Name: Surgical Technique for the Implantation of a Biomimetic Artificial Intervertebral Disc in a Goat Animal Model (Video) | JoVE Journal
Uploaded: 2025-10-10T13:50:00.000+00:00
Duration: 7 min 6 s
Description: Learn a novel surgical technique for implanting the BioAID biomimetic artificial intervertebral disc using a goat model. This method demonstrates accurate placement, immediate stability, and potential for clinical applications in cervical spine repair.

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5 minutes

This publication is part of the BioAID project (project no. 10025453), supported by the AES Open Technology Program and partly financed by the Dutch Research Council (NWO).

<ol><li>Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Epidemiology%2C+diagnosis%2C+and+treatment+of+neck+pain%5BTitle%5D)+AND+%22Mayo+Clin+Proc%22%5BJournal%5D)">Epidemiology, diagnosis, and treatment of neck pain.</a> Mayo Clin Proc. 90 (2), 284-299 (2015).</li>
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<li>Jacobs, C. A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mechanical+characterization+of+a+novel+biomimetic+artificial+disc+for+the+cervical+spine%5BTitle%5D)+AND+%22J+Mech+Behav+Biomed+Mater%22%5BJournal%5D)">Mechanical characterization of a novel biomimetic artificial disc for the cervical spine.</a> J Mech Behav Biomed Mater. 142, 105808(2023).</li>
<li>Platt, S. R., Da Costa, R. C. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aPlatt%2C+SR+%22Cervical+vertebral+column+and+spinal+cord.Veterinary+surgery%3A+small+animal%22">Cervical vertebral column and spinal cord.Veterinary surgery: small animal</a>. , Elsevier. St. Louis. (2018).</li>
<li>Chin, K. R., Lubinski, J. R., Zimmers, K. B., Sands, B. E., Pencle, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+experience+and+two-year+follow-up+with+a+one-piece+viscoelastic+cervical+total+disc+replacement%5BTitle%5D)+AND+%22J+Spine+Surg%22%5BJournal%5D)">Clinical experience and two-year follow-up with a one-piece viscoelastic cervical total disc replacement.</a> J Spine Surg. 3 (4), 630-640 (2017).</li>
<li>Dicesare, J. A. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mechanical+failure+of+the+Mobi-C+implant+for+artificial+cervical+disc+replacement%3A+report+of+4+cases%5BTitle%5D)+AND+%22J+Neurosurg+Spine%22%5BJournal%5D)">Mechanical failure of the Mobi-C implant for artificial cervical disc replacement: report of 4 cases.</a> J Neurosurg Spine. 33 (6), 727-733 (2020).</li>
<li>Wang, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparative+study+between+Caspar+cervical+retractor+system+and+traditional+S+retractor+in+application+on+anterior+cervical+decompression+and+fixation%5BTitle%5D)+AND+%22Orthop+Surg%22%5BJournal%5D)">Comparative study between Caspar cervical retractor system and traditional S retractor in application on anterior cervical decompression and fixation.</a> Orthop Surg. 15 (2), 510-516 (2023).</li>
<li>Seo, J. H., Ju, C. I., Kim, S. W., Kim, J. K., Shin, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+efficacy+of+bone+cement+augmented+screw+fixation+for+the+severe+osteoporotic+spine%5BTitle%5D)+AND+%22Korean+J+Spine%22%5BJournal%5D)">Clinical efficacy of bone cement augmented screw fixation for the severe osteoporotic spine.</a> Korean J Spine. 9 (2), 79-84 (2012).</li>
</ol>

The authors have no conflicts of interest to declare.

The results of this cadaveric and in vivo goat animal model study demonstrate the precision and reproducibility of the described protocol for artificial disc implantation at the C4-C5 level in cervical spines. This study effectively evaluated the technical feasibility of the procedure, emphasizing the importance of imaging, specific customized instrumentation, and proper alignment of the implant, vertebral structures, and surgical approach during key surgical steps23.
A significant outcome of this study was the reliable creation of properly aligned keel channels and stable prosthesis placement. The systematic use of fluoroscopy during the surgical procedure ensured accuracy, particularly during trial disc placement and final prosthesis insertion. This imaging-based approach is meant to minimize the risk for misalignment, which has been reported as a potential complication in previous studies of artificial disc implantation24. Additionally, the application of the Caspar vertebral distractor provided a controlled and stable working space, allowing for precise disc material removal and keel channel preparation. Using Caspar vertebral distractor for artificial disc implantation closely mirrored approaches used in anterior cervical decompression and fixation, further supporting the translational potential of this protocol25.
