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Cervical spine disc prosthesis: radiographic, biomechanical and morphological post mortal findings 12 weeks after implantation. A retrieval example


There is a gap between in vitro and clinical studies concerning performance of spinal disc prosthesis. Retrieval studies may help to bridge this gap by providing more detailed information about motion characteristics, wear properties and osseous integration. Here, we report on the radiographic, mechanical, histological properties of a cervical spine segment treated with a cervical spine disc prosthesis (Prodisc C, Synthes Spine, Paoli, USA) for 3 months. A 48-year-old male received the device due to symptomatic degenerative disc disease within C5–C6. The patient recovered completely from his symptoms. Twelve weeks later, he died from a subarachnoid hemorrhage. During routine autopsy, C3–T1 was removed with all attached muscles and ligaments and subjected to plain X-rays and computed tomography, three dimensional flexibility tests, shear test as well as histological and electronic microscopic investigations. We detected radiolucencies mainly at the cranial interface between bone and implant. The flexibility of the segment under pure bending moments of ±2.5 Nm applied in flexion/extension, axial rotation and lateral bending was preserved, with, however, reduced lateral bending and enlarged neutral zone compared to the adjacent segments C4–C5, and C6–C7. Stepwise increase of loading in flexion/extension up to ±9.5 Nm did not result in segmental destruction. A postero-anterior force of 146 N was necessary to detach the lower half of the prosthesis from the vertebra. At the polyethylene (PE) core, signs of wear were observed compared to an unused core using electronic microscopy. Metal and PE debris without signs of severe inflammatory reaction was found within the surrounding soft tissue shell of the segment. A thin layer of soft connective tissue covered the major part of the implant endplate. Despite the limits of such a case report, the results show: that such implants are able to preserve at least a certain degree of segmental flexibility, that direct bone implant contact is probably rare, and that debris may be found after 12 weeks.

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  1. Andersson PA, Sasso RC, Rouleau JP, Carlson CS, Goffin J (2004) The Bryan cervical Disc: wear properties and early clinical results. Spine J 4:303S–309S

    Article  Google Scholar 

  2. Bertagnoli R, Yue JJ, Pfeiffer F, Fenk-Mayer A, Lawrence JP, Kershaw T, Nanieva R (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410

    PubMed  Google Scholar 

  3. DiAngelo DJ, Foley KT, Morrow BR, Schwab JS, Song J, German JW, Blair E (2004) In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant. Neurosurg Focus 17:E7

    PubMed  Google Scholar 

  4. Dietl RH, Krammer L, Kettler A, Wilke HJ, Claes L, Lumenta CB (2002) Pullout test with three lumbar interbody fusion cages. Spine 27:1029–1036

    PubMed  Article  Google Scholar 

  5. Goffin J, Van Calenbergh F, van Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single –level and bi-level. Spine 28:2673–2678

    PubMed  Article  Google Scholar 

  6. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlmann HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528

    PubMed  CAS  Google Scholar 

  7. Jensen W, Anderson P, Nel L, Rouleau J (2005) Bone ingrowth in retrieved Bryan cervical disc prosthesis (Presented at the 2004 CSRS Meeting). Spine 30:2497–2502

    PubMed  Article  Google Scholar 

  8. Kotani Y, Cunningham BW, Abumi K, Dmitriev AE, Ito M, HU N, Shikinami Y, McAfee PC, Minami A (2005) Multidirectional flexibility analysis of cervical artificial disc reconstruction: in vitro human cadaveric spine model. J Neurosurg Spine 2:188–194

    PubMed  Google Scholar 

  9. Kurtz S, van Ooij A, Peleza J, Ciccarelli L, Zeiger A, Villaraga M (2005) Polyethylen wear and rim fracture of retrieved total disc arthroplasty. Eur Spine J (Suppl) 14:S14, Abstract, presented at ESS meeting 2005, Barcelona, Spain

  10. Pickett GE, Rouleau JP, Duggal N (2005) Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 30:1949–1954

    PubMed  Article  Google Scholar 

  11. Pitzen TR, Barbier D, Tintinger F, Steudel WI, Strowitzki M (2002) Screw fixation to the posterior cortical shell does not influence peak torque and pullout in anterior cervical plating. Eur Spine J 11:494–499

    PubMed  Article  CAS  Google Scholar 

  12. Pitzen T, Franta F, Barbier D, Steudel WI (2004) Insertion torque and pullout force of rescue screws for anterior cervical plate fixation in a fatigued initial pilot hole. J Neurosurg Spine 2:198–201

    Google Scholar 

  13. Robertson JT, Papadopoulos SM, Traynelis VC (2005) Assessment of adjacent—segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417–423

    PubMed  Article  Google Scholar 

  14. Smith GW, Robinson RA (1958) The treatment of cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 40-A(3):607–624

    CAS  Google Scholar 

  15. Wilke HJ, Claes L, Schmitt H, Wolf S (1994) A universal spine tester for in vitro experiments with muscle force simulations. Eur Spine J 3:91–97

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Tobias Pitzen.

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Pitzen, T., Kettler, A., Drumm, J. et al. Cervical spine disc prosthesis: radiographic, biomechanical and morphological post mortal findings 12 weeks after implantation. A retrieval example. Eur Spine J 16, 1015–1020 (2007).

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  • Spine
  • Implants
  • Disc replacement
  • Biomechanics
  • Case report