02/12/2010
AO Technical Commission Approved

Prodisc-C Vivo

Those that continue to have significant pain may have symptomatic cervical disc disease, which is defined as neck or arm (radicular) pain and/or a functional/neurological deficit with at least one of the following conditions confirmed by imaging (CT, MRI, or x-rays):

  • Herniated nucleus pulposus
  • Spondylosis (defined by the presence of osteophytes)
  • Loss of disc height.

The traditional approach to relieving such pain is a standard decompression and fusion at the symptomatic levels. While this technique has demonstrated good patient outcomes in terms of pain reduction, there may be other unintended consequences that result from altering the natural biomechanics of the cervical spine [1].

Cervical Total Disc Replacement (TDR) may provide the solution. Decompression and restoration of disc height can be achieved as normal to alleviate pain. In addition, the preservation of the preoperative range of motion and restoration of biomechanical stability may reduce the incidence of adjacent-segment degeneration [2].

The Prodisc-C Vivo is the next evolution of the cervical TDR. Building on the success of the pre-existing Prodisc-C family, the new design keeps the features that have proved so clinically advantageous, while incorporating new features that reduce the required remodelling and simplify the overall technique.

Prodisc-C Vivo maintains the following features at the core of the already successful Prodisc-C family of implants:

  • Fixed center of rotation that resists shear forces and enables controlled motion
  • Ball-and-socket articulation using the proven combination of CoCrMo/UHMWPE
  • Titanium alloy endplates that reduce the MRI artefacts.

Additionally, Prodisc-C Vivo offers the following new benefits:

  • Primary fixation with spikes
  • Anatomical implant design with convex cranial endplate
  • Simple surgical technique with two main steps, trialing and implant insertion.

Because of the anatomical, keel-less design of the Prodisc-C Vivo, vertebral body preparation is not required, which simplifies the surgery and enables a less traumatic implantation. Furthermore, the endplates of the vertebral bodies generally do not require remodelling to accommodate the implant. This reduces OR time and leaves the bone intact, minimizing the potential risk of postoperative implant subsidence.

Again, because the endplates do not require remodelling the instrumentation of the Prodisc-C Vivo is done in two simple steps: trialing and implant insertion.

References

  • Gore DR, Sepic SB, Gardner GM (1987) Neck pain: a long-term follow-up of 205 patients. Spine 12(1):15.
  • Murrey D, Janssen M, et al (2009) Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine 9(4):275286.

a-b) Trial to determine implant size. b-c) Implant insertion.

Case: Man with neck and arm pain

A 50-yr-old man presented with a 4 month history of neck and arm pain on the right side. Repeated trials of conservative treatment, including imageguided injections, had not led to a significant relief of symptoms. Clinical examination showed a C6 radiculopathy on the right side with pain, hypoaesthesia, and a slight biceps weakness.

The MRI (Fig 1a) showed a disk herniation C5/6 medial and paramedian right-sided. The preop xrays (Fig.1b-c) showed a slight narrowing of the disc space at C5/6. The segment was still mobile.

A microsurgical discectomy, decompression and implantation of a Prodisc-C Vivo implant was performed (Fig. 2a-b).

The early and 6 month outcome was excellent. The segment showed preserved mobility (Fig. 2c extension and Fig. 2d flexion). The patient returned to work after two weeks and returned to normal activities.

Cervical total disc replacement - Prodisc-C Vivo

Prodisc-C Vivo technique with technical tips to assist in implantation as well as case presentations of clinical application

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