Figures and 2 Tables
Nucleus prosthesis: a new concept ........ ...................................................... 98
A. Studer
MOTION SEGMENT Graf ligamentoplasty: a 7-year follow-up ................................................... 101
CONTROLLED BY A. Gardner and K. C. Pande
FLEXIBLE FIXATION With 10 Figures
Mechanical supplementation by non-rigid fixation
in degenerative intervertebrallumbar segments: the Wallis system ........... 108
J. Senegas
With 6 Figures
The dynamic neutralization system for the spine:
a multi-center study of a novel non-fusion system ...................................... 114
T. M. Stoll, G. Dubois, and O. Schwarzenbach
With 5 Figures and 8 Tables
The objectives for the mechanical evaluation of spinal instrumentation
have changed ................................................................................................ 123
D. S. McNally
With 6 Figures
Development and preclinical testing
of a new tension-band device for the spine: the Loop system .................... 130
M. D. Garner, S. J. Wolfe, and S. D. Kuslich
With 4 Figures and 1 Table
VII
Elastic stabilization alone or combined with rigid fusion in spinal surgery:
a biomechanical study and clinical experience based on 82 cases .............. 136
S. Caserta, G. A. La Maida, B. Misaggi, D. Peroni, R. Pietrabissa,
M. T. Raimondi, and A. Redaelli
With 10 Figures and 3 Tables
Rationale, principles and experimental evaluation
of the concept of soft stabilization ............................................................... 142
R. C. Mulholland and D. K. Sengupta
With 3 Figures
FUTURE A potential role for cell-based therapeutics
in the treatment of intervertebral disc herniation ........................................ 150
T. M. Ganey and H. J. Meisel
With 7 Figures
A biological approach to treating disc degeneration:
not for today, but maybe for tomorrow ....................................................... 159
M. Alini, P. J. Roughley, J. Antoniou, T. Stoll, and M. Aebi
With 2 Figures and 1 Table
Arthroplasty of the spine:
Robert Gunzburg
H. Michael Mayer
the long quest for mobility
Marek Szpalski
Max Aebi
Joint replacement is a logical step in tion of mobility and damping, with
the treatment of severe joint patholo load repartition properties. To add to
gies with irreversible lesions resist the complexity, the center of rotation
ing conservative therapy. While hip constantly moves along the three
arthrodesis brought relief to many axes. Reproducing this complex
patients, total replacement opened structure and function is a challenge
a new era in orthopedics and revo well beyond the design of the hip
lutionized the quality of life for implant, which is mainly a simple
coxarthrosis sufferers. These pio ball joint structure. Whereas hip im
neering efforts were soon followed plants represent mainly mUltiple
by similar techniques being proposed variations around a common theme,
for other peripheric joints, some the principles governing the different
times with only qualified success. spinal arthroplasty designs are multi
Knee replacement is now routine ple and totally distinct. The same can
surgery, whereas shoulder arthro be said about the materials used in
plasty is less common, while ankle, those designs. This challenge has
elbow and wrist arthroplasties have stimulated the productive imagina
given disappointing results because tion of both surgeons and engineers.
of their more complex structural and The ratio between the number of
functional properties. patents and publications and the
At the spinal level, arthrodesis be number of designs that reached the
came, very early, the gold standard animal implantation level, not to
of treatment for severe intervertebral mention clinical use, is enormous.
disc pathologies. The next logical This wide heterogeneity of designs
step was to envision functional re reflects well the complexity of the
placement, and this step was taken as task involved in the creation of an
R. Gunzburg early as 1956, when the first inter artificial implant mimicking the na
Eeuwfeestkliniek, Antwerp, Belgium vertebral implant was described. ture and function of the disc.
