PURPOSE: Low back pain is a significant socio-economic problem which is expected to deepen. Degenerative disc disease is considered to be one of its main causes. Unsuccessful conservative treatments usually lead to surgical treatments, including methods providing pain relief by vertebral fusion in the affected segment. However, this leads to changes in biomechanics, which is why approximately 30 years ago total disc replacements appeared. This work aims at determining the current state of treatments with this kind of replacement, comparing the results with those of fusion methods and assessing why fusion continues to dominate. Current treatments of degenerative disc disease by advanced procedures (regenerative and gene therapy, 3D printing) is also examined and evaluated, and future developments are considered. METHODS: A critical review based on available scientific articles from online databases. The main keywords used were "lumbar", "total", "disc" and "replacement", supplemented according to the individual, monitored areas ("follow-up", "fusion", "future" etc.). For the articles found through database search (n = 895), narrower selection was made and the result was 33 articles included in review. REVIEW: Total disc replacements have not yet satisfactorily demonstrated that they are superior to fusion methods in long term follow-up. Advanced methods are in their infancy. CONCLUSIONS: Additional research and development of total disc replacements is still necessary. For implants, the 3D scan - 3D model - 3D printing chain and its related technologies are increasingly important. The development of regenerative procedures using induced pluripotent stem cells and gene therapies is important, but conservative treatments and primary prevention should also be developed because regenerative procedures and gene therapies apparently will not be used routinely until the future.

• MeSH
• artroplastika meziobratlové ploténky * škodlivé účinky   metody   MeSH
• bederní obratle chirurgie   MeSH
• degenerace meziobratlové ploténky * chirurgie   komplikace   MeSH
• fúze páteře * škodlivé účinky   metody   MeSH
• lidé MeSH
• lumbalgie * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Cíl: Cílem této práce bylo posoudit analgetický efekt a výsledný funkční stav u pacientů s degenerativním postižením meziobratlové ploténky bederní páteře léčených perkutánní cementovou diskoplastikou. Materiál a metodika: Do této prospektivní studie byli zařazeni pacienti operovaní perkutánní cementovou diskoplastikou pro degenerativní posti- žení meziobratlové ploténky. Všichni pacienti absolvovali neurologické a radiologické vyšetření před operací a po operaci. Zhodnocena byla míra bolesti pomocí vizuální analogové škály (visual analogue scale) a funkční stav pomocí dotazníku Oswestry Disability Index. Výsledky: Celkový soubor tvořilo 8 pacientů. Minimální doba sledování byla 12 měsíců. Průměrná hodnota na vizuální analogové škále před operací byla 6,3 bodu a po operaci 2,4 bodu. Redukce bolesti byla 61,9%. Průměrná hodnota Oswestry Disability Indexu před operací byla 22,1 bodu a po operaci 13,3 bodu. Míra funkčního zlepšení byla 39,8%. Závěr: Perkutánní diskoplastika je alternativní minimálně invazivní operační technika, která řeší chronickou bolest, jejímž generátorem je diskopatie. V porovnání s otevřenými technikami nahrazujícími meziobratlovou ploténku je perkutánní diskoplastika minimálně zatěžující jak lokálně pro páteř, tak celkově pro organismus pacienta.

Aim: The aim of this study was to assess analgesic effect and resulting functional status in patients with lumbar degenerative disc disease treated with percutaneous cement discoplasty. Methods: This prospective study included patients who were treated by percutaneous cement discoplasty for lumbar degenerative disc disease. All patients underwent neurological and radiological examinations before and after surgery. The pain intensity was evaluated using the Visual Analogue Scale and the Oswestry Disability Index questionnaire. Results: A total of 8 patients were included in this study. The minimum follow-up was 12 months. The mean value of Visual Analogue Scale was 6.3 points preoperatively, respectively 2.4 points postoperatively. The average Oswestry disability index was 22.1 points before surgery and 13.3 points after surgery. Conclusion: The percutaneous cement discoplasty is alternative minimally invasive technique for chronic pain management caused by degenerative disc disease of the lumbar spine. The percutaneous cement discoplasty is least burdensome both locally for the spine and generally for the organism of the patient in comparison to standard surgical methods.

