P21。无融合翻修颈椎间盘置换术：一种新的人工椎间盘去除“杠杆”技术

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100645

Sheng Jia Huang MD

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引用次数: 0

摘要

背景背景颈椎椎间盘置换术（CDA）是治疗颈椎退变性椎间盘疾病的一种成熟的运动保持手术。然而，改良CDA具有挑战性，通常需要融合或后路减压技术。目的：我们报告一例由于先前未完成椎体关节减压而未进行融合的CDA翻修手术。本报告详细介绍了在修订CDA期间使用的一种新颖的“杠杆”技术，提供了对该过程的全面逐步描述。据我们所知，这是第一份记录没有融合的修订CDA整个过程的报告。研究设计/背景/患者样本：54岁女性，无明显病史，在C5/6和C6/7部位因椎间盘突出（HIVD）导致的放射至右侧上肢的颈部疼痛接受了原发性CDA。尽管做了手术，她的症状仍持续了一年。随访颈椎计算机断层扫描（CT）显示双侧椎间孔狭窄，原因是C5/6和C6/7的无椎关节减压不完全，这是CDA翻修的指征。结果测量/方法患者使用Synthes Prodisc-C Vivo假体对CDA进行了改良，CDA超过C5/6和C6/7。充分暴露后，使用高速金刚石毛刺（Medtronic Legend®Metal Cutter mc30,3 mm）切除先前植入的人工椎间盘的前部。前间隙足够宽，以方便将核心从其窝中取出。取出核心后，使用Freer升降机使用“杠杆”技术分离剩余的金属部件，保留终板，以便在对裸露关节进行彻底减压后放置新的人工椎间盘。术后，患者在保持颈椎活动的同时症状明显缓解。在两年的随访中，颈椎x线片证实假体定位稳定，无神经功能恶化、下沉或对齐不良的迹象。结果CDA失败的标准翻修策略通常包括假体移除后融合，后路椎间孔切开术或椎板切除术并固定。在这种情况下，我们通过“破坏”先前的人工椎间盘而不是牺牲终板来进行改良CDA，以最佳地保留骨结构。这项技术可以最大限度地减少骨质流失，降低术后下沉的风险。然而，“杠杆”技术的适用性取决于具体因素，包括翻修的原因和先前植入椎间盘的类型。这种方法特别适用于异位骨化或初始减压不完全的病例。此外，具有最小龙骨设计和有限终板准备的人工椎间盘似乎是这种翻修技术最合适的候选者。结论：我们采用新颖的“杠杆”技术成功地进行了不融合的CDA翻修，最大限度地保留了终板并保持了颈椎的活动能力。该方法在两年的随访期间显示出持续的临床疗效和影像学稳定性，为基于融合的翻修策略提供了可行的替代方案。FDA器械/药物状态C体内产品（批准用于该适应症）。

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P21. Revision cervical disc arthroplasty without fusion: a novel “leverage” technique for artificial disc removal

BACKGROUND CONTEXT

Cervical disc arthroplasty (CDA) is an established motion-preserving procedure for cervical degenerative disc disease. However, revision CDA is challenging and often requires fusion or posterior decompression techniques.

PURPOSE

We present a case of revision CDA performed without fusion due to previous incomplete decompression of the uncovertebral joints. This report details a novel “leverage” technique used during revision CDA, providing a comprehensive step-by-step description of the procedure. To our knowledge, this is the first report documenting the entire process of revision CDA without fusion.

STUDY DESIGN/SETTING

N/A

PATIENT SAMPLE

A 54-year-old female, with no significant medical history, underwent primary CDA at C5/6 and C6/7 for neck pain radiating to the right upper limb, attributed to herniated intervertebral discs (HIVD) at these levels. Despite the procedure, her symptoms persisted for one year. Follow-up cervical spine computed tomography (CT) revealed bilateral foraminal stenosis due to incomplete decompression of the uncovertebral joints at C5/6 and C6/7, which was the indication of revision CDA.

OUTCOME MEASURES

N/A

METHODS

The patient underwent revision CDA over C5/6 and C6/7 using the Synthes Prodisc-C Vivo prosthesis. After adequate exposure, the anterior aspect of the previously implanted artificial disc was excised using a high-speed diamond burr (Medtronic Legend® Metal Cutter MC30, 3 mm). The anterior gap was sufficiently widened to facilitate the removal of the core from its socket. Following core extraction, a Freer elevator was employed to disengage the remaining metal components using “leverage” technique, preserving the endplates for the placement of a new artificial disc after thorough decompression of the uncovertebral joints. Postoperatively, the patient experienced significant symptomatic relief while maintaining cervical motion. At the two-year follow-up, cervical spine radiographs confirmed stable prosthesis positioning without evidence of neurological deterioration, subsidence, or malalignment.

RESULTS

Standard revision strategies for failed CDA typically involve prosthesis removal followed by fusion, posterior foraminotomy, or laminectomy with fixation. In this case, we performed a revision CDA by “disrupting” the previous artificial disc rather than sacrificing the endplates, allowing for optimal preservation of bony structures. This technique minimizes bone loss and reduces the risk of postoperative subsidence. However, the applicability of the “leverage” technique depends on specific factors, including the reason for revision and the type of the previously implanted disc. This approach is particularly suited for cases involving heterotopic ossification or incomplete initial decompression. Additionally, artificial discs with minimal keel design and limited endplate preparation appear to be the most suitable candidates for this revisional technique.

CONCLUSIONS

We successfully performed a revision CDA without fusion using a novel “leverage” technique, which maximized endplate preservation and maintained cervical mobility. This approach demonstrated sustained clinical efficacy and radiographic stability over a two-year follow-up period, offering a viable alternative to fusion-based revision strategies.