Purpose of the study: ACDF is the cervical surgical technique the most widely used for the treatment of severe discopathy in rugby players. Different techniques have been applied, with no real consensus for the technical procedures or the postoperative rehabilitation. The goal is to normalise the surgical treatment and rehabilitation for elite rugby players who have had a cervical fusion for discopathy with the objective of resuming rugby three months postoperatively.

Material and methods: This was a retrospective study including 85 high-level rugby players (professional and semi-professional players) operated on by three surgeons from 2003 to 2008 for one or two levels presenting discal herniation (levels C3 to T1) with cervicobrachial nevralgia unresponsive to conservative treatment. Postoperative function was assessed with the cervical handicap index, a visual analogue scale for pain, consumption of analgesics, and possibility to resume rugby at three months. Flexion-extension radiographs of the cervical spine were obtained. All patients underwent ACDF using a Peek cage filled with autologous iliac bone fixed with a plate or a compressive staple. The patient completed a self-administered satisfaction questionnaire during follow-up. The radiographs and the clinical exam were done by an independent observer (GG).

Results: Mean follow-up was 26 months (4–55). Mean operative time was 50 minutes (30–70). Mean hospital stay 2.3 days (1–3). There was no difference between plate and staple fixation. There were no major postoperative complications. Fusion was radiographically achieved in all cases. All patients played competition rugby three months after surgery. At last follow-up, seven players had interrupted rugby playing for personal reasons or for other intercurrent medical conditions. Seventy-eight percent stated their clinical situation had improved and that they were satisfied.

Conclusion: The results of this series confirm the pertinence of this method to achieve effective fusion authorising resumption of rugby playing three months postoperatively. Use of a Peek cage filled with autologous bone and stabilised with fixation appears to be necessary to allow rapid functional rehabilitation exercises using a programme of three phases of one month. The normalisation of the treatment for sever cervical discopathies in the high-level rugby player appears to be possible and safe, compared with data in the literature.

Purpose of the study: Discectomy-anterior fusion has proven efficacy for many diseases of the cervical spine. Nevertheless, the loss of motion and the over-solicitation of adjacent levels are arguments in favor of disc replacement. This prospective study examined the early clinical and radiological results obtained in the first 41 patients treated with a new cervical disc prosthesis, Mobi-C.

Material and methods: A prospective multicentric clinical and radiological study is being conducted to analyze the safety and efficacy of Mobi-C for degenerative disease. Indications are radiculopathies due to discal herniation or foraminal osteophytic stenosis involving one or two levels from C3 to T1. An independent observer reviewed the patients. SF36, the Neck Disability Index, and a visual analogue scale for pain as well as radiographic mobility were noted.

Results: Mean age was 42 years (range 31–56 years). There were 23 men and 18 women. Eight patients had two disc replacements. Mean follow-up was six months (range 3–10 months). Mean operative time was 65 min, similar to operative time for fusion. Blood loss was 90 ml. NSAID were prescribed for the first 15 days. There were no intraopeartive complications and no revisions. Postoperative complications were minimal. There were no specific complications related to the prosthesis, its insertion or its function. The function and quality-of-life scores showed a significant improvement at last follow-up. Radiographically, motion was also improved in most patients.

Discussion: The early results on the safety and efficacy of this new cervical prosthesis are promising. Primary stability has been excellent and there have been no specific prosthesis-related complications. Furthermore, several operators have mentioned how easy it is to insert the Mobi-C.

Conclusion: The clinical results in terms of pain and function as well as the radiological results have been satisfactory both at the early and at the later assessments. Insertion of this prosthesis is a simple process, similar to insertion of an intersomatic cage, elements arguing in favor of a cervical disc prosthesis. Further follow-up will be needed to assess the long-term efficacy and possible effect on prevention of accelerated degeneration of the adjacent discs.

INTRODUCTION: Intervertebral degeneration is characterised by instability due to permanent decrease in the stiffness of the intervertebral segment and concentration of stress upon the posterior portion of the disc, and by morphologic changes in the posterior elements due to posterior displacement of loading, notably enlargement of the lamina and zygapophyseal joints. These changes lead to reduction in the cross-sectional area of the vertebral canal.

In order to counterbalance these changes, an implant has been developed with an interspinous blocker and an artificial ligament made of Dacron. This obviates the need for a permanent fixation in the vertebral bone, avoiding the risk of loosening. Inhibition of hyperextension limits narrowing of the posterior canal, resulting in an increase in its cross-sectional area of up to 40%.

A first-generation implant for nonrigid stabilisation of lumbar segments was developed in 1986 with a titanium interspinous blocker. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with significant resolution of residual low back pain with no serious adverse effects.

After careful analysis of the points that could be improved,a second-generation,improved implant called the ‘Wallis implant’ was developed with a redesigned blocker made of PEEK (polyetheretherketone), a more resilient material.

METHODS: Biomechanical studies were used to verify the effectiveness of this implant in increasing intervertebral stiffness, reducing mobility, and unloading the facet joints and the posterior portion of the disc.

A prospective multicenter international observational study was begun a year ago.

RESULTS: Preliminary results confirm the clinical efficacy of this treatment on low back pain and nerve root symptoms, especially in recurrent disc herniation and canal stenosis.

DISCUSSION: Nonrigid intervertebral fixation with the Wallis implant clearly appears to be a useful technique in the management of initial forms of degenerative intervertebral lumbar disc disease. The method should rapidly assume a specific role along with total disc prostheses in the new step-wise surgical strategy to obviate definitive fusion of degenerative intervertebral segments. Moreover, dynamic stabilisation with the Wallis system is totally reversible and leaves all other options open.

Wallis is recommended for patients with lumbar disc disease who have: (i) discectomy for massive herniated disc leading to substantial loss of disc material, (ii) a second discectomy for recurrence of herniated disc, (iii) discectomy for herniation of a transitional disc with sacralization of L5, (iv) degenerative disc disease at a level adjacent to a previous fusion or prosthesis, (v) isolated disc resorption, notably with concomitant type-1 Modic changes, associated with low back pain, or (vi) symptomatic narrow canal treated by resection of the superior aspect of the laminae.