Bone cement, particularly polymethyl methacrylate (PMMA), has been used often in treatments such as vertebroplasty and kyphoplasty to stabilize spinal compression fractures25. Bone cement has also been used to improve the fixation of pedicle screws in osteoporotic spines, since it has been proven to improve their stability in compromised bone26. In the current surgical technique, bone cement and titanium locking plates were used to increase stability by anchoring the prosthesis and limiting displacement, and allowing the assessment of long-term osseo-integration of the artificial disc fiber jacket mantle with the vertebral endplate. These precautions were implemented to enhance the implant's long-term integrity and ensure long-lasting spinal fixation. However, the additional use of bone cement and plate fixation will most likely increase the potential for implant-related complications such as increased stress on adjacent structures, impaired bone remodeling, foreign body reactions, or difficulties in revision surgery. Future artificial disc studies on long-term functional outcome should also focus on the necessity for this additional step to prevent keel migration. 
While this in vivo study in goats was primarily designed to assess the feasibility and short-term outcomes of artificial disc implantation, the results demonstrated successful implantation without any radiographic signs of infection, implant migration, or implant material disintegration over the 21-day postoperative period. Functional assessments were conducted to evaluate the short-term post-operative recovery of the animal, including neurologic recovery, pain response, mobility, and overall well-being, were monitored, and all four animals exhibited normal behavior, good appetite, and no signs of pain, lameness, or surgical site infection. These findings indicate that the described protocol is effective and well-tolerated in experimental goats. 
Potential troubleshooting strategies for common intraoperative issues (e.g., implant misalignment, difficulty in keel slot creation, or cement misapplication) were solved or prevented by precise preparation of the procedure on pre-operative imaging and measurement of intervertebral disc and vertebral dimensions and fluoroscopy. The method's efficiency, usability, and reproducibility was supported by repeated intra-operative checks with fluoroscopy and confirmed precise positioning in dorsal recumbency, supported the use of instruments customized to the size of the goat, and monitored all the surgical steps involving neck positioning, anatomical identification of the correct location, keel sawing, keel placement, implant placement, cement application, and plate fixation. 
Despite its strengths, this study is limited by its relatively short follow-up duration. While the 21-day period provided critical insights into early postoperative outcomes, long-term biomechanical stability, bone integration, and functional adaptation require further evaluation over extended periods. Additionally, the variations in individual anatomy, age, and bone density of animals may influence outcomes and should be considered in future studies. Although the biomechanical analysis of the original version of this artificial disc has already demonstrated its ability to mimic the complex kinetic of the natural disc21, the mechanical evaluation of the final version with the new inner core, has been completed, and the results will be published in a future long term-cohort study involving these four goats.
In conclusion, this study demonstrated the precision, reproducibility, and safety of the described artificial disc implantation protocol in an in vivo goat model. The findings suggest that this technique holds promise for motion-preserving cervical spine interventions and may serve as a valuable foundation for further translational research. Future studies should include the analysis of motion-preserving cervical spine interventions, along with longer follow-up periods and histopathological examination of spinal units are necessary to assess long-term implant stability and endplate osseointegration to determine safety and possible clinical use in dogs and ultimately in humans.

Worldwide, neck pain ranks as the fourth most common cause of disability, affecting over 30% of individuals annually1. Although commonly linked to aging and degenerative changes, neck pain can also occur in younger individuals and dogs due to genetic factors, lifestyle habits, and biomechanical strain. While neck pain may result from various factors, intervertebral disc (IVD) disease is among the most significant causes, particularly because of its role in compressing neural structures.
In the cervical spine, IVD disease leads to compressive cervical myelopathy (CCM), a well-recognized spinal disorder affecting both humans and dogs2,3. In humans, CCM manifests as neck pain, numbness, and motor dysfunction2. Similarly, large dog breeds like Great Danes and Doberman Pinschers are susceptible to cervical spondylomyelopathy (CSM), commonly known as Wobbler syndrome. CSM involves spinal cord compression due to disc protrusions, vertebral osseous changes, vertebral instability, and degenerative changes in ligaments and facet joints. Together, these factors cause spinal cord and nerve root compression, leading to the clinical signs such as an uncoordinated gait, especially in the hind limbs, along with weakness that may progress to the front limbs. Dogs may show neck pain, stiffness, and reluctance to lower their head, often displaying discomfort upon palpation4,5. The most commonly diagnosed form of Wobbler syndrome in dogs is disc-associated CSM primarily affecting the C4-C5, C5-C6, and C6-C7 spinal segments6.