H.M. Mayer However, it took many more years The few designs that are in com
Orthopiidische Klinik and a great variety of proposed im mercial production and current hu
Miinchen-Harlaching,
plant designs before clinical applica man use have to withstand the test of
Munich Spine Center, Munich, Germany
tions could be attempted. time and of evidence-based medi
M. Szpalski The problems in designing a suc cine. There are few prospective stud
Centre Hospitalier Moliere Longchamp,
cessful intervertebral implant are ies on this topic, and no true ran
Brussels, Belgium
linked to the three-column structure domized control trial demonstrating
M. Aebi of the spine, which involves three the superiority of spine arthroplasty
Division of Orthopaedic Surgery,
separate joints at each level. Further over fusion has been published to
McGill University,
more, the intervertebral disc is not a this day. We should also be guided
Royal Victoria Hospital,
Montreal, Quebec, Canada true joint, and serves a double func- by the experience in other areas of
2
joint replacement, showing that a joint arthroplasty, ligamentoplasty, probably lie more in possibilities of
great number of problems and com nevertheless, uses implants to main disc repair by cell biology than in re
plications only become apparent tain mobility and is also discussed placement by mechanical hardware.
through a process of true long-term here. In the meantime, we hope that the
follow-up. The different approaches pre techniques described here will prove
Clinical experience with different sented in this volume reflect current their efficacy in methodologically
implants, principles of design and thought on the subject. New ideas sound studies, and that spinal surgery
surgical techniques are presented in will probably arise and, in the more will join the rest of orthopedic care
this volume. Although not a true distant future, the solutions will in the quest for motion.
REVIEW
Spine arthroplasty: a historical review
Marek Szpalski
Robert Gunzburg
Michael Mayer
Abstract Degenerative disc disease sent, in chronological order, an
is one of the most frequently encoun overview of the designs published in
tered spinal disorders. The interver the literature as well as in the patents
tebral disc is a complex anatomic granted in this field. The very fact
and functional structure, which that such a long list of implants,
makes the development of an effi based on highly varied principles,
cient and reliable artificial disc a has been proposed, and that only
complex challenge. Not only is the very few have reached the level of
disc function arduous to reproduce, animal models, let alone human im
but there are important consequences plantation, clearly demonstrates how
associated with the conception and challenging the task of designing an
the choice of materials that will have intervertebral disc replacement is.
to bear the loads. Biochemical prob Proper randomized controlled trials
lems have complicated things even are now on the way, and should help
M. Szpalski (~) more. Two different principles have in assessing the efficacy and real
Department of Orthopedics,
been applied in the realisation of a place of spine arthroplasty in the
Centre Hospitalier Moliere Longchamp,
142 rue Marconi, 1190 Brussels, Belgium discal replacement: a metallic and/or treatment of spinal disorders. Only
e-mail: [email protected] polyethylene prosthesis allowing then will spinal surgery join the list
mainly mobility or a prosthesis en of successful joint replacements.
R. Gunzburg
Euwfeestkliniek, Antwerp, Belgium abling the reproduction of viscoelas
tic properties. Of course some de Keywords Spine· Arthroplasty .
M. Mayer
vices attempt to combine both princi Artificial disc . Intervertebral disc .
Orthopiidische Klinik -Miinchen-Harlaching,
Munich Spine Center, Germany ples. In this paper we will try to pre- Degeneration
disorders (e.g. knee, hip) until the advent of reliable
Introduction
arthroplasty techniques. Arthroplasty allows for pain re
lief while keeping or restoring function. It was therefore
Degenerative disc disease is one of the most frequently
seen as appealing to apply this principle to the spine by re
encountered spinal disorders. Disc arthrosis, segmental
placing a degenerated disc instead of fusing a segment.
instability and spondylolisthesis are the principal indica
tions for spinal fusion. However, there is a lack of preci
sion concerning the definition of certain "pathologies" Conception of disc arthroplasty
[175], and the relation between degenerative lesions, ac
tual low back pain and the need for fusion is, at best, open The structure, function and aetiopathogenesis of periph
to debate [138]. eral joints such as the hip or the knee are fundamentally
The pain generated by a degenerative joint is linked to different from those of the functional spinal unit. The
its mobility, and the suppression of the latter should in function of a peripheral joint is to allow a wide range of
duce pain relief at the cost of impaired function. Hence, mainly rotatory movements by means of cartilaginous in
fusion became the standard treatment in many severe joint terfaces. The hip biomechanics is relatively simple, and
