Lumbar and cervical viscoelastic disc replacement: Concepts and current experience

Abstract

The ideal lumbar and cervical discs should provide six degrees of freedom and tri-planar (three-dimensional) motion. Although all artificial discs are intended to achieve the same goals, there is considerable heterogeneity in the design of lumbar and cervical implants. The “second generation total disc replacements” are non-articulating viscoelastic implants aiming at the reconstruction of physiologic levels of shock absorption and flexural stiffness. This review aims to give an overview of the available implants detailing the concepts and the functional results experimentally and clinically. These monobloc prostheses raise new challenges concerning the choice of materials for the constitution of the viscoelastic cushion, the connection between the components of the internal structure and the metal endplates and even the bone anchoring mode. New objectives concerning the quality of movement and mobility control must be defined.

Keywords: Lumbar disc replacement, Cervical disc replacement, Viscoelastic, Total disc replacement, Lumbar spine, Cervical spine, Disc arthroplasty

Core tip: Although all artificial discs are intended to achieve the same aims, there is considerable heterogeneity in the design of lumbar and cervical implants. The “second generation total disc replacements” are non-articulating viscoelastic implants aiming at the reconstruction of physiologic levels of shock absorption and flexural stiffness. This review aims to give an overview of the available implants. We herein discuss the new challenges concerning the choice of materials, the connection between the components of the internal structure and the metal endplates and even the bone anchoring mode. We discuss the consequences of the different technological choices and we emphasize the special features to watch out for when monitoring these implants in the future.