Generally, human and dog patients suffering from disc-related CCM and CSM, respectively, respond well to conservative medical treatment, lifestyle modifications, and physiotherapy. Human and veterinary patients with advanced, degenerative forms of IVD disease in which significant compression of neural structures no longer responds to conservative strategies are treated surgically7,8. Conventional surgical techniques for cervical myelopathy, such as decompressive and distraction-stabilization procedures (spinal fusion) are commonly employed to relieve neural compression and restore spinal stability9,10. Although these surgical treatments can effectively relieve pain, they fail to restore spinal unit function and often result in accelerated degeneration or complete immobilization of the affected spinal segment. Furthermore, spinal fusion has been associated with the development of adjacent segment disease (ASD), as immobilization of the fused segments may lead to increased mechanical stress and accelerated degeneration at adjacent levels. Nevertheless, this association remains a subject of ongoing debate in the literature9,11.
Over the last two decades, intervertebral disc (IVD) replacement, known as cervical disc arthroplasty (CDA), using an artificial disc prosthesis, has been used to preserve segment mobility and has become an established option in human clinical practice following FDA approvals in the early 2000s12. In the preclinical phase, disc arthroplasty has been investigated extensively using experimental animal models such as goats, sheep, and dogs13,14,15. To date, the veterinary application of CDA in dogs is rare, and long-term follow-up studies are lacking. While a few studies have reported developing artificial discs to maintain segment mobility in dogs16,17, recent evidence by Falzone et al. (2022) highlights important limitations. Their findings demonstrated a higher incidence and severity of subsidence in dogs treated with artificial discs (Adamo disc) compared to dogs undergoing distraction fixation. Clinical deterioration and the need for revision surgery were also more common in the animals treated with Adamo artificial discs, raising concerns about its long-term biomechanical performance18.
Although CDA has been approved for use in humans, and various generations of artificial discs are now available, several limitations make this technique challenging, particularly for younger patients who require long-term implant stability19. The most critical issues include migration, displacement, and subsidence of the artificial disc20. Consequently, a novel artificial disc (BioAID) has been developed based on the premise that mimicking the natural structure and biomechanics of the IVD may help preserve physiological loading patterns and reduce the risk of adjacent spinal segment disruption.
In this biomimetic artificial IVD (BioAID), the nucleus pulposus (NP) of the natural IVD is simulated by a viscoelastic inner core, the annulus fibrosus (AF) is represented by a tension-resistant ultra-high-molecular-weight polyethylene (UHMWPE) fiber jacket, and the connection between the IVD and adjacent vertebrae is replicated by titanium endplates with keels that ensure stability, anchorage, and resistance to migration. To evaluate its functionality, the implant relies on access to the ventral aspect of the neck, removal of the IVD, and the use of specialized surgical instruments specifically designed for artificial disc implantation. A custom-designed surgical approach, along with these specialized surgical instruments, is necessary due to the artificial disc's unique structural and functional characteristics, distinguishing it from conventional CDA systems. With the aim of translating the technique to clinical use in both human and veterinary patients, the present work provides a detailed manual for artificial disc implantation, outlining the surgical planning and method at the C4-C5 IVD level in a goat model - an animal frequently utilized in spinal research due to its anatomical relevance and accessibility.
The biomimetic artificial IVD is designed to mimic the structure and function of the natural disc (Figure 1A,B). The original design of this implant (refer to the TABLE OF MATERIALS) was composed of a gelatinous swelling hydrogel that simulates the nucleus pulposus, an ultra-high-molecular-weight polyethylene (UHMWPE) membrane that embraced the hydrogel core, a hydroxyapatite coated high-tensile UHMWPE fiber jacket that represents the AF, and 3D-printed titanium endplates with keels (Figure 1C) that secure the disc to the adjacent vertebrae. Biomechanical evaluation of the original design of this novel artificial disc showed that it can mimic the kinematic behavior of the replaced intervertebral disc21. In the most recent version of this implant, the hydrogel inner core has been replaced by a viscoelastic material (polycarbonate polyurethane (PCU) (Figure 1D). The artificial disc implant first underwent plasma etching treatment and then sterilization using the Ethylene Oxide (EO) gas sterilization method (refer to the TABLE OF MATERIALS) and tested for sterility using aerobic/anaerobic bacterial growth (ABG) analysis.
