ARTIFICIAL DISC & COMPLICATION · 1970’s to 80’s –Urbaniak –Lee –Kotsuik –Steffee. ......
Transcript of ARTIFICIAL DISC & COMPLICATION · 1970’s to 80’s –Urbaniak –Lee –Kotsuik –Steffee. ......
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ARTIFICIAL DISC & COMPLICATION
Wayne Cheng, MD
Bones and Spine
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HISTORY
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HISTORY
1955 Hamby/Cleveland– Cement injection
1962 Nachemson– Silicone injection
1964 Fernstrom– Ball bearing
1970’s to 80’s– Urbaniak
– Lee
– Kotsuik
– Steffee
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History-Present
Charite’ (depuy) Prodisc (synthes)
Maverick (Medtronic) Flexicore (stryker)
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Current Indication
Chronic lower back pain due to degenerative disc disease.
One level (L4 – S1)
Failed 6 months of conservative tx.
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Discogenic pain
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Discogenic Pain
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Radiograph
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Discography
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Approach
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Step 1 - Sizing
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Step 2 - Trialing
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Step 3 –Midline Identification
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Step 4 – Pilot driver
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Step 5- Insert Endplates
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Step 6 –Core Trial & Insertion
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Results – IDE (Randomized/Prospective)
Characteristics Artificial disc Fusion
# of subjects 205 99
Age -years old 39.6 39.6
L5/S1 70% 67%
Surg. Time (min)
205 min 209 min
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Results – IDE (Randomized/Prospective)
Characteristics Artificial disc Fusion
Complication (device-related)
7.8% 4%
Complication(neurological)
12.1% 17.2%
15% improv.(Oswestry score)
64% 58%
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Pain Relief (VAS)
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Pain & Function (ODI)
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Range of Motion
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Patient Satisfaction(2 years)
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Wear-10 million cycles
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Case 1
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Intra-op xray
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Flexion – Extension xray
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Case 2 – multi-level
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Case 2– multi-level
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Case 2 hybrid (post op)
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Case 3 hybrid
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Complication-Case 1
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Case 1-post op xray
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Case 1 (6 wks post op)
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Case 1 (post op xray)
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Case 2 (Post disco CT)
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Case 2 (intra-op)
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Case 2 (post op standing)
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Case 2 (anterior fusion)
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Case 2 (final)
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Case 3 (post op myelogram)
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Case 3 (post op CT)
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Case 4 complication
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Case 4 - complication
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Case 4 – complication
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Complication
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Conclusion
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