This document discusses anterior cervical fusion versus cervical disc arthroplasty for treating cervical spine issues. It provides details on the surgical challenges, approaches, and various cervical disc prosthesis designs, including the Bryan, PCM, M6C, Rhine, Mobi-C, and Synergy. Follow-up images and studies on the Mobi-C prosthesis over 4-7 years show maintained motion and lordosis with no revisions, suggesting cervical disc arthroplasty can preserve function and reduce adjacent level issues compared to fusion while providing safe, durable results.

1. ANTERIOR CERVICAL FUSION
CERVICAL DISC ARTHROPLASTY
LEFLOT JEAN-LOUIS M.D.
UH BRUGMANN BRUSSELS

2. FUSION VERSUS DISC PROSTHESIS ?

3. ANATOMY

4. PATHOLOGICAL ANATOMY

5. SAGITTAL DISBALANCE

6. SAGITTAL DISBALANCE
Analgesic position
Decrease the pressure
on the back of the disc
Open the foramens
Degenerative
Intersomatic height loss

7. SAGITTAL DISBALANCE

8. OUR SURGICAL CHALLENGES
 Neurological release
 Sagittal balance
 Preserve the function

9. SURGICAL APPROACH
Positioning of the Head!
At the zenith (better centering of the prosthesis)
or slight left rotation for a right anterolateral
approach
Neutral position
AVOID HYPEREXTENSION !!!
Risk of aggravation of cervical myelopathy

10. SURGICAL APPROACH
The right approach is easier for the right-handed and for
better centering of a prosthesis (position of the
esophagus)
For low cervical levels : visualize the recurrent laryngeal
nerve to avoid voice disorder
Horizontal is more aesthetic
Vertical for more than 3 levels, but scar more visible and
less flexible

11. SURGICAL APPROACH
Pre-vascular anterolateral
approach
«Smith-Robinson»
Atraumatic
Finger and "Peanut"
tampon dissection

12. SURGICAL APPROACH

13. SURGICAL APPROACH
Low incidence of complications but some
very serious
 Dysphagia
 Hematoma
 Paralysis n. Recurrent laryngeal
 Dural injury
 Esophageal perforation
 Aggravation myelopathy
 Syndrome of Claude Bernard Horner

14. CERVICAL FUSION
Neurological release
Stability and sagittal
balance
Loss of function and
adjacent overload

15. CERVICAL FUSION
F 38y
Cervical discopathies
C4C5 and C5C6
Sagittal Static Disorder

16. CERVICAL FUSION
F42y
Cervical spondylosis
(C5C6, C6C7)
Cervical disc
herniation canal &
narrowing C5C6
Anterolisthesis C4/C5

17. CERVICAL FUSION
H 59 y
Cervical spondylosis
(C5C6 + Spinal Stenosis)
(C6C7)
Hypersignal C5C6
(Myelopathy)

18. CERVICAL FUSION
Myeopathy
What is softened
is softened !
... a little bit too
late !

19. CERVICAL FUSION
DECOMPENSATION OF ADJACENT LEVELS
DECO

20. CERVICAL FUSION
DECOMPENSATION OF ADJACENT LEVELS

21. CERVICAL DISC PROSTHESIS
Preserve the function
to reduce constraints
on adjacent segments

22. CERVICAL DISC PROSTHESIS
Neurological release
Stability and sagittal
balance
Restore the Function

23. CERVICAL DISC PROSTHESIS WHICH ONE TO USE ?
 Design
Range of Motion
Materials
Heights (mm)
Footprints
Shape
Fixation
Regulatory

24. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC)
My revelation in 2002 for
dynamic surgery of the
cervical spine
Motion occurs within
polymer & provides
compression
Mimics properties of
natural disc

25. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC)
Control at 10
years

26. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC) 14Y

27. CERVICAL DISC PROSTHESIS BRYAN (MEDTRONIC) 15Y

28. CERVICAL DISC PROSTHESIS PCM (CERVITECH LINK)
No compression
Fail to closely
replicate physiologic
stability & motion

29. CERVICAL DISC PROSTHESIS PCM (CERVITECH LINK)
M-47y
multistage lesions with more
osteophytosis at levels C3C4 and C5C6
Hybrid stabilization to reduce the rigidity
of the treated segment, with excellent
restitution of cervical lordosis

30. CERVICAL DISC PROSTHESIS PCM (CERVITECH LINK)

31. CERVICAL DISC PROSTHESIS PCM (CERVITECH LINK)

32. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
Motion occurs within
polymer & provides
compression
Mimics properties of
natural disc

33. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)

34. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 1Y

35. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 5Y

36. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 1Y

37. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS) 4Y

38. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
PROBLEM OF WEAR DEBRIS-5Y

39. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
PROBLEM OF WEAR DEBRIS-6Y

40. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
PROBLEM OF WEAR DEBRIS-6Y
Journal of Neurosurgery : Spine 2019

41. CERVICAL DISC PROSTHESIS M6C (SPINALKINETICS)
PROBLEM OF WEAR DEBRIS-7Y

42. CERVICAL DISC PROSTHESIS RHINE (K2M)
Metal plates manufactured with holes
Over molding process through metal endplates
Manufacture & plasma spray endplates
Manufacture & plasma spray endplates

43. CERVICAL DISC PROSTHESIS RHINE (K2M)

44. CERVICAL DISC PROSTHESIS RHINE (K2M)

45. CERVICAL DISC PROSTHESIS RHINE (K2M)

46. CERVICAL DISC PROSTHESIS RHINE (K2M)

47. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)

48. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
CORE WITH CONTROLLED MOBILITY

49. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
CORE WITH CONTROLLED MOBILITY

50. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
CORE WITH CONTROLLED MOBILITY
Classical «Ball & Socket» Controlled mobility of the core : Mobi-C

51. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)

52. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
M 48y
Control
3y

53. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)

54. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)

55. CERVICAL DISC PROSTHESIS MOBI-C (LDR ZIMVIE)
M 48y
Corporectomy
Fusion C4-C7
Mobi-C C3C4
Controle
4y

56. CERVICAL DISC PROSTHESIS SYNERGY (SPINE SOLUTIONS)

57. CERVICAL DISC PROSTHESIS SYNERGY (SPINE SOLUTIONS)

58. CONCLUSIONS
Mobi-C Study for FDA accreditation
- Return to work faster
- Results at 7 years as good and even
better
- Less surgical revision at adjacent
levels
- Problem of wear debris ?
Cross-linked polyethylene core with
minimization of mechanical stresses