<img alt="Biomedical implant diagram with fiber jacket, membrane, and endplate components; technical specs included." class="xfigimg" src="/files/ftp_upload/68623/68623fig1.jpg" data-altupdatedat="1783396841000" data-alt="Figure 1"> 
Figure 1: The design of the artificial disc implant. (A) Schematic cross-sectional view of the artificial disc implant. (B) Real images of the artificial disc implant. (C) Titanium endplate design with corresponding measurements. (D) Schematic representation of viscoelastic inner core. Adapted from Jacobs et al. (2023)21 with modifications. <a href="https://www.jove.com/files/ftp_upload/68623/68623fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Various imaging modalities were used throughout the study to ensure precise planning, guidance, and evaluation of implant placement. Preoperative imaging was critical for assessing anatomical structures and verifying implant suitability and fit. Intraoperative imaging aided in precise surgical execution and postoperative imaging was used to verify implant positioning and alignment. All imaging procedures were performed in accordance with institutional guidelines and radiation safety regulations.
Preoperative radiographic imaging was carried out with digital X-ray equipment (refer to the TABLE OF MATERIALS) to analyze anatomical structures and determine the size of the IVD space, which is needed for preoperative planning. Standard ventrodorsal and lateral radiographs were taken with proper positioning and exposure settings to provide the best image quality. During surgery, a C-arm fluoroscopy device (refer to the TABLE OF MATERIALS) was used to guide the procedure and confirm proper implant placement. A high-resolution CT scanner (refer to TABLE OF MATERIALS) was used to assess postoperative implant placement and anatomical alignment. For detailed examination, thin-slice axial images were acquired, allowing multiplanar reconstruction and three-dimensional visualization. To ensure accurate assessment of postoperative outcomes, image analysis was performed using specialized software (refer to the TABLE OF MATERIALS).
To provide a manual for artificial disc implantation, the protocol describes the preoperative management, anesthesia, surgical procedure, and postoperative care.

<table><tbody><tr><td>&lt;strong&gt;Laborotory of implants&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>3D Lab</td><td>University Medical Center Utrecht 3D, Utrecht, Netherlands&amp;nbsp;</td><td></td><td>The laboratory responsible for designing the implantation device. [https://www.umcutrecht.nl/nl/3d-lab/] </td></tr><tr><td>&lt;strong&gt;Software&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Clideo.com</td><td>Clideo Ltd. , Cyprus</td><td></td><td>Online video editor and tools.</td></tr><tr><td>Materialise Mimics software version 25.1</td><td>Materialise, Leuven, Belgium</td><td></td><td>CT DICOM data processing</td></tr><tr><td>3-Matic software version 17</td><td>Materialise, Leuven, Belgium</td><td></td><td>Software to design the implantation devices</td></tr><tr><td>RadiAnt DICOM Viewer (version 2024.2)</td><td>Medixant, Pozna&lt;img alt=&quot;Equation 1&quot; src=&quot;/files/ftp_upload/68623/68623eq1.jpg&quot; style=&quot;margin: auto;&quot;/&gt;, Poland</td><td></td><td>CT DICOM viewer</td></tr><tr><td>&lt;strong&gt;Implant