• MeSH
• artroplastika meziobratlové ploténky * metody   MeSH
• chronická bolest diagnóza   chirurgie   MeSH
• degenerace meziobratlové ploténky chirurgie   komplikace   MeSH
• dospělí MeSH
• kostní cementy * terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie * diagnóza   chirurgie   MeSH
• magnetická rezonanční tomografie MeSH
• měření bolesti MeSH
• miniinvazivní chirurgické výkony MeSH
• perkutánní diskektomie MeSH
• polymethylmethakrylát terapeutické užití   MeSH
• prospektivní studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• vizuální analogová stupnice MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from -2.4° preoperatively to -6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 ( clinicaltrials.gov ).

• MeSH
• artroplastika meziobratlové ploténky * přístrojové vybavení   metody   MeSH
• bolest krku diagnostické zobrazování   etiologie   chirurgie   MeSH
• časové faktory MeSH
• chirurgická dekomprese metody   MeSH
• degenerace meziobratlové ploténky komplikace   diagnostické zobrazování   chirurgie   MeSH
• diskektomie metody   MeSH
• dospělí MeSH
• krční obratle * MeSH
• lidé MeSH
• lordóza diagnostické zobrazování   etiologie   chirurgie   MeSH
• měření bolesti MeSH
• následné studie MeSH
• posuzování pracovní neschopnosti MeSH
• prospektivní studie MeSH
• protézy kloubů * MeSH
• software MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

Cíl: Prezentovat výsledky pětiletého sledování pacientů po implantaci mobilní náhrady krčního disku Mobi‑C, zhodnotit klinické i radiologické výsledky a jejich vzájemný vztah. Soubor a metodika: Retrospektivně zpracovaná studie s prospektivním sběrem dat. Na Neurochirurgickém oddělení FN Plzeň jsme sledovali 17 pacientů s 18 implantovanými disky Mobi‑C po dobu pěti let. Indikací k operaci byly známky radikulopatie a/nebo myelopatie v korelaci s grafickým nálezem. Vstupním radiologickým nálezem byla hernie disku podle magnetické rezonance. Hodnotili jsme vývoj klinického nálezu škálami –Visual Analogue Scale (VAS), modifikovaná Japanese Orthopedic Association Score (mJOA), u míšních lézí Nurickova škála. Rozsah pohybu operovaného segmentu a celé krční páteře jsme posuzovali podle dynamických snímků. Výskyt heterotopické osifikace byl zpracován dle Mehrenovy klasifikace. Výsledky byly zhodnoceny neparametrickým Wilcoxonovým testem na hladině významnosti 0,05. Výsledky: Po pěti letech nedochází ke snížení rozsahu pohybu v operovaném segmentu, medián rozsahu pohybu segmentu zůstává na předoperační hodnotě 7,0 (p = 0,2932). Rozsah pohybu krční páteře se nevýznamně zvětšil, medián z 36 na 48 (p = 0,0997). Při hodnocení osifikace byl stupeň 0 u 28 %, naopak stupeň IV, plná fúze, u 11 % segmentů. Statisticky významné zlepšení neurologického nálezu nastalo u všech sledovaných. Změna mediánu škály VAS z 5,5 na 2 (p = 0,0009) a mediánu mJOA z 16 na 18 (p = 0,0025). Závěry: Implantace mobilní náhrady krčního disku Mobi‑C je efektivní volba léčby degenerativního onemocnění krčních disků z hlediska klinického výsledku. Rozsah pohybu operovaného segmentu se po dobu pěti let nezmenšil. Vztah mezi výsledným klinickým stavem pacienta a funkčním rozsahem pohybu implantátu jsme neprokázali.

