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In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement

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Abstract

Purpose and methods

For the treatment of degenerative disc diseases of the cervical spine, anterior cervical discectomy and fusion (ACDF) still represents the standard procedure. However, long term clinical studies have shown a higher incidence of pathologies in the adjacent segments. As an alternative to spinal fusion, cervical total disc replacement (cTDR) or dynamically implants were increasingly used. This in vitro study analyzed the kinematics and intradiscal pressures in seven multi-segmental human cervical spine using hybrid multidirectional test method. The aim of our study was to compare the intact condition with a single-level dynamic stabilization with DCI®, with cTDR (activC®) and with simulated ACDF (CeSPACE® cage and CASPAR plate).

Results

No significant changes in the kinematics and pressures were observed in all segments after arthroplasty. The DCI® significantly decreased the motion of the treated segment in flexion/extension and lateral bending with some remaining residual mobility. Thereby the motion of the upper segment was increased significantly in flexion/extension. No significant changes of the intradiscal pressures were observed. With simulated fusion the motion of the indexed level was significantly decreased in flexion/extension and axial rotation with the greatest changes in the adjacent levels and the highest pressures.

Conclusion

Based on our biomechanical study the DCI® can pose an alternative to fusion, which has a lesser effect on adjacent levels. This might reduce the risk of long-term degeneration in those levels. In particular, the facet joint arthritis and kyphotic deformity, as a contraindication to the arthroplasty, could be a clinical application of the dynamic implant.

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Acknowledgments

This study was funded by the Paradigm Spine GmbH and in parts by grants of the HiLF program of the Hannover Medical School. Aesculap AG provided the implants for the cTDR and ACDF.

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Authors and Affiliations

  1. Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Bastian Welke, Michael Schwarze & Christof Hurschler

  2. Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Thorsten Book, Stephan Magdu & Dorothea Daentzer

Authors
  1. Bastian Welke
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  2. Michael Schwarze
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  3. Christof Hurschler
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  4. Thorsten Book
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  6. Dorothea Daentzer
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Corresponding author

Correspondence to Bastian Welke.

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Conflict of interest

The corresponding author BW received honoraria for lectures during two workshops of the Paradigm Spine GmbH.

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Welke, B., Schwarze, M., Hurschler, C. et al. In vitro investigation of a new dynamic cervical implant: comparison to spinal fusion and total disc replacement. Eur Spine J 25, 2247–2254 (2016). https://doi.org/10.1007/s00586-015-4361-8

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  • DOI: https://doi.org/10.1007/s00586-015-4361-8

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