manufacturer&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Amnovis</td><td>Amnovis, Aarschot, Belgium</td><td></td><td>Printing and postprocessing of the implantation instruments including the trail cages+ Saw guide [https://www.amnovis.com/]</td></tr><tr><td>3D-metal print&amp;nbsp;</td><td>3D-metal print production &amp;amp; engieering, Houlle, France</td><td></td><td>Printing and postprocessing of the BioAID titanium endplate. [https://www.3d-metalprint.com/]</td></tr><tr><td>OSYPKA AG</td><td>Rheinfelden, Germany</td><td></td><td>Ethylene Oxide (EO) sterilization of BioAID implant after assemblly, the implant is placed in an EO (8%) sterilizer. The sterilization cycle runs at a low temperature (38&amp;deg;-42&amp;deg;C) for 3 hours. [https://osypka.de/]</td></tr><tr><td>Empa</td><td>Emp, St.Gallen, Switzerland</td><td></td><td>Plasma Etching applying 2x 40 min Ar/O2 plasma, 16/4 sccm, 30 W, 4 Pa within a batch reactor [https://www.empa.ch/]</td></tr><tr><td>&lt;strong&gt;Implant component&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Bionate&amp;reg; 80A PCU</td><td>DSM Biomedical, Geleen, Netherlands</td><td>7006035</td><td>Hardbess average: 82.6, Molecular weight Mw: 385272 Da, PDI: 2.5, Tensile strenght: 8402.1 psi, Thickness&amp;nbsp; 1.8mm</td></tr><tr><td>UHMWPE membrane&amp;nbsp;</td><td>DSM Biomedical, Geleen, Netherlands</td><td></td><td>Thickness of 38 um, areal density of 5g/m2, Poresize of 0.9um</td></tr><tr><td>UHMWPE knitted fiber jacket&amp;nbsp;</td><td>Centexbel, Gr&amp;acirc;ce-Hollogne, Belgium</td><td></td><td>2/1 lapping, 8 stitch/cm</td></tr><tr><td>Ulteeva Purity&amp;trade;&amp;nbsp;</td><td>DSM Biomedical, Geleen, Netherlands</td><td></td><td>Ulteeva +HA,&amp;nbsp; SGX, dtex110, TS 100, formerly Dyneema Purity&amp;reg;</td></tr><tr><td>&lt;strong&gt;Instrument and machine&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>ProX DMP320&amp;nbsp;</td><td>3D systems, South Carolina, USA</td><td></td><td>Direct metal printing machine using selective laser melting technology&amp;nbsp;</td></tr><tr><td>Miele professional G 7826</td><td>Miele Nederland B.V., Vianen, Netherlands</td><td></td><td>The hygienic washing machine&amp;nbsp;</td></tr><tr><td>BLUE SEAL 100*360 mm</td><td>Interster, Wormerveer, Netherlands</td><td>3FKFB210819</td><td>The transparent sterilization laminate size 100*360 mm</td></tr><tr><td>MMM sterilizer OB10643</td><td>MMM Group, Planegg, Germany</td><td></td><td>Steam autoclave</td></tr><tr><td>Fluoroscopy model NZS 229</td><td>Philips, Eindhoven, Netherlands</td><td></td><td>Fluoroscopy</td></tr><tr><td>AGFA DR 600&amp;nbsp;</td><td>AGFA Valory, Belgium</td><td></td><td>X-Ray Machine</td></tr><tr><td>64-slice, Siemens SOMATOM Definition AS</td><td>Siemens Medical Solutions USA, Inc., USA</td><td></td><td>CT- scan Machine</td></tr><tr><td>Foley Catheter 10frx40cm with 10cc Balloon</td><td>Teleflex, USA</td><td>170605-12</td><td>Foley urine catheter size 12</td></tr><tr><td>Ioban 2</td><td>3M, MN, USA</td><td>6640EU</td><td>Iodine-impregnated surgical drape&amp;nbsp;</td></tr><tr><td>2.0 LeiLOX locking screw titanium</td><td>Rita Leibinger, BW, Germany</td><td>245-420-18</td><td>Titanium self tapping locking screw 2.4 mm.