Aim: To present clinical outcome and radiological findings in a group of patients five years after an implantation of mobile total disc replacement prostheses Mobi-C. Material and methods: Retrospection of prospectively collected data after five years from 17 patients with 18 disc prostheses Mobi-C implanted at the Department of Neurosurgery, Charles University Teaching Hospital in Plzen, Czech Republic. The surgery was indicated in the presence of symptoms of radiculopathy and/or myelopathy in correlation with soft disc herniation on magnetic resonance. Clinical condition was evaluated using the Visual Analogue Scale (VAS), modified Japanese Orthopaedic Association Scale (mJOA) and the Nurick Scale Range of motion of the operated spinal segment and the entire cervical spine was assessed with dynamic X rays. Heterotopic ossification was evaluated according to the Mehren classification. The results were statistically tested with nonparametric Wilcoxon test on the 0.05 significance level. Results: Range of motion five years after the implantation was not restricted, median remained the same. 7.0 (p = 0.2932), range of motion of the entire cervical spine was not significant; median increased from 36 to 48 (p = 0.0997). Heterotopic ossification grade 0 was found in 28%, bony fusion, degree IV, in 11%. Statistically significant improvement in neurological findings was found in all patients. The median score on VAS changed from 5.5 to 2 (p = 0.0009) and mJOA median from 16 to 18 (p = 0.0025). Conclusions: With respect to clinical outcome, total disc replacement with mobile prosthesis Mobi-C is an effective option in the treatment of cervical disc degeneration. The range of motion of the operated segment remained stable during five years after the implantation. No correlation was found between clinical outcome and range of motion of the prosthesis. Key words: prosthesis – total disc replacement – cervical spine – disc herniation – heterotopic ossification – spine mobility The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

• MeSH
• artroplastika meziobratlové ploténky * metody   statistika a číselné údaje   MeSH
• dospělí MeSH
• heterotopická osifikace * epidemiologie   komplikace   radiografie   MeSH
• krční obratle chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• meziobratlová ploténka * chirurgie   MeSH
• nemoci míchy chirurgie   radiografie   MeSH
• neurologické vyšetření MeSH
• obnova funkce MeSH
• pohyb MeSH
• pooperační komplikace MeSH
• progrese nemoci MeSH
• protézy a implantáty MeSH
• radikulopatie chirurgie   radiografie   MeSH
• retrospektivní studie MeSH
• statistika jako téma MeSH
• výhřez meziobratlové ploténky * chirurgie   radiografie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

• MeSH
• artroplastika meziobratlové ploténky metody   MeSH
• degenerace meziobratlové ploténky chirurgie   MeSH
• dospělí MeSH
• krční obratle chirurgie   MeSH
• lidé MeSH
• meziobratlová ploténka chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• artroplastika meziobratlové ploténky metody   trendy   využití   MeSH
• chirurgické nástroje normy   využití   MeSH
• diagnostické zobrazování metody   využití   MeSH
• fluoroskopie využití   MeSH
• intervenční radiologie metody   normy   MeSH
• lidé MeSH
• perkutánní diskektomie metody   trendy   využití   MeSH
• počítačová rentgenová tomografie metody   využití   MeSH
• pooperační komplikace MeSH
• pooperační péče MeSH
• referenční standardy MeSH
• statistika jako téma MeSH
• výhřez meziobratlové ploténky komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

