Footprint Mismatch of Cervical Disc Prostheses with Chinese Cervical Anatomic Dimensions

Background: The footprint of most prostheses is designed according to Caucasian data. Total disc replacement (TDR) has been performed widely for cervical degenerative diseases in China. It is essential to analyze the match sizes of prostheses footprints and Chinese cervical anatomic dimensions in our study. Methods: The anatomic dimensions of the C4-C7 segments of 138 patients (age range 16-77 years) in a Chinese population were measured by computed tomography scans. We compared the footprints of the most commonly used cervical disc prostheses (Bryan: Medtronic, Minneapolis, MN, USA; Prestige LP: Medtronic, Fridley, Minnesota, USA; Discover: DePuy, Raynham, MA, USA; Prodisc-C: Synthes, West Chester, PA, USA) in China with Chinese cervical anatomic dimensions and assessed the match of their size. Results: The mismatch of available dimensions of prostheses and anatomic data of cervical endplates ranged from 17.03% (C4/C5, Prestige LP, Prodisc-C) to 57.61% (C6/C7, Discover) in the anterior-posterior (AP) diameter, and 35.51% (C4/C5, Prodisc-C, Prestige LP) to 94.93% (C6/C7, Bryan) in the center mediolateral (CML) diameter. About 21.01% of endplates were larger than the largest prostheses in the AP diameter and 57.25% in the CML diameter. All available footprints of prostheses expect the Bryan with an unfixed height, can accommodate the disc height (DH), however, 36.23% of the middle DH was less than the smallest height of the prostheses. The average disc sagittal angles (DSAs) of C4-C7 junctions were 5.04 degrees, 5.15 degrees, and 4.13 degrees respectively. Only the Discover brand had a built-in 7 degrees lordotic angle, roughly matching with the DSA. Conclusions: There is a large discrepancy between footprints of prostheses and Chinese cervical anatomic data. In recent years, possible complications of TDR related with mismatch sizes are increasing, such as subsidence, displacement, and heterotopic ossification. Manufacturers of prostheses should introduce or produce additional footprints of prostheses for Chinese TDR.