Fusion vs motion preservation

• Solid fusion stops pain related o the motion segment

• Adjacent motion segment degenerates faster- 25% symptomatic at 20 years

PRESTIGE

• Formerly Bristol disc (Cummins)

• 2-nd generation modified as 2-piece all

• metal prosthesis (ball-and-socket)

• Secured vertebral bodies anterior screws

• 100 implantations

Prestige titanium

BRYAN DISC

• Two anatomically shaped metal plates

• Low friction, low wear rates

• 4000 implantations• RCT with fusion 2002

20 centres >500 pt

Prodisc C

• Cobalt - Chrome Alloy• (CoCr)

MATERIALS

• Primary: Central Keel

• Secondary:

• Titanium Plasma Spray surface

FIXATION

MIDLINE MARKING

RETAINER SCREW INSERTION

VERTEBRAL BODY RETAINER

DISTRACTION

DISCECTOMY AND DECOMPRESSION

KEEL CUTTING

BOX CUTTING

ADJUSTMENT DEPTH TRIAL

TRIAL IMPLANT INSERTION

IMPLANT INSERTION

Final result

Surgical approaches

• C1/2 anterior: trans oral

• C1/2 posterior: midline sub-occipital

• Sub-axial anterior: anterior cervical decompression

• Sub-axial posterior: cervical laminectomy, laminoplasty, foramenotomy

Posterior Approaches

• Occiput C1 C2• Subaxial C2-7

Posterior cervical fixation

• C1/2 with or without occipital fixation

• C3-7

• cervicothoracic

Atlantoaxial instability

C1 articular mass screw

C1/C2 articular mass screws

Incision

First steps

Exposure of the spines and laminae 2

Exposure of lateral masses

Exposure of the laminae and lateral masses

Removal of the laminae

Spectrum of pathology

• Prolapsed discs, osteophytic compression: ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts• Infection: discitis, osteomyelitis, epidural

abscess

Spectrum of pathology

• Prolapsed discs and osteophytic compression; ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis

• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts