Daniel Choi, MD, completed 100 prodisc C-Vivo implants and said he’s seen similar advantages compared to other total disc designs.
Dr. Choi spoke with Becker’s to reflect on the milestone and how he approached the learning curve.
Note: This conversation was lightly edited for clarity.
Question: You’ve used the prodisc implant in 100 implantations. Can you talk about the biggest learning curve that you’ve encountered?
Dr. Daniel Choi: Anyone who is a high volume cervical disc arthroplasty surgeon would tell you that cervical disc replacement is significantly more technically demanding than doing a cervical fusion. The reason for that is because of the balancing of the implant.
Where you place the implant in the disc space really matters. It has to be completely central, and on the sagittal plane, it has to be balanced. The targeting of the implant and where you put it have to be much more precise than when we do fusion surgery. If you’re off by one or two millimeters in a spinal fusion, the outcome will be the same. But the outcome of a cervical disc replacement has a lot to do with the placement of the implant as well.
The intraoperative workflow and ensure that you get everything right in the surgery is probably the steepest learning curve. There’s a lot of microtechniques that I do in arthroplasty whether I’m using a drill to ensure that there’s symmetric sizing of the uncus or making sure that the disc space is completely symmetric. Then when you’re trying to do all these kinds of technical maneuvers, your operative timing increases too. Studies show that cervical disc arthroplasty actually increases your risk of dysphasia compared to anterior cervical discectomy and fusion because you’re spending more time trying to get this implant perfect. So you have to be able to do all these maneuvers to ensure accuracy, but still keep your operative time acceptable.
Q: It sounds like there are a lot of moving parts involved. How many cases did it take you to get comfortable with this?
DC: I’ve been doing cervical disc arthroplasty for about four years. It wasn’t part of my practice when I first started, and I was putting in an implant that utilizes a keel. I got comfortable with that implant. But even with that one it took at least 15 to 20 implantations before I was completely comfortable.
Q: So comparing the prodisc design with the keel-based disc implant, which one do you think will take off long term?
DC: There is definitely a wide variety of designs. I’ve mostly used discs that are considered more stable with the keel. Prodisc C-Vivo doesn’t have the keel, but it is still a very stable disc arthroplasty design. I have not had a single one of them migrate or loosen. I know there are case reports out there of it, but I have yet to see it. Then, interoperably when I’ve had to remove an implant, it is very difficult to remove, so once it’s in the disk space it appears to be very stable.