</td></tr><tr><td>PDS 2-0 with CP-1 needle</td><td>Johnson &amp;amp; Johnson Medical GmbH, Norderstedt, Germany</td><td>PDP466H</td><td>Polydioxanone plus antibacterial 2-0 (absorbable suture material)&amp;nbsp;</td></tr><tr><td>Monocryl 2-0 with Taperpoint Plus needle</td><td>Johnson &amp;amp; Johnson Medical GmbH, Norderstedt, Germany</td><td>MCP3170H</td><td>Poliglecaprone 25 plus antibacterial 2-0 (absorbable suture material) with taperpoint plus needle</td></tr><tr><td>Monocryl 2-0 with Reverse Cutting needle</td><td>Johnson &amp;amp; Johnson Medical GmbH, Norderstedt, Germany</td><td>MCP4443H</td><td>Poliglecaprone 25 plus antibacterial 2-0 (absorbable suture material) with reverse cutting needle</td></tr><tr><td>Syncage C short holder</td><td>SYNTHES GMBH, Switzerland&amp;nbsp;</td><td>3,96,989</td><td>Special Holder for trial implant size 4.5.</td></tr><tr><td>Curion&amp;reg; CuriBag urine bag (2-liter), 25 pieces</td><td>Medeco BV, Netherlands</td><td>55902</td><td>110 cm tube and a cross valve</td></tr><tr><td>Shiley&amp;trade; Endotracheal Tube with TaperGuard&amp;trade; Cuff</td><td>Medtronic co. Minnesota, USA</td><td>18790S</td><td>Murphy Eye with Preloaded Stylet, 9.0 mm I.D., 12.1 mm O.D.</td></tr><tr><td>Collin Baby Self retaining retractor</td><td>Brun GmbH, Tuttlingen, Germany</td><td>BV329R</td><td>COLLIN (BABY) Abdominal Retr.self-retaining, complete retractor, 155 mm (6 1/8&quot;), with ball snap closure, cons. of BV328R, BV327R, BV326R</td></tr><tr><td>Metzenbaum Blunt-Tipped Scissors</td><td>Aesculap GmbH, Tuttlingen, Germany</td><td>BC601R</td><td>Metzenbaum scissors - Straight - blunt/blunt - 14.5 cm</td></tr><tr><td>Gelpi Retractor&amp;nbsp;</td><td>Wipro, Bengaluru, India</td><td>051-9970</td><td>HGIII set L=185mm</td></tr><tr><td>Gelpi Retractor&amp;nbsp;</td><td>Aesculap GmbH, Tuttlingen, Germany</td><td>BV996R</td><td>HGIII set L=135mm</td></tr><tr><td>Beaver Blade Handle&amp;nbsp;</td><td>Vet spectrum, Lyon, France</td><td>SAH.002544</td><td>size 4&#039;&#039;, baldes number: 64 and 65&amp;nbsp;</td></tr><tr><td>Synthes 2.0 mm Drill Bit</td><td>SYNTHES GMBH, Switzerland&amp;nbsp;</td><td>310.19</td><td></td></tr><tr><td>Kirschner&amp;nbsp; wiers</td><td>SYNTHES GMBH, Switzerland&amp;nbsp;</td><td>292.20</td><td>Synthes 2.0 mm KWIRE W/TROCAR POINT 150 mm</td></tr><tr><td>CASPAR, Vertebral distractor</td><td>KLS, Tuttlingen, Germany</td><td>SBH 110-740-02</td><td>left, short toothed bar: 110 mm</td></tr><tr><td>C-Lox&amp;nbsp; Spinal Curette&amp;nbsp;</td><td>Rita Leibinger, BW, Germany</td><td>134-0700-22</td><td>Stainless Steel 22cm</td></tr><tr><td>MTI Curette&amp;nbsp;</td><td>MTI, Ohio, USA</td><td></td><td>L= 8.8mm, Total L = 19mm, &lt;img alt=&quot;Equation 2&quot; src=&quot;/files/ftp_upload/68623/68623eq2.jpg&quot; style=&quot;margin: auto;&quot;/&gt;&amp;nbsp;curette 6.3mm, Curette hook 45&lt;img alt=&quot;Equation 3&quot; src=&quot;/files/ftp_upload/68623/68623eq3.jpg&quot; style=&quot;margin: auto;&quot;/&gt;</td></tr><tr><td>Chevalier Jackson Laryngeal Grasping Forceps&amp;nbsp;</td><td>Stryker, Michigan, USA</td><td>S35.43000</td><td>11.75&amp;Prime; 299MM</td></tr><tr><td>Scoville Curette&amp;nbsp;</td><td>GerMedUSA, New York, USA</td><td>G46-1502</td><td>10&quot; Down</td></tr><tr><td>Saw blade</td><td>DePuy Synthes, Indiana, USA</td><td>519.104S</td><td>Usable Length: 50mm, Cut thickness: 0.6mm, Width: 10mm</td></tr><tr><td>Orthopedic COLIBRI II</td><td>DePuy Synthes, Indiana, USA</td><td>5,32,101</td><td>Drill/Ossilating saw</td></tr><tr><td>PALACOS&amp;reg; R (bone cement)</td><td>Heraeus (Kulzer), Germany</td><td>K202475</td><td>High-viscosity bone cement&amp;nbsp;, radiopaque, coulred green</td></tr><tr><td>LeiLOX Ti alloy reconstruction plate</td><td>Rita Leibinger, BW, Germany</td><td>142-0220-04</td><td>4 holes. distance between 2 holes aprox. 