Korge Andreas, Siepe Christoph J, Heider Franziska, Mayer H Michael
Wirbelsäulenzentrum, Schön Klinik München Harlaching, München, Germany.
Oper Orthop Traumatol. 2010 Nov;22(5-6):480-94. doi: 10.1007/s00064-010-9024-7.
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.
Cervical median or mediolateral disk herniations, symptomatic cervical disk disease (SCDD) with anterior osseous, ligamentous and/or discogenic narrowing of the spinal canal.
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.
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.
Functional postoperative care and mobilization without external support, brace not used routinely, soft brace possible for 14 days due to postoperative pain syndromes.
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.
通过前外侧入路，使用带有中央龙骨固定终板的模块化人工椎间盘假体对颈椎进行动态椎间支撑。
颈椎中央或中外侧椎间盘突出症、伴有椎管前方骨质、韧带和/或椎间盘源性狭窄的症状性颈椎间盘疾病（SCDD）。
颈椎骨折、肿瘤、骨质疏松症、关节源性颈部疼痛、严重小关节退变、节段性不稳定增加、后纵韧带骨化（OPLL）、严重骨质减少、急慢性全身性、脊柱或局部感染、全身性和代谢性疾病、已知的植入物过敏、妊娠、严重肥胖（体重指数>36kg/m²）、患者依从性降低、酗酒、药物滥用和成瘾。
采用微创前外侧入路暴露颈椎前路。固定椎间保留螺钉。进行椎间盘切除术。使用椎体保留器和椎体撑开器进行节段性撑开。去除终板软骨。显微镜辅助下进行椎管减压。插入试验性植入物以确定合适的植入物尺寸、高度和位置。在双平面影像增强器控制下，使用钻导向器和钻头进行龙骨制备钻孔，使用龙骨切割清洁器清除龙骨切割处的骨材料，使用相应的位置测量仪对龙骨切割深度进行放射学控制。在侧位影像增强器控制下植入原始植入物。取出植入物插入器。
术后进行功能护理和无需外部支撑的活动，通常不使用支具，因术后疼痛综合征可能使用软支具14天。
在一个中心对78例患者（平均年龄48岁）植入100个颈椎Prodisc-C椎间盘假体。术后24个月进行临床和放射学随访。基于视觉模拟量表和颈部残疾指数有显著改善。指数节段的节段性前凸和活动度有放射学改善。指数节段的自发融合发生率为8.75%，与临床结果无显著相关性。
