Better understanding of biomechanics, improvements in technology, and new knowledge of the disease process in the spine have led to rapid advances in spinal instrumentation. Cervical total disc replacement tdr is an established alternative to anterior cervical discectomy and fusion acdf with excellent longterm outcomes and low failure rates. Get free shipping on spinal instrumentation surgical techniques isbn. The patients had degenerative disc disease and were treated with the activl implant or the prodisc l or charite implant. Posterior instrumentation of the lumbar spine with the bakl posterior system chapter 5. Dynamic reconstruction of the spine medone, thieme.
Meticulous attention must be paid to the surgical technique to maximize the chances of a good result. The charite fda approved october 2004 and prodiscl fda. As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. These pioneers of minimal access surgery demonstrated that a routine procedure, the microdiscectomy, could be performed using a novel retractor system combined with an.
Dec 20, 2008 degenerative disc disease at some stage requires surgical treatment to improve the pain situation. Denver spine surgeons is a group practice composed of. Zigler md is an orthopaedic spine surgeon at the texas back institute and is codirector of the center for disc replacement. Every surgery resident, even surgical interns, will benefit from a great surgery text. Prospective, randomized, multicenter fda investigational device exemption study of the prodisc l total disc replacement compared with circumferential arthrodesis for the treatment of 2 level lumbar degenerative disc disease results at 24 months.
The insertion technique must be rigorous, with precise centering in the disc space, taking account of. What are surgeons learning about lumbar artificial disc. Centinel spine announces initial cases with flx platform. The prodisc total disc replacement is an artificial intervertebral check fda approval disc made from metal and plastic that is used to treat pain associated with degenerative disc disease ddd. This means that you would not need to have bone taken from your hip. In 1989, marnay described the prodiscl, which has plates with a central titanium stem. The prodisc c is a device that has two metal bearing surfaces and a sandwiched polymer plastic bearing. Cervical disc arthroplasty has been in practice in the us for more than 10 years.
By your description, the polymer intermediate bearing surface subluxed or dislocated into the spinal canal and compressed the cord causing myelopathy. Artificial disc replacement models artificial disc replacement. Lumbar artificial disc lumbar artificial disc replacement. Prodisc orthopedic manual surgical instrument, strut used in spinal surgery. The surgical technique used in the singlelevel pdl implantation followed that described in the standard us technique for the pdl investigational device exemption ide study. Mark evers, md is excellent to supplement the authors you mentioned. Prodiscl lumbar disc replacement back pain is a leading cause for physician visits, with approximately 6080% of the us population experiencing episodes of acute low back pain at least once in their lives.
Success as defined by an improvement in sf36 showed a 79% success rate with prodiscl versus 70% with fusion, another benchmark that approached statistical significance. Longterm lumbar low back artificial disc studies show positive. It has an additional cavity at the posterior end of both keels. Check the lateral position using the image intensifier. Orthopedic manual surgical instrument product code lxh.
Artificial disc replacement has made great strides since it was first approved to treat low back pain in 2005 and neck pain in 2007. After surgery surgery with the prodisc l total disc replacement is considered major surgery. In recent years nonfusion techniques in spine surgery using total disc replacement. See the surgical technique manual for step by step instructions.
The latest technologies and surgical approaches for motion preservation of the spine. The pilot study was successful, although it has yet. Femoral canal preparation use the box osteotome and canal finder for initial entry into femoral canal. Remotion total wrist arthroplasty from greens operative hand. There were 218 patients who received the activl and 106 patients who received either prodiscl or charite. Cammisa on being chosen by new york magazine for its prestigious best doctors 2015 list dynamic reconstruction of the spine, second edition is the most uptodate resource on the instrumentation, technologies, and fundamental science integral to achieving spine motion. Cervical total disc replacement tdr is intended to address discogenic pain, restore disc height, and preserve functional motion between two vertebral bodies in patients with symptomatic cervical disc disease. The prodiscl total disc replacement is a ball and socket implant consisting of two metal endplates and one plastic inlay. Degenerative disc disease at some stage requires surgical treatment to improve the pain situation. This book is your complete guide to all contemporary forms of spinal implant systems. Synthes spine prodiscl lumbar total disc replacement. The implant was developed using the clinically proven ball and socket concept used in joint replacement implants for over 40 years. Surgical technique prepare acetabulum if acetabular reconstruction is required, prepare the acetabulum using the surgical technique for the intended acetabular component.
