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: [Link] 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: [Link] 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: [Link] Image 2. Available: [Link] Image 3. Available: [Link] Image 4. Available: [Link]
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Image 6. Available: [Link] Image 7. Avaliable [Link] Image 8. Avaliable: [Link] Image 9. Avaliable: [Link] Image 10. Avaliable: [Link] Image 11. Avaliable: [Link] Image 12. Avaliable: [Link] 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.