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Siviero Agazzi, Alain Reverdin and Daniel May

lumbar interbody fusion updated. Clin Orthop 193: 16–19, 1985 9. Cloward RB : The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10 : 154 – 166 , 1953 Cloward RB: The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10: 154–166, 1953 10. Collis JS : Total disc replacement: a modified posterior lumbar interbody fusion. Report of 750

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W. Jeffrey Elias, Nathan E. Simmons, George J. Kaptain, James B. Chadduck and Richard Whitehill

. Cloward RB : The treatment of ruptured intervertebral discs by vertebral body fusion. J Neurosurg 10 : 154 – 167 , 1953 Cloward RB: The treatment of ruptured intervertebral discs by vertebral body fusion. J Neurosurg 10: 154–167, 1953 7. Collis JS : Total disc replacement: a modified posterior lumbar interbody fusion. Report of 750 cases. Clin Orthop 193 : 64 – 67 , 1985 Collis JS: Total disc replacement: a modified posterior lumbar interbody fusion. Report of 750 cases. Clin Orthop 193: 64–67, 1985

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Hans-Joachim Wilke, Sinead Kavanagh, Sylvia Neller, Christian Haid and Lutz Eberhart Claes

studies the authors have shown that the adverse effects of spinal fusion might include accelerated degenerative changes at the levels adjacent to the surgically treated vertebral level. 10, 11, 16 To maintain the mobility of the spinal motion segment a number of prosthetic devices have been developed. Currently there are two strategies: a total disc replacement such as the Charité 3 or replacement of the nucleus pulposus. 15 One advantage of the latter procedure is that it preserves the existing anatomical structures, which include the annulus, the endplates of the

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Christopher E. Wolfla, Dennis J. Maiman, Frank J. Coufal and James R. Wallace

. 3. Cloward RB : Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin Orthop 154 : 74 – 82 , 1981 Cloward RB: Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin Orthop 154: 74–82, 1981 4. Collis JS : Total disc replacement: a modified posterior lumbar interbody fusion. Report of 750 cases. Clin Orthop 193 : 64 – 67 , 1985 Collis JS: Total disc replacement: a modified posterior lumbar interbody fusion. Report of 750 cases. Clin Orthop 193

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Yoshihisa Kotani, Kuniyoshi Abumi, Yasuo Shikinami, Masahiko Takahata, Ken Kadoya, Tsuyoshi Kadosawa, Akio Minami and Kiyoshi Kaneda

implanted artificial disc is underway in the US, it remains uncertain whether artificial disc replacement effectively reduces low-back pain in the long term. The artificial disc for total disc replacement anteriorly has several benefits: wide surface area occupation, excellent mechanical endurance, and wide ROM. Surgical indications, however, are extremely limited—that is, to application in cases of degenerative disc disease and postdiscectomy disorders without neurological deficits. 7, 10, 14, 24, 41 The ideal indications for future artificial disc replacement include

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Fred H. Geisler, Scott L. Blumenthal, Richard D. Guyer, Paul C. McAfee, John J. Regan, J. Patrick Johnson and Bradford Mullin

-column stiffness. 16, 43, 45 Third, total lumbar joint replacement replaces both anterior and posterior lumbar segment components. Currently, no such devices are available in any US FDA trial, nor are any being used elsewhere in the world. Finally, total disc replacement is used to replace the entire lumbar disc. These devices require healthy facet joints as well as intact posterior ligaments and muscular structures. In addition to hard implants having metal ends that attach to the osseous endplates, there are also some soft implants composed entirely of elastic with potential

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Yoshihisa Kotani, Bryan W. Cunningham, Kuniyoshi Abumi, Anton E. Dmitriev, Manabu Ito, Niabin Hu, Yasuo Shikinami, Paul C. McAfee and Akio Minami

follow-up period of 2 years. Spine 21: 995–1000, 1996 7. Cummins BH , Robertson JT , Gill SS : Surgical experience with an implanted artificial cervical joint. J Neurosurg 88 : 943 – 948 , 1998 Cummins BH, Robertson JT, Gill SS: Surgical experience with an implanted artificial cervical joint. J Neurosurg 88: 943–948, 1998 8. Cunningham BW , Lowery GL , Serhan HA , Dmitriev AE , Orbegoso CM , McAfee PC , et al : Total disc replacement arthoroplasty using the AcroFlex

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Patrick W. Hitchon, Kurt Eichholz, Christopher Barry, Paige Rubenbauer, Aditya Ingalhalikar, Satoshi Nakamura, Kenneth Follett, Tae Hong Lim and James Torner

–76, 1997 23. Mayer HM , Wiechert K , Korge A , Qose I : Minimally invasive total disc replacement: surgical technique and preliminary clinical results. Eur Spine J 11 (Suppl 2) : S124 – S130 , 2002 Mayer HM, Wiechert K, Korge A, Qose I: Minimally invasive total disc replacement: surgical technique and preliminary clinical results. Eur Spine J 11 (Suppl 2): S124–S130, 2002 24. Ray CD : The artificial disc , in Weinstein JN (ed): Clinical Efficacy and Outcome in the Diagnosis and

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Rudolf Bertagnoli, James J. Yue, Frank Pfeiffer, Andrea Fenk-Mayer, James P. Lawrence, Trace Kershaw and Regina Nanieva

Object. Cervical anterior decompression and total-disc replacement is currently being investigated as an alternative treatment in patients with symptomatic intervertebral cervical spondylosis with and without radiculopathy. The authors prospectively investigated the safety and efficacy of using the ProDisc-C disc for cervical arthroplasty in the treatment of symptomatic cervical spondylosis.

Methods. Sixteen patients in whom a diagnosis of symptomatic cervical spondylosis had been established were prospectively treated with complete anterior cervical discectomy and ProDisc-C cervical disc arthroplasty. Overall 12 single- and four two-level procedures were performed (20 prostheses). Patients underwent pre- and multiple postoperative assessments (3 and 6 weeks and 3, 6, and 12 months).

The median age of all patients was 50 years (range 32–60 years). Levels of surgery included seven C5–6, six C6–7, and three C4–5. Neck and arm pain as well as disability scores were significantly improved by 3 months and remained significantly improved at 1 year. No additional fusion surgeries were necessary at the affected or unaffected levels. Radiography revealed an affected disc motion from 4 to 12°. No surgery- or device-related complications were documented.

Conclusions. Analysis of preliminary results involving ProDisc-C arthroplasty indicates significant improvement in pain and functional outcome scores. No spontaneous fusions at the level of surgery or at adjacent levels were noted. Long-term follow-up studies will be necessary before more definitive treatment recommendations can be formulated.

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Chris J. Neal, Michael K. Rosner and Timothy R. Kuklo

, MR imaging is frequently conducted. Degenerative changes are represented by the loss of disc space height, decreased disc hydration, and the presence of Modic endplate changes. 21 If surgery is performed, current postoperative protocols also require evaluation of the involved and adjacent segments with flexion-extension radiography and computerized tomography scanning. In no study, however, have investigators assessed the ability of MR imaging to evaluate the adjacent segments after total disc replacement. The ability of neuroimaging to document the adjacent