Revista de Medicina Desportiva (English) July 2018 - Page 17

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Rev . Medicina Desportiva informa , 2018 ; 9 ( 4 ): 15-18 .

Disc Arthroplasty and Sports practice

Dr . Diogo Moura 1 , Dr . Marcel Sincari 2 , Prof . Doutor Fernando Fonseca 3
1
Orthopedics and Traumatology Resident ; 2 Neurosurgery specialist ; 3 Director of the Orthopedics and Traumatology Department . Coimbra University Hospital Center . Portugal
ABSTRACT
Despite the increasing popularity of disc arthroplasty in predominantly young and active patients for treatment of symptomatic degenerative disc disease , currently there is still no strong scientific evidence about its benefits in comparison to classic treatment , the intersomatic fusion . Current studies , despite of some controversy , support disc arthroplasty have strict indications and is associated with a more functional and mobile spine , guaranteeing less adjacent segment disease and an earlier return to physical activities when compared to fusion . In theory , high impact , contact sports and intense activities can induce repetitive and intense axial and rotational loads to the spine and to the disc prosthesis , which can be associated with a higher risk of early arthroplasty failure . In this paper we present current scientific evidence about disc arthroplasties biomechanics rational and its clinical results and review the few studies about these implants application in athletic patients .
KEYWORDS
Disc arthroplasty , disc replacement , spine column , intervertebral disc , discopathy , sports
Disc arthroplasty – concept and biomechanics
The classical surgical treatment for advanced degenerative is the interbody arthrodesis , meagning the excision of the intervertebral disc and the fusion of the vertebral bodies with the application of cages and bone graft . Despite success on symptomatic relief , some patients develop adjacent disc disease , which consists of symptomatic degeneration of adjacent discs due to the biomechanical change of load distribution caused by the loss of mobility due to the arthrodesis of a segment , as well as the compensatory increase in the mobility of the non-arthrodesis levels . In addition , the most active patients will have lower cervical spine mobility , which can impair sports activity and quality of life . In order to by-pass this problem , the discs arthroplasties were developed , which in theory allow mobility and to recreate biomechanics , function and distribution of loads similar to normal in the affected segment and could be associated with lower disc degeneration rates of adjacent levels ( Figure 1 ). 1 However , currently the indications for disc arthroplasties are relatively restricted and a correct surgical indication is the key for success of a surgical intervention . 2
The discs arthroplasties should be applied on isolated symptomatic degenerative discopaties that do not respond to conservative treatment for six months and , generally , only in patients without structural deformities or spinal instability , in particular , without facets osteoarthrosis , and with acceptable bone quality . 2 As such , in view of the high prevalence of the counterindications referred to as the advancing age , most of the arthroplasties are performed in young patients , many of them with important activity level and expectations of a high functional level . 3 , 4 A prospective randomized multicentric compared study with 187 patients , with a two-year follow-up time , which underwent cervical disc arthroplasty , showed an increase on cervical spine mobility significantly superior than those subjected to arthrodesis (+ 5.9 ° VS-0.8 °, p = 0.001 ). Contributions to cervical spine mobility were equivalent in the various levels of patients submitted to arthroplasty , including that replaced by disc prosthesis , thus recreating a more physiological mobility , with uniform discs contributions to the total mobility arc . In turn , patients subjected to arthrodesis , contributions to total mobility were , as expected , significantly higher in the adjacent non-arthrodesis segments .
Several studies on cervical arthroplasties and lumbar discs demonstrated superior clinical-functional results and faster recovery time compared to arthrodesis . The solid fixation of the prosthesis dispiers in the vertebral bodies allows to initiate controlled mobilization in the first days of postoperative and thus start the rehabilitation early . 5-
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Despite this , due to the lack of consistent long-term results , some reviews suggest caution in the application of arthroplasties due to the risk of complications that may only arise in the long term . The prevention of the disease of the adjacent disc remains unsubstantiated and some studies have verified that a considerable portion of the disc arthroplasty develops heterotopic ossification and long-term mobility loss with no clear advantage compared to arthrodesis . 30-32
