Intervertebral disc replacement

Hugo Nascimento Biomaterials: Materials in Medicine

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Have you ever heard of somebody that has a chronic back pain? Maybe your parents? Grandparents? Uncles?

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Vertebral column

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Intervertebral disc
Jelly-like nucleus made by water and proteoglycans

Collagen fibres Allows motion and act as a shock absorber

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Natural ageing and degeneration

Ruptures

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Main causes of back pain related with the column

Inflammations due to disc degeneration (natural ageing Low/moderate back pain[2].

injuries or process)

Disc herniation: disc, usually the nucleus is pressing the nerve endings or the spinal cord[2].

Disc Herniation

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How to treat it?

ACDF

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As an Alternative to ACDF: Intervertebral disc replacement

Motion preservation[3]; Not overloading of adjacent or nonadjacent segments[3].

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BRYAN Cervical Disc System, 2009.

How does the prosthesis look like?

The prosthesis itself

Composed by two metal shells articulated with a polyurethane core[1].

Metal shells

Polyurethane core
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Most recent device approved by FDA (US), PCM Cervical Disc, 2013

Manufacturers

The most extensively clinically utilised, studied and tested metal-on-polyethylene artificial discs are the PRODISC and the SB CHARITE total discs[4].

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Prodisc, approved in 2006 by FDA [5]. SB Charit, approved in 2004 by FDA [5].

X-RAY
Bi-level disc replacement

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Materials used

Usually the metal part is made by titanium alloys or a cobalt-chromium-molybdenum alloys[6]. The core is made by an ultra-high molecular weight polyurethane[6].

Immune system response

All the biomaterials used in this kind of prosthesis have already been extensively tested using biocompatibility tests. Main cause for long-term failure:

Mechanical stress generating wear debris, causing inflammations attracting macrophages[7]. Leading to a chronic inflammation. (they try to eat the foreign bodies).

Concluding
Great

advance relieving pain and preserving motion; Low rate of rejection biomaterials technology;

References
1.

Garrido, B.J., T.A. Taha, and R.C. Sasso, Clinical Outcomes of Bryan Cervical Disc Arthroplasty A Prospective, Randomized, Controlled, Single Site Trial With 48-Month Follow-up. Journal of Spinal Disorders & Techniques, 2010. 23(6): p. 367-371. Peter F. U, Jr., M.D., What is Degenerative Disc Disease? Available: http://www.spinehealth.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease. Accessed: 08 August 2013. Heidecke, V., et al., Intervertebral disc replacement for cervical degenerative disease - clinical results and functional outcome at two years in patients implanted with the Bryan (R) cervical disc prosthesis. Acta Neurochirurgica, 2008. 150(5): p. 453-459. Behl, B., et al., Biological effects of cobalt-chromium nanoparticles and ions on dural fibroblasts and dural epithelial cells. Biomaterials, 2013. 34(14): p. 3547-3558. FDA. Food and Drug Administration (US). Available: http://www.fda.gov/MedicalDevices/default.htm. Accessed: 08 August 2013. Goffin, J., et al., Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: Single-level and bi-level. Spine, 2003. 28(24): p. 2673-2678. Frick, C., et al. (2006). Effects of prosthetic materials on the host immune response: evaluation of polymethyl-methacrylate (PMMA), polyethylene (PE), and polystyrene (PS) particles. J Long Term Eff Med Implants 16(6): 423-433.

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Image References

Image 1. Available: http://www.spinalkinetics.com/wp-content/uploads/2010/09/replacement.jpg Image 2. Available: http://www.backpainpro.info/images/back_pain2.jpg Image 3. Available: http://upload.wikimedia.org/wikipedia/commons/f/f8/Illu_vertebral_column.jpg Image 4. Available: http://www.spine-health.com/video/degenerative-disc-disease-interactive-video

Image 5. Available: http://www.spine-health.com/video/degenerative-disc-disease-interactive-video

Image 6. Available: http://www.spine-health.com/video/degenerative-disc-disease-interactive-video Image 7. Avaliable http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm327490.jpg Image 8. Avaliable: http://jrphysio.co.uk/resources/disc.jpg Image 9. Avaliable: http://www.eorthopod.com/images/ContentImages/spine/spine_cervical/cervical_discectomy_fusion/cervical_antdisc_intro01.jpg Image 10. Avaliable: http://media.corporate-ir.net/media_files/IROL/25/251324/Images/1244729914384_high_resolution.jpg Image 11. Avaliable: http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm077628.gif Image 12. Avaliable: http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm080697.gif Image 13. Avaliable: Goffin, J., et al., Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: Single-level and bi-level. Spine, 2003. 28(24): p. 2673-2678.