The failure rate, defined by reoperations, revisions, and removal or addition of devices, was low and no dif ferent between the prodiscl and fusion cases. May 10, 2016 serious devicerelated complication rates were 10% for activl artificial disc and 45% for prodiscl p0. In the prodisc study patients, the average was nine months of failed non surgical treatment. Surgical implants must never be reused or reimplanted. Thieme has some sub specialty books in neurosurgery, laproscopy and in other niche areas. The prodisc l artificial disc replacement is a useful tool in the treatment of discogenic pain syndrome. Therefore, over the course of six to nine months, if a patient is not getting better with the therapies that help most peoplethat being rest, physical therapy, spinal injections, andor antiinflammatory medicationwe have very good validation that. The prodiscl total disc replacement is designed to replace your unhealthy disc. The semiconstrained design allows for near anatomic motion while diminishing shear forces. The prodisc l total disc replacement is an artificial intervertebral disc made from metal and plastic that is used to treat pain associated with degenerative disc disease ddd. Lumbar total disc replacement wheeless textbook of orthopaedics. The prodisc l total disc replacement surgery does not require bone graft. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery of better outcomes to patients undergoing such surgery.
A prospective randomized multicenter food and drug administration ide trial, jeffrey a. Prodisc l lumbar disc replacement back pain is a leading cause for physician visits, with approximately 6080% of the us population experiencing episodes of acute low back pain at least once in their lives. Patients will be assigned a treatment, either prodisc or spinal fusion surgery, according to a blocked randomization schedule. Lanman, md, a spinal neurosurgeon and leader in total disc replacement, shares his thoughts on the current state of this surgical alternative to spinal fusion.
Prodiscl artificial discs shown on the right are fda. Prodiscl surgical technique depuy synthes 17 sfw788r vario case for prodiscl struts the prodiscl struts hold the disc segment open and facilitate the discectomy procedure and the insertion of the prosthesis. As opposed to fusion technologies, which bring immediate pain relief but that will again develop over the next years due to adjacent level disease, motionsparing devices appear to avoid this condition. The prodisc c implant has been designed to maintain the physiologic range of motion in the spine. Disc prosthesis for lumbar degenerative disease and axial. Even though the device appears undamaged, it may have small defects and internal stress patterns that may lead to early breakage. This cavity can lodge potential residual bone debris and thereby facilitates the posterior positioning of the implant.
The prodiscl artificial disc replacement is a useful tool in the treatment of discogenic pain syndrome. The prodisc c implant is composed of three components two cobalt chrome alloy cocrmo endplates and an ultrahigh molecular weight polyethylene uhmwpe inlay. Use aseptic technique when removing the prodisc l total disc replacement components. The surgical technique for the prodiscl has been previously described. Purchase handbook of surgical technique 1st edition. In summary, this case demonstrates anterior artificial disc extrusion following trauma and the surgical approach to management. The text uses the a positive care approach to surgical problem. The patientsassignment randomization will be performed using a 2 to 1 ratio of prodisc recipients to control spinal fusion recipients.
Jun 09, 2016 remotion total wrist arthroplasty from greens operative hand surgery 7e. The prodisc l is a ball and socket design with a semiconstrained biomechanical concept. International meeting for advanced spinal techniques imast, lumbar total disc replacement with the prodiscl artificial disc versus fusion. Synthes spine prodiscl lumbar total disc replacement demonstration video. The prodiscl total disc replacement system synthes spine, west chester, pa, usa was used in all patients. Furthermore, techniques for removal of the prodisc c device have not been described previously. Bertagnoli prospine, straubing, germany introduction. Prodisc disc replacement the spine institute santa monica. Ddd is defined as discogenic back pain pain resulting from a degenerated intervertebral disc with degeneration of the disc confirmed by patient. The patient is placed supine on a fluoroscopic table with a pillow behind the knees and arms abducted 90 to the torso. Remotion total wrist arthroplasty from greens operative hand surgery 7e. This surgical procedure posterior cervical foraminotomy originated in the 1940s, and 1950s when the pioneers stookey, frykholm, murphey, and simmons had standardized the technique and were publishing excellent results with over 90 percent positive outcomes, and a very low 1. L ld xl xld prodiscc surgical technique depuy synthes 7 hkeel design hkeel is the latest design improvement of the prodiscc, manufactured since april 2006. Working with leading spine surgeons from around the world, the prodisc l instrumentation and surgical technique has been refined to facilitate safe and.
Prodisc l surgical technique depuy synthes 17 sfw788r vario case for prodisc l struts the prodisc l struts hold the disc segment open and facilitate the discectomy procedure and the insertion of the prosthesis. Besides surgical techniques, several biological approaches, including. As with any major surgery, you should expect some discomfort as well as a period of rehabilitation. Cases of implant failure and migration are scarce and primarily limited to several years postoperatively. All patients were operated on while under general anesthesia. Many of you will be provided a text at the start of residency, so ask your department before investing hundreds in one of these books. Artificial disc replacement, also known as artificial disk replacement and total disc replacement tdr, refers to the artificial disc replacement surgery and to the manmade device, which replaces the entire function of the diseased or damaged intervertebral disc of the spinal column. The procedure led to a statistically significant improvement in the functional scores. Use aseptic technique when removing the prodiscl total disc replacement components.