The last generation of disc prosthesis seek to recreate the anatomy of the intervertebral disc , consisting of a fibrous ring and artificial pulposus nucleus ( Figure 2 ). 33 This anatomical recreation aims to restore the biomechanics and physiological mobility of the native intervertebral disc , thus avoiding the degenerative changes occurring at adjacent levels after an interbody fusion . 33 Its application usually implies a previous approach , and can now be carried out in a minimally invasive way . After identification of the vertebral bodies , their distraction is performed and total discectomy is done . The following is vertebral endplates cruentation and , after adequate measurement of the implant dimensions , the notches corresponding to those at the prosthesis with the use of its own instrument are created in the vertebral endplates . The implant is applied in distraction and , after confirmation of its correct positioning with the use of the image intensifier , the distraction is removed in order to obtain compression . The notches and porous coating of the prosthesis seek to promote its stability and osteointegration ( Figure 2 ).
Disc arthroplasty in sportsmen
The physical exercise benefits for health are clearly demonstrated ,
Revista de Medicina Desportiva informa july 2018 · 15
Rev. Medicina Desportiva informa, 2018; 9(4):15-18. Disc Arthroplasty and Sports practice Dr. Diogo Moura 1 , Dr. Marcel Sincari 2 , Prof. Doutor Fernando Fonseca 3 1 Orthopedics and Traumatology Resident; 2 Neurosurgery specialist; 3 Director of the Orthopedics and Traumatology Department. Coimbra University Hospital Center. Portugal ABSTRACT Despite the increasing popularity of disc arthroplasty in predominantly young and active patients for treatment of symptomatic degenerative disc disease, currently there is still no strong scientific evidence about its benefits in comparison to classic treatment, the intersomatic fusion. Current studies, despite of some controversy, support disc arthroplasty have strict indications and is associ- ated with a more functional and mobile spine, guaranteeing less adjacent segment disease and an earlier return to physical activities when compared to fusion. In theory, high impact, contact sports and intense activities can induce repetitive and intense axial and rotational loads to the spine and to the disc prosthesis, which can be associated with a higher risk of early arthroplasty failure. In this paper we present current scientific evidence about disc arthroplasties biomechanics rational and its clinical results and review the few studies about these implants application in athletic patients. KEYWORDS Disc arthroplasty, disc replacement, spine column, intervertebral disc, discopathy, sports Disc arthroplasty – concept and biomechanics The classical surgical treatment for advanced degenerative is the interbody arthrodesis, meagning the excision of the intervertebral disc and the fusion of the vertebral bod- ies with the application of cages and bone graft. Despite success on symp- tomatic relief, some patients develop adjacent disc disease, which consists of symptomatic degeneration of adjacent discs due to the biome- chanical change of load distribution caused by the loss of mobility due to the arthrodesis of a segment, as well as the compensatory increase in the mobility of the non-arthrodesis levels. In addition, the most active patients will have lower cervical spine mobility, which can impair sports activity and quality of life. In order to by-pass this problem, the discs arthroplasties were developed, which in theory allow mobility and to recreate biomechanics, function and distribution of loads similar to normal in the affected segment and could be associated with lower disc degeneration rates of adjacent levels (Figure 1). 1 However, currently the indications for disc arthroplasties are relatively restricted and a correct surgical indication is the key for suc- cess of a surgical intervention. 2 The discs arthroplasties should be applied on isolated symptomatic degenerative discopaties that do not respond to conservative treatment for six months and, generally, only in patients without structural deformi- ties or spinal instability, in particular, without facets osteoarthrosis, and with acceptable bone quality. 2 As such, in view of the high prevalence of the counterindications referred to as the advancing age, most of the arthroplasties are performed in young patients, many of them with important activity level and expec- tations of a high functional level. 3,4 A prospective randomized multi- centric compared study with 187 patients, with a two-year follow-up time, which underwent cervical disc arthroplasty, showed an increase on cervical spine mobility significantly superior than those subjected to arthrodesis (+ 5.9° VS-0.8°, p = 0.001). Contributions to cervical spine mobility were equivalent in the vari- ous levels of patients submitted to arthroplasty, including that replaced by disc prosthesis, thus recreating a more physiological mobility, with uniform discs contributions to the total mobility arc. In turn, patients subjected to arthrodesis, contri- butions to total mobility were, as expected, significantly higher in the adjacent non-arthrodesis segments. Several studies on cervical arthro- plasties and lumbar discs demon- strated superior clinical-functional results and faster recovery time compared to arthrodesis. 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