[Total cervical disk replacement--implant-specific approaches: keel implant (Prodisc-C intervertebral disk prosthesis)].

OBJECTIVE

Dynamic intervertebral support of the cervical spine via an anterolateral approach using a modular artificial disk prosthesis with end-plate fixation by central keel fixation.

INDICATIONS

Cervical median or mediolateral disk herniations, symptomatic cervical disk disease (SCDD) with anterior osseous, ligamentous and/or discogenic narrowing of the spinal canal.

CONTRAINDICATIONS

Cervical fractures, tumors, osteoporosis, arthrogenic neck pain, severe facet degeneration, increased segmental instability, ossification of posterior longitudinal ligament (OPLL), severe osteopenia, acute and chronic systemic, spinal or local infections, systemic and metabolic diseases, known implant allergy, pregnancy, severe adiposity (body mass index > 36 kg/m2), reduced patient compliance, alcohol abuse, drug abuse and dependency.

SURGICAL TECHNIQUE

Exposure of the anterior cervical spine using the minimally invasive anterolateral approach. Intervertebral fixation of retainer screws. Intervertebral diskectomy. Segmental distraction with vertebral body retainer and vertebral distractor. Removal of end-plate cartilage. Microscopically assisted decompression of spinal canal. Insertion of trial implant to determine appropriate implant size, height and position. After biplanar image intensifier control, drilling for keel preparation using drill guide and drill bit, keel-cut cleaner to remove bone material from the keel cut, radiologic control of depth of the keel cut using the corresponding position gauge. Implantation of original implant under lateral image intensifier control. Removal of implant inserter.

POSTOPERATIVE MANAGEMENT

Functional postoperative care and mobilization without external support, brace not used routinely, soft brace possible for 14 days due to postoperative pain syndromes.

RESULTS

Implantation of 100 cervical Prodisc-C disk prostheses in 78 patients (average age 48 years) at a single center. Clinical and radiologic follow-up 24 months postoperatively. Significant improvement based on visual analog scale and Neck Disability Index. Radiologic improvement of segmental lordosis and mobility in the index segment. Incidence of spontaneous fusion in the index segments 8.75% without significant relation to the clinical outcome.