Abstract
The health of an intervertebral disc is based on a complicated interplay between physiology and biomechanics. The nucleus pulposus must remain well hydrated, and the surrounding anulus fibrosus must be competent in order for the disc to function properly. If either of these components fail, the disc will begin to degenerate, and clinically relevant symptoms may appear. Disc degeneration has traditionally been treated by either discectomy or immobilization of the affected vertebrae, and though these treatments can be effective, they also have their limitations. To help fill the therapy gap that exists for treating moderate degenerative disc disease, the PDN device has been developed. The device consists of a hydrogel core and a polyethylene jacket that are designed to assume the cushioning function of a healthy disc, while restoring/maintaining disc height and allowing normal range of motion. To receive the device, patients must have a preoperative disc height of at least 5 mm and the vertebral endplates must be free of significant defects such as Schmorl’s nodules or fractures. Two approaches can be used for implanting PDN devices: a hemilaminotomy approach, where the disc is accessed through the back, or an Anterior-Lateral transPsoatic Approach (ALPA), where the disc is accessed from the side. In either case, the nucleus material is removed from the disc, and the devices are placed transversely within the nucleus cavity. The amount of research and development currently taking place in the field of disc arthroplasty gives hope that the treatment of degenerative disc disease will soon become multifaceted, with numerous choices being available to surgeons and their patients.
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References
Bushell GR, Ghosh P, Taylor TF, Akeson WH (1977) Proteoglycan chemistry of the intervertebral disks. Clin Orthop 129:115–123
Cassidy JJ, Hiltner A, Baer E (1989) Hierarchical structure of the intervertebral disc. Connect Tissue Res 23:75–88
Fennell AJ, Jones AP, Hukins DW (1996) Migration of the nucleus pulpo-sus within the intervertebral disc during flexion and extension of the spine. Spine 21:2753–2757
Ghosh P (1988) The biology of the intervertebral disc, vols I, II. CRC Press, Boca Raton
Holm S, Maroudas A, Urban JPG, Selstam G, Nachemson A (1981) Nutrition of the intervertebral disc: solute transport and metabolism. Connect Tissue Res 8:101–119
Hukins DW (1992) A simple model for the function of proteoglycan and collagen in the response to compression of the intervertebral disc. Proc R Soc Lond B Biol Sci 249:281–285
Klein JA, Hickey DS, Hukins DW (1983) Radial bulging of the anulus fibrosus during compression of the intervertebral disc. J Biomech 16:211–217
Meakin JR, Redpath TW, Hukins DW (2001) The effect of partial removal of the nucleus pulposus from the intervertebral disc on the response of the human anulus fibrosus to compression. Clin Biomech 16:121–128
Ray CD (1991) Lumbar interbody threaded prostheses. In: Brock M, Mayer HM, Weigel K (eds) The artificial disc. Springer, Berlin Heidelberg New York, pp 53–67
Ray CD (1992) The artificial disc: introduction, history, and socioeconomics. In: Weinstein JN (ed) Clinical efficacy and outcome in the diagnosis and treatment of low back pain. Raven Press, New York, pp 205–225
Ray CD, Sachs BL, Norton BK, Mikkelsen ES, Clausen NA (2002) Prosthetic disc nucleus implants: an update. In: Gunzburg R, Szpalski M (eds) Lumbar disc herniation. Lippincott Williams & Wilkins, Philadelphia
Urban MR, Fairbank JCT, Etherington PJ, Loh L, Winlove CP, Urban JPG (2001) Electrochemical measurement of transport into scoliotic intervertebral discs in vivo using nitrous oxide as a tracer. Spine 26:984–990
Yu S, Haughton VM, Ho PS, et al (1988) Progressive and regressive changes in the nucleus pulposus. II. The adult. Radiology 169:93–97
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© 2004 Springer-Verlag Berlin Heidelberg
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Ray, C.D., Vazquez, R. (2004). The PDN® prosthetic disc-nucleus device. In: Gunzburg, R., Mayer, H.M., Szpalski, M., Aebi, M. (eds) Arthroplasty of the Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18508-3_12
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DOI: https://doi.org/10.1007/978-3-642-18508-3_12
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