--- title: 'Future of Cervical TDR' type: 'lesson' url: 'https://doc.social/courses/spine-surgery-think-tank-2022/future-of-cervical-tdr' course: 'Spine Surgery Think Tank 2022' course_url: 'https://doc.social/courses/spine-surgery-think-tank-2022' position: '1 of 4' author: 'FRANK PHILLIPS' transcript: 'yes' --- # Future of Cervical TDR ## Summary Dr. Hyun Bae discusses the future of Cervical Arthroplasty ## Transcript 1,190 words · 7 min · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source. [0:08] This, um, this is the talk of the future, all right? CDR, what we're gonna do in the future. And I think it's all about expanding indications like, um, Jack, I've been doing total disc replacement the cervical Spine for now 19 years. [0:21] And so when you start doing that, you, you know, you start expanding your indications, right? Cause you can't do the same thing over and over, and you kind of see your results and over time, you start expanding your indications. And I think this is what we're going to see in the future, right? And I think this is where it's the most impactful, you know, one, two-level cervical arthroplasty versus fusion. Yes, it's impactful, but I don't think this is the most impactful. I think it's impactful. [0:44] In expanded indications when you're doing multi-level Surgery and you can save a multi-level fusion. So this is a hybrid. This is just a paper saying that if you have a fusion before you come back, if you do a total arthroplasty at the adjacent level, the patients are doing better. This is a paper in Korea that shows that patients actually do better, which is what you would expect. [1:04] Now, [1:05] But this is what I'm saying about saving a multi-level fusion. So this is a patient, 48-year-old, 2004, comes, you know, you do an ACDF great procedure, but comes back later with adjacent levelvel disease at both levels at C4-5 and C5-6. And so this patient gets, you know, what you would do, right? But fusions are hard, Multi-level fusions are hard. And so she has a pseudoarthrosis. Now we're doing a posterior fusion. [1:33] And I think at the end result, yes, it's good. We would all say, hey, I, I, I, I healed her. But did we do the best for her? And so, you know, this is where you're going to see the impact in the future. And I think insurance companies and payers are now allowing this. So it's an ACDF done in 2012. Same thing, C6, C7 gets fused. [1:53] But now, it's a two-level arthroplasty instead, right? And functionally, completely different picture. So when you look at the impact between this patient and the patient I just showed you before, tremendous difference in impact. And I think this is the future of arthroplasty where we're truly going to see tremendous difference in impact. OK, cervical myelopathy, very controversial, right? But I do think if the Primary object is a decompression, and you can adequately decompress. [2:21] The cord, then I do think that we will see, and I do do this, artificial disc for cervical myelopathy. OK. [2:31] Now, there're definitely different cases that, you know, that you see. And so this case, yeah, I probably treated this case 10 years ago. But this is a case that, you know, obviously has a skip level, has cervical myelopathy, older patients, 63, right? So I'm thinking that the older patients are going to benefit, even though a lot of us would say, oh, they don't move, they're stiff. Those patients will benefit the most. It's almost like you have a stiff Hip, and you have Hip Arthritis, and you get a total arthroplasty in your Hip. [2:57] That is a benefit. OK. So this patient, I think easily, easily we could do this for, right? 4 level fusion, say, hey, this is a success. This doesn't heal well, easily we could do this as well, do a front back Surgery at 4 levels. Great operation. Many of us who have done this and many of us have done this. [3:16] But also this patient can be treated this way, right? Just a different outcome, right, from one versus the Other. So I think we'll see this. Now we're treating level by level. We're not, you know, doing something to the unaffective level at C4-5. It's just a better procedure. We'll see this. And then, you know, cases like this that come about, you know, previous fusion at C71 has two non-adjacent stenosis, myelopathy returning at 65. OK. What are you going to do here? Are you're going to do a four-level fusion? [3:46] No. [3:48] Why just treat it level by level, right? So I think these cases are things that we're going to see. [3:53] Now, what would you do here? [3:57] Right, well, [4:00] Laminoplasty, cause the decompression is the Primary mode of what makes the patient better, right? We're just trying to decrease our impact after with Surgery. So laminoplasty, a great procedure. This is where I, I don't see an indication for cervical arthroplasty yet, maybe. [4:15] So another case, multi-level older patient, right? Avoid the four-level fusion. I haven't done a 4-level fusion anteriorly in the last probably 10 years. OK. Very simple, right? Now you decrease this to a 2-level fusion. It's multi-level, much better outcome for this patient, I think. OK. [4:33] So, as we start doing this, no question, imaging is going to be critical because we're starting to treat patients with spondylotic myelopathy, spondylotic myeloradiculopathy. And those patients will require new MRIs. And so if the patient comes back with symptoms and you placed an artificial disc, you don't know if it's the next level. [4:52] At the level that you treat it. So I think it's crucial as we get into the future of having better MR compatible discs. OK. So, you know, lower, just to know that, you know, the lower the Tesla, the better for artifacts. So you want to go one Tesla if you're trying to eliminate Marsh protocol, if they have a chrome cobalt disc or a titanium disc. [5:13] New materials. This is obviously the simplify that was just released uh last year. So it's a ceramic with peak spacers, amazing MR compatibility, right? And I think all new discs are going to be like this because we're going to treat multi-level spondylosis, and we need to go back and see the level that we treated. [5:32] OK, so Clinical trials, this is just short. Obviously, we've seen this yesterday, but a diamond on diamond bearing, that will come into Clinical trials, nowhere is what is reported. [5:43] MR compatible as well. This is in Clinical trials right now. This is the Bagura disc. It's actually a beautiful disc. It's titanium. I love the Swiss because they're black. They tried to design it really, really nicely and it's sexy, but also very, very good disc, very easy to insert, titanium, and more compatible. And they're about halfway through their Clinical Trial 1 and 2 level. So we may see that relatively soon. [6:06] Another disc, synergy disc in Clinical trials as well. Now, they're, what they've told me is they've gotten this down to about a 4.5 millimeter. So a really, really narrow disc, which I think is an advantage, OK, because that's always a challenge. [6:21] And then this is the two-level Prodisc, the extension of basically the Prodisc, see what's available in Europe, smaller keel on one, and then this kind of domed implant that I think is a little bit easier to insert. And those two are in Clinical trials and we'll probably see them very soon. [6:37] Thank you. ## In this course - [Next: Predictive Analytics: A Way to Determine Who Should or Shouldn't Have Spinal Deformity Surgery](https://doc.social/llms/courses/spine-surgery-think-tank-2022/predictive-analytics-a-way-to-determine-who-should-or-shouldnt-have-spinal-deformity-surge.md) - [All lessons: Spine Surgery Think Tank 2022](https://doc.social/llms/courses/spine-surgery-think-tank-2022.md)