9mm, Length= 32.95mm, Width max. = 5.95mm, Width min.= 3.6mm, Hight = 1.55mm&amp;nbsp;</td></tr><tr><td>Actimove Cerviroll</td><td>Ottobock, Duderstadt, Germany</td><td>72859-44</td><td>foam mantle around the neck (size Large)</td></tr><tr><td>&lt;strong&gt;Medications&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Dexdomitor 0.5 mg/ml</td><td>Orion Corporation, Espoo, Finland</td><td>EU/2/02/033/001-002</td><td>Dexmedetomidine hydrochloride 0.5 mg/ml for injection (10ml)&amp;nbsp;</td></tr><tr><td>Buprenorfine 20um/hours plaster</td><td>SANDOZ BV, Almere, Netherlands</td><td>RVG 114802</td><td>Transdermal patch</td></tr><tr><td>Propofol 20 mg/ml</td><td>Fresenius Kabi Nederland b.v., Huis ter Heide, Netherlands</td><td>RVG 110811</td><td>Propofol 20 mg/ml emulsion for injection or infusion (50ml)&amp;nbsp;</td></tr><tr><td>Flunixin meglumine 50mg/ml</td><td>&amp;nbsp;Laboratories Calier S.A., Les Franqueses del Vall&amp;egrave;s, Spian</td><td>ES/V/0127/001</td><td>Bottle 100 ml, QM01AG90 - Flunixin</td></tr><tr><td>Neopen&amp;reg;</td><td>MSD intervet, Boxmeer, Nethehrlands</td><td>REG NL 1556</td><td>Neomycin (100mg/ml)-Procaine Benzylpenicillin (200mg/ml)</td></tr><tr><td>Remifentanil 2mg</td><td>Mylan B.V., Amstelveen, Netherlands</td><td>RVG 104757</td><td>REMIFENTANIL HYDROCHLORIDE 2.19 mg/vial COMPOSITION corresponding to REMIFENTANIL 2 mg/vial</td></tr><tr><td>Betadine shampoo</td><td>Mylan B.V., Amstelveen, Netherlands</td><td>RVG 08943</td><td>Povidone-iodine 75 mg/ml (120ml)</td></tr><tr><td>Betadine oplossing</td><td>Mylan B.V., Amstelveen, Netherlands</td><td>RVG 01331&amp;nbsp;</td><td>Povidone-iodine solution 100mg/ml (500ml)</td></tr><tr><td>Amoxicillin / Clavulanic acid</td><td>SANDOZ BV, Almere, Netherlands</td><td>RVG 29725</td><td>Containing 500mg of Amoxicillin and 50 mg of Clavulanic acid (powder)</td></tr><tr><td>HiBiScrub</td><td>M&amp;ouml;lnlycke Health Care AB., Utrecht, Netherlands</td><td>RVG 10156</td><td>Chlorhexidine digluconate 40 mg/ml (500ml)</td></tr><tr><td>Chlorhexidine 0.5% in alcohol 70%&amp;nbsp;spray (magneta)</td><td>ADDED PHARMA, Oss, Netherlands</td><td>ROL. 1642783</td><td>Chlorhexidine 0.5% in alcohol 70%&amp;nbsp;spray (250ml)</td></tr><tr><td>Cisatracurium 2mg/ml&amp;nbsp;</td><td>Hameln Pharma GmbH, Hameln, Germany</td><td>9266716</td><td>1 ml&amp;nbsp;contains: Cisatracurium besylate2.68 mg (equivalent to 2 mg cisatracurium)</td></tr></tbody></table>

surgical technique for the implantation of a biomimetic artificial intervertebral disc in a goat animal model

Surgical Technique for the Implantation of a Biomimetic Artificial Intervertebral Disc in a Goat Animal Model

Cervical disc arthroplasty (CDA) has emerged as a surgical solution for patients with degenerative compressive cervical myelopathy but faces limitations, particularly in achieving stable integration. One of the primary challenges with current artificial discs is the risk of migration and dislocation due to insufficient osseointegration with the adjacent vertebrae. While CDA