PURPOSE OF THE STUDY To present the results of an independent prospective monocentric study of patients with ProDisc-C Total Disc Replacement (CTDR) followed up for 4 years, and to analyse the most frequent late complications, in particular heterotopic ossification. MATERIAL In the period from October 2004 to May 2006, a total of 61 patients underwent ProDisc-C CTDR involving one or two segments at the Department of Spinal Surgery, University Hospital in Motol. This study included 39 patients who were followed up for at least 4 years. With the exception of one patient operated on two segments, the patients were treated by ProDisc-C CTDR at one level. METHODS In the study, only the surgical procedure recommended by the implant manufacturer (Synthes, USA) was used and all operations were performed by a team with the same leading surgeon. Clinical assessment. The patients were examined before surgery, immediately after it and at 6 and 12 weeks and 6, 12, 24 and 48 months post-operatively. At each follow-up, responses to the questionnaire were obtained, and the patients' health status was evaluated on the basis of Neck Disability Index (NDI) and Visual Analogue Score (VAS) values for cervical spine and radicular pain, the use of analgesics and personal satisfaction. Radio-graphic assessment. Pre- and post-operative radiographs were taken in antero-posterior and lateral projection, and flexion, extension and lateral bending films were obtained The height of the intervertebral disc space at the affected level was measured and range of motion in flexion and extension was evaluated together with the adjacent levels. In addition, subsidence, loosening, failure or displacement of the implant was assessed, as well as the presence of heterotopic ossification. The results were statistically analysed using Student's t-test. RESULTS The clinical results at 1, 2 and 4 years of follow-up were as follows: NDI values, 44.9 pre-operatively, 26.1, 25.8 and 25.1 post-operatively, improvement by 44.1% after 4 years; VAS for cervical spine pain, 5.8 pre-operatively, 3.0, 2.7 and 2.7 postoperatively, improvement after 4 years by 53.7%; VAS for radicular pain, 6.3 pre-operatively, 2.9, 2.9 and 2.7 postoperatively, improvement by 57.1% after 4 years. The radiographic findings showed the average intervertebral disc space height of 3.2 mm at the affected level before and 7.4 mm after surgery, with no significant change in the following period. The average range of disc motion at the affected level was 4.2 degrees before and 11.1 degrees after surgery, with 11.4 degrees at 4 years of follow-up. During that period, heterotopic ossification was recorded in 10 (25%) treated discs, with five of them (12.5%) classified as grade III or IV Spontaneous fusion across the disc replacement level was found in three cases (7.5%). Two patients (5%) developed kyphosis at the affected disc level. The statistical analysis showed a significant difference between the pre-operative VAS values and those at 6 post-operative weeks for both cervical spine and radicular pain (t = 4.4 and t = 5.3, respectively; p < 0.05). No significant difference in VAS values was found between 6 weeks and 3 months after surgery for either condition (t = 1.69 and t = 0.3; p > 0.05). Changes in VAS values in the following period were minimal and non-significant. The differences in NDI values before surgery and at 6 weeks after it, and between 6 weeks and 3 months post-operatively were significant (t = 11, p < 0.05 and t = 3.8, p < 0.05, respectively). In the following period, changes in the values were minimal and non-significant. DISCUSSION Short-term studies on various types of cervical disc replacement have been optimistic and reported good clinical results and few complications. However, with longer follow-ups there has been an increasing incidence of heterotopic ossification as the most frequent late complication. Although the number of patients diagnosed with it is growing, heterotopic ossification influences the patient's clinical problems only little. What are its causes and how to prevent it are questions to be fully answered yet. CONCLUSIONS Heterotopic ossification is the most frequent late complication of total disc replacement. Many factors may be responsible for its development and therefore its prevention is not clear. The correct indication and appropriate surgical technique are most often recommended, and are considered also by the authors to be most important. Restricted motion at the treated segment/s has no significant effect on the patient's clinical status.

• MeSH
• artroplastika meziobratlové ploténky * metody   MeSH
• degenerace meziobratlové ploténky * chirurgie   radiografie   MeSH
• heterotopická osifikace * epidemiologie   radiografie   MeSH
• krční obratle * patofyziologie   radiografie   MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• prospektivní studie MeSH
• protézy a implantáty * využití   MeSH
• Check Tag
• lidé MeSH

This article deals with an experimental work on spinal segment kinematics. A structure a unique mechanism for spinal segment loading is described. This mechanism can perform periodic loading by pure bending (flexion/extension) or by coupled bending, shear and compression. The kinematics of particular vertebra is measured by means of motion capture technique. In this case, a commercial system Qualisys was used. The raw results are time sequences of marker’s coordinates corresponding to moving bodies (vertebra). These data are post processed in a Matlab software and converted to more readable kinematic description using instantaneous axis (or center in 2D) of rotation. These experimental data will be used for numerical determination of load transition ratios between two adjacent vertebras.

• Klíčová slova
• helikální osy, měření optickou metodou, kinematika,
• MeSH
• artroplastika meziobratlové ploténky metody   trendy   využití   MeSH
• biomechanika MeSH
• bolesti zad chirurgie   MeSH
• financování organizované MeSH
• modely u zvířat MeSH
• páteř fyziologie   patofyziologie   patologie   MeSH
• pohyb fyziologie   MeSH
• prasata MeSH
• rotace škodlivé účinky   MeSH
• statistika jako téma MeSH
• tělesná námaha fyziologie   MeSH
• torze mechanická MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH

• MeSH
• artroplastika meziobratlové ploténky metody   MeSH
• meziobratlová ploténka chirurgie   MeSH
• protézy a implantáty MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie