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Cervical Total Disk Replacement: Available Implant Size Matters.

Richard D Guyer1, Domagoj Coric2, Pierce D Nunley3

  • 1Center for Disk Replacement at Texas Back Institute, Plano, TX.

Clinical Spine Surgery
|March 28, 2022
PubMed
Summary
This summary is machine-generated.

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Many cervical spine disks are smaller than 4mm, indicating a risk of overdistraction with total disk replacement (TDR) implants. Surgeons often preferred smaller TDR heights, suggesting a need for further study on clinical outcomes.

Area of Science:

  • Spine surgery
  • Orthopedic devices
  • Biomechanical engineering

Background:

  • Cervical total disk replacement (TDR) offers outcomes comparable or superior to anterior cervical discectomy and fusion.
  • Restoring disk height is a key surgical goal, but overdistraction with implants poses risks.
  • Understanding native disk heights is crucial for selecting appropriate TDR sizes.

Purpose of the Study:

  • To measure disk space heights adjacent to and at the level of cervical total disk replacement (TDR).
  • To analyze the distribution of cervical disk space heights requiring TDR.
  • To investigate the utilization of smaller-sized TDR devices when available.

Main Methods:

  • Post hoc analysis of data from two FDA Investigational Device Exemption (IDE) trials.

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  • Radiographic measurement of disk heights in 259 adjacent levels and 162 treated levels.
  • Evaluation of the usage frequency of 4mm, 5mm, and 6mm TDR devices.

    • Main Results:

    • 55.2% of adjacent disk spaces and 82.7% of treated disk spaces measured less than 4mm in height.
    • When the 4mm TDR was available, it was used in 38.4% (1-level trial) and 54.3% (2-level trial) of treated levels.
    • Surgeons selected the 4mm TDR in 49.4% of all implanted levels, indicating a preference for smaller sizes.

    Conclusions:

    • A significant proportion of cervical disk spaces are narrower than 4mm, highlighting the potential for overdistraction with larger TDRs.
    • The frequent selection of smaller TDR heights suggests a surgeon preference that warrants further investigation.
    • Additional research is needed to correlate the use of lower-profile TDRs with clinical and radiographic outcomes.