Contraindications to ctdr are previous anterior cervical surgery, posterior joint osteoarthritis which is. Prodisc l total disc replacement because it is designed to allow some motion in the disc space. Spinal neurosurgery and reconstructive peripheral nerve surgery, baylor college of medicine, houston, tx, usa. Longterm lumbar low back artificial disc studies show. The patients had degenerative disc disease and were treated with the activl implant or the prodiscl or charite implant. The prodisc l total disc replacement is designed to replace your unhealthy disc. Centinel spine announces initial cases with flx platform of. The prodiscl is a ball and socket design with a semiconstrained biomechanical concept. The plastic inlay snaplocks into the lower endplate and provides the ball that rides in the socket of the upper endplate that is intended to. Anteroposterior carm fluoroscopic imaging with the carm at 0 is then performed.
Apr 18, 2018 this surgical procedure posterior cervical foraminotomy originated in the 1940s, and 1950s when the pioneers stookey, frykholm, murphey, and simmons had standardized the technique and were publishing excellent results with over 90 percent positive outcomes, and a very low 1. This list is part of a series of articles about the best books for medical students. The personal and monetary costs associated with this widespread problem are staggering. Physical capability outcomes after total disc replacement. The prodisc l total disc replacement is a ball and socket implant consisting of two metal endplates and one plastic inlay. Fellowshiptrained spine team provides disc replacement. There will be separate study arms for one and two level patients. Smith department of neurosurgery,the university of texas health science center, houston, houston, tx 77030professor and director. Thus, tdr may prevent subsequent adjacent disc degeneration. Artificial disc replacement in spine surgery othman. The prodisc l implant is composed of three components two cobalt chrome alloy cocrmo endplates and an ultrahigh molecular weight polyethylene uhmwpe inlay. There were 218 patients who received the activl and 106 patients who received either prodisc l or charite. Should i consider artificial disc replacement for my back or.
The plastic inlay snaplocks into the lower endplate and provides the. The activl implant is an investigational device while the prodiscl and charite disc replacement are fdaapproved. Prodisc l total disc replacement orthopedic spine surgery. Total disc replacement vertebral endplate abstract book artificial disc. Remotion total wrist arthroplasty from greens operative. Find a back doctor or surgeon at texas back institute. It not only highlights the newest devices, but also gives you the clinical guidelines you need to choose and apply the best.
Cervical artificial disc extrusion after a paragliding. A comprehensively updated text takes account of new developments in surgical techniques and equipment. The introduction of the tubular retractor system metrx, medtronic, memphis, tn, usa by foley and smith in the late 1990s allowed spine surgeons to treat symptomatic herniated discs with minimally invasive techniques. The surgical technique used in the singlelevel pd l implantation followed that described in the standard us technique for the pd l investigational device exemption ide study. The surgical indication was established in patients with multilevel symptomatic ddd that was resistant. The content focuses on the concepts and skill development cognitive and procedural required of surgical technologists in the operative environment. A new final chapter on surgical craftsmanship brings the skills all together for the surgeon in the operating theatre, uniting and applying the relevant factors in the correct sequence and focussing on getting it right first time.
Camerons current surgical therapy is the highest rated by surgical. Implantation trialing 89 midline identification 10 confirm positioning 11 endplate insertion 12 core trial and insertion 14 final positioning 15 closing 16. This new edition meets the requirements of the revised core curriculum for surgical technologists, 5th edition. There was very little information, only listing that there was one podisc l insert failure in a patient lifting heavy weights. It is written by surgical technologists for surgical technologists. Ddd is defined as discogenic back pain pain resulting from a degenerated intervertebral disc with degeneration of the disc confirmed by patient history and.
The activl implant is an investigational device while the prodisc l and charite disc replacement are fdaapproved. The authors report a case of anterior extrusion of a c4c5 prodiscc depuy synthes, west chester, pa. Zigler md is an orthopaedic spine surgeon at the texas back institute and is. Your doctor may prescribe medicines to help you manage any pain or nausea you may experience. The prodisc l implant has been designed to maintain the physiological range of motion in the spine. Materials and methods for longterm followup of tdr patients. Complete discectomy discectomy 6 endplate preparation 7 iv. Reoperation rates at the index level were 5% for activl artificial disc and 27% for prodiscl p0. This is the first detailed report of anterior extrusion of a prodisc c artificial disc. Click on the med school books main page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for usmle steps 1, 2, and 3 the surgical internship is unique in that you will care for the full spectrum of patients. Noninferiority as well as superiority have been well established in the literature, and more spine surgeons are confident to perform this surgery in place of fusion 5860. Coda plif spacercadence plif spacertraxis surgical technique chapter 8. Jan 01, 2011 director, reconstructive spinal and peripheral nerve surgery, mischer neuroscience instituteprofessor, vivian l.