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  • nihs
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    Dr. Corenman-

    Really appreciate this forum and the personal responses that you give on this site.

    I was wondering if you have had any experience working with the mobi-c disc from LDR Corp? Their 5 year, supposedly randomized study, is said to show superiority to fusion especially in the 2 level case. What’s your thoughts on this? Do you think that these FDA randomized trials paid by the manufacturers are biased?

    I’ve been recommended by my surgeon for 2 level replacement using the mobi-c disc. To my untrained eyes, the 3 piece detached (or unconstrained) design worries me somewhat. I hear that surgery requires removal of the anterior and posterior longitudal ligaments, and with these natural elements removed how does a device like this stay in place. Understand that there are other ligaments and tendons, but is that enough to keep these discs working properly for the long term and even in hard impacts? Do you think that there is a concern for hyper mobility of operated levels?

    Just wanted to get your thoughts.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    The poly on metal discs all are slightly constrained meaning that they are a “cup and saucer” design. The components are not attached or “hooked together” which is OK as I have not seen any reports of catastrophic dislocation. There are reports of detachment from the bone-disc interface but not the actual discal surfaces that I am aware. There is a disc that I use (Bryan) that has shock absorption (unlike the metal and poly discs) and both surfaces are attached together to prevent a catastrophic failure.

    There are indications for ADR vs. ACDF (fusion) that should be followed. If you have significant neck pain as a component (as compared to majority arm pain), your discs are collapsed (less than 50% of normal height) and the range of motion on flexion extension films are significantly limited, you would do better with a fusion. If you have severe stenosis (narrowing of the spinal canal), you would do better with a fusion. If you have instability (see cervical degenerative spondylolisthesis), an artificial disc is contraindicated.

    The ADRs I like but really do not protect from adjacent segment degeneration. The ADR is better for preserving range of motion with the caveats that I noted above. You have to be careful reading the studies as there are extrapolations of the data that might be more positive that they seem.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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