O P O L E Department of Neurosurgery – State Medical Center OPOLE - POLAND POLAND Early experiences and technical remarks on five different cervical arthroplasty systems. Dariusz Latka, MD PhD, Tomasz Krzeszowiec, MD, Boguslaw Maj, MD Mister chairman, ladies and gentelmen. I’ve got the great honour to present you the paper on cervical arthroplasty coming from the small 40-bed neurosurgical department in the district hospital in Opole……. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E OPOLE, POLAND POLAND Department of Neurosurgery State Medical Center ……….beautiful historic city, south of Poland. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Author Disclosure Information O P O L E POLAND D. Latka, MD PhD Medronic*; Synthes*; Johnson & Johnson*; T. Krzeszowiec, MD B.Maj, MD Disclousure information…. * Grants/Research Support/Other Financial or Material Support Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

CERVICAL ARTHROPLASTY = the most expensive way to fuse ????? O P O L E POLAND CERVICAL ARTHROPLASTY = the most expensive way to fuse ????? My neurosurgery teacher when he’s learned that I’ve started cervical arthroplasty program in my Department told me that arthroplasty is the most expensive way to fuse. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

What for? The begining of our arthroplasty experience – Dec 2003 O P O L E What for? SYDNEY 2001 POLAND In december twenty O three we also have been full of frightens. But our nowadays experience indicates that the aim of arthroplasty surely is not the effect shown on this movie, but my boss opinion is not longer true. The begining of our arthroplasty experience – Dec 2003 Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 What for? O P O L E POLAND The incidence of symptomatic adjacent segment degeneration requiring further surgery following cervical fusion is estimated as high as 3% per level/per year 1,5yr postop The incidence of symptomatic adjacent segment degeneration requiring surgery following cervical fusion is estimated as high as 3% per level/per year. That is the real reason for looking for the alternative to this procedure. Cervical arthroplasty should help to avoid overload of adjacent segments and its degeneration. Cervical arthroplasty should help to avoid overload of adjacent segments. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Barriers Cost of the implant Difficulty of implantation O P O L E POLAND Cost of the implant Difficulty of implantation The main barrier in wider use of arthroplasty is the price of an implant, especially in Polish, rather poor medical care system. The price of the prothesis in Poland can be 10 times bigger than the price of simple cage used for standard fusion. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E POLAND We’ve started our experince with arthroplasty with Bryan disc protheis. It wasn,t really the piece of cake procedure. The preparation of the prothesis nest was very complicated, unpleasant for the neurosurgeon forced to to something blindly, only under X- ray control. So it isn’t strange that the procedure required the intensive preoperation training. We weren’t enthusiastic and have limited our experience only to three cases. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Barriers Difficulty of implantation Price DISCOVER PRESTIGE PRODISC C O P O L E Barriers POLAND Price BRYAN ACCEL PRESTIGE PRODISC C DISCOVER Difficulty of implantation The recent years brought the more simple systems of arthroplasty, what allows us to cancel this second barrier. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Aim of the study POLAND Presentation of five different arthroplasty systems used in Opole Own rules of patients’ qualification to this procedure Early radiological and clinical outcomes Four different cervical disc replacement systems have been employed in Opole. In the present study we discuss the intraoperative technical problems, retrospectively review our own rules of patient qualification to this procedure, and perform the early radiological and clinical outcome evaluation. BRYAN ACCEL PRESTIGE PRODISC DISCOVER ACTIVE C Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Material 7 years DEC 2003 – NOV 2010 858 anterior cervical procedures O P O L E 119 patients underwent a total of 127 cervical disc replacements POLAND BRYAN ACCEL PRESTIGE PRODISC DISCOVER ACTIVE C 1 000 000 population 7 years DEC 2003 – NOV 2010 858 anterior cervical procedures During the past seven years the group of 119 patients underwent a total of 127 cervical disc replacements from among almost six hundred operated on due to cervical disc disease. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E BRYAN ACCEL POLAND The new modern Bryan implantation technique is more user friendly than the former one and it allows far more vision control. The necessity of angle measurements is still time consuming, but the main advantyge of this system is the lentiform shape of the prothesis remaining the most physiological situation after surgery. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E PRESTIGE POLAND The Prestige LP prothesis, the system we are most familiar with, is a complete two element metal construction allowing most physiological movement including not only AP and latral bendings but also the anterior translation. It is very easy to implant. The only disadvantage is the necessity of the railways’ preparation with so called railway cutter, which can sometimes convert the bloodless operative field into more bloody one. No one likes it. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E PRODISC POLAND The Prodisc C prothesis is being settled in almost the same manner. Although it is a three element construction it is applicated in one piece like the cage. The disadvantages are: deep railways for anchors wchich can weaken the structure of vertebral bodies, the lack of translation in movement and the plastic element of unknown mechanical durability. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Discover POLAND The Discover is a construction very similar to Prodisc, but with no neccesity to cut anything for anchors in the neighbouring bodies. The only disadvantage is the need of severe distraction while inserting it. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Active C POLAND The AciveC is a construction very similar to Prodisc, but with double and smaller anchors in one of the the neighbouring bodies, and pinssimillar to Discover in another. It gives easier possibilities to multilevel arthtoplasies. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Number of surgical steps 9 6 7 5 Mean sugery time 1h 50’ 1h 05’ 1h 15’ 1h 10’ 1h12’ Mean number of intraoperative X-ray expositons 8 3 4 POLAND BRYAN ACCEL PRESTIGE PRODISC DISCOVER ACTIVE C According to our experienece the arthroplasty in all systems are comparably easy to perform, maybe except Bryan Accel, easier than in previous version but still demanding. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 α O P O L E BRYAN ACCEL POLAND PRESTIGE α α The early radiological evaluation confirms the maintenance of motion in every employed system and in every case of our series. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E α PRODISC POLAND DISCOVER α Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Early clinical outcome (according to ODOMS criteria) (n=119): POLAND 44 60 15 Early clinical results were comparable to good outcomes attained by fusion procedures according to ODOMS criteria….. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

