ESP Disc Replacement

ESP Disc Replacement

Five-year follow-up of clinical and radiological outcomes of LP-ESP elastomeric lumbar total disc replacement in active patients

Jean-Yves Lazennec, MD, PhD, Jean-Patrick Rakover, MD, Marc-Antoine Rousseau, MD PhD

Abstract

Background context

The surgical treatment of degenerative disc disease at the lumbar spine may involve fusion. Total disc replacement (TDR) is an alternative treatment to avoid fusion-related adverse events, specifically adjacent segment disease. New generation of elastomeric non-articulating devices has been developed to more effectively replicate the shock absorption and flexural stiffness of native disc.

Purpose

To report 5 years clinical and radiographic outcomes, range of motion (ROM), and position of the center of rotation after a viscoelastic lumbar TDR.

Study Design

Prospective observational cohort study

Patient sample

Sixty-one patients

Outcome Measures

The clinical evaluation was based on visual analog scale (VAS) for pain, Oswestry disability index (ODI) score, short form-36 (SF-36) including the physical component summary (PCS) and the mental component summary (MCS), and general health questionnaire-28 (GHQ28). The radiological outcomes were ROM and position of the center of rotation at the index and the adjacent levels and the adjacent disc height changes.

Methods

Our study group included 61 consecutive patients with monosegmental disc replacement. We selected patients who could provide a global lumbar spine mobility analysis (intermediate functional activity according to the Baecke score). Hybrid constructs had been excluded. Only the cases with complete clinical and radiological follow-up at 3, 6, 12, 24, and 60 months were included.

Results

There was a significant improvement in VAS (3.3±2.5 vs. 6.6±1.7, p<.001), in ODI (20±17.9 vs. 51.2±14.6, p<.001), GHQ28 (52.6±15.5 vs. 64.2±15.6, p<.001), SF-36 PCS (58.8±4.8 vs. 32.4±3.4, p<.001), and SF-36 MCS (60.7±6 vs. 42.3±3.4, p<.001). The mean location centers of the index level and adjacent discs were comparable to those previously published in asymptomatic patients. According to the definition of Zigler and Delamarter, all of our cases remained grade 0 for adjacent level disc height (within 25% of normal).

Conclusions

This series reports significant improvement in midterm follow-up after TDR, which is consistent with previously published studies but with a lower rate of revision surgery and no adjacent level disease pathologies. The radiographic assessment of the patients demonstrated the quality of functional reconstruction of the lumbar spine after LP-ESP viscoelastic disc replacement.

The ESP Disc Replacement is a mono-bloc total disc replacement implant that restores natural disc functions.

The ESP disc replacement is made of 2 titanium alloy end-plates and an elasto-meric cushion. The spikes on the end-plates outer surfaces improve primary fixation. The combination of a hydroxyapatite (HA) coating on top of a T40 rough surface are considered as one of the best existing coating. The titanium alloy used for the end plates allows clear medical imaging and guarantees good bony fixation over time.

  • Between the 2 titanium end-plates the elsatomeric parts are injected for controled resistance to compression, flexion and rotation. These elastomeric parts are concentric and their fixation prohibits micro motion. The materials used for the implants have been tested for biocompatibility according to the ISO standard 10993.
  • Minimally invasive anterior approach which allows reduced hospital stay and improves rehabilitation
  • Tested up to 40 million cycles
  • ESP should give a significant reduction in pain severity, re-establish lumbar curvature and natural disc functions
  • ESP allows quick return to normal daily activities

Origin of The ESP Disc Replacement

Concept of a “Silent Block” ESP®

The development of the ESP disc range originally came from Professor Roy Camille, from La Pitié Salpétrière Teaching Hospital in Paris (France). After inventing the pedicle screw which became the gold standard for Spine fusions, Pr. Roy Camille started to work on analysing the natural disc properties and designed a prosthesis to restore these.

Third generation disc replacements

Both CP-ESP and LP-ESP  belong to the 3rd generation of disc replacements. Their specific mono-bloc design resulting from over a decade development allows them mimic the properties of natural discs. They provide movements in all directions without any friction and without any risks of debris production nor dislocation.

Lumbar ESP Disc Replacement

The Lumbar ESP Disc Replacement – LP-ESP

The LP-ESP cervical disc replacement has been developed to mimic the natural lumbar disc and allow the spine to behave as if the replaced disc would be natural in all situations.

  • Over 10 years of research and development
  • 10 years of follow up (since 2004)
  • 6° of freedom
  • Adaptive center of rotation
  • No surface bearing for an increased lifetime
  • Improved stability
  • shock absorbing
  • Designed to fit and restore patient lordosis

Structure of the LP-ESP® Lumbar Disc Replacement

  • Titanium endplates 
TA 6V ISO 583213 and hydroxyapatite coating
  • Inner core (Silicone nucleus)
  • Outer core (Polycarbonate urethane annulus)
ESP Disc Replacement

The Cervical ESP Disc Replacement – CP-ESP

The CP-ESP cervical disc prosthesis has been developped to mimic the natural cervical disc and allow the spine to behave as if the replaced disc would be natural in all situations.

Specifics

  • Heights from 5mm to 7mm
  • Benefits from over 10 years of development
  • 6 degrees of freedom
  • Adaptive center of rotation
  • No surface bearing for increased lifetime
  • Improved stability
  • Shock absorbing

 

 

Cervical ESP Disc Replacement

Other natural  elasto-meric non-articulating devices:
Spinal Kinetics M6 > >

Disc Replacement Surgeon
Dr. Ritter-Lang  > >