……… and in pre- and postoperative neck disability index evaluation. O P O L E POLAND Neck Disability Index (NDI) in arthroplasty group N=119 ……… and in pre- and postoperative neck disability index evaluation. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E Dynamic of cervical arthroplasties per year number (percentage of all anterior cervical discsectomies) POLAND We can notice the rapidly growing mumber of arthroplasty in compare to fusion in our department. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E POLAND Age structure The key to solve this mistery are of course the indications. Even the simple analysis of mean age of patients indicates the widening of indications. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 O P O L E IDEAL CERVICAL ARTHROPLASTY CANDIDATE young active no major changes on adjacent levels no instabillity persistent mobility of operated segments on X-rays POLAND On the beginning we supposed that the ideal candidate to arthroplasty should be like this lady: young active with no major changes on adjacent levels, no instability and with persistent mobility of operated segments on functional radiograms. The only doubt concerns this last parameter. The lack of mobility on preoperative radiograms can be the matter of muscle constriction in acute phase of cervical syndrome. ? Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Intraoperative evaluation of segments’ mobility persistance O P O L E Intraoperative evaluation of segments’ mobility persistance POLAND We decided to qualify patients to the arthroplasty basing on intraoperative mobility evaluation, like in this case. So our early experience indicates us the possibility of arthroplasty in patients with no mobility of the sick segment in preoperative radiograms. The more important for us is the intraoperative mobility. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 Conclusions O P O L E POLAND Cervical arthroplasty with Bryan, Prodisc C, Discover, ActiveC and Prestige LP is a safe and effective treatment option as demonstrated by clinical and radiological result. Our early results let us hope that combining of anterior cervical decompression with arthroplasty could advantage in quicker convalescence without the need for plating and fusion, bone grafting or cervical immobilization in a collar. The long term benefits of cervical arthroplasty remain to be seen. Arthroplasty with all introduced systems is a safe and effective treatment option as demonstrated by clinical and radiological results. Our early results let us hope that combining of anterior cervical decompression with arthroplasty could advantage in quicker convalescence without the need for plating and fusion, bone grafting or cervical immobilization in a collar. The long term benefits of cervical arthroplasty remain to be seen. Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.

İlginiz için teşekkür ederim O P O L E POLAND İlginiz için teşekkür ederim Fuse or not to fuse… Spine Experts Group Annual Meeting 2010, Istanbul Dec 2-3, 2010 XIV World Congress of Neurological Surgery. Boston, MA, USA. Aug 30-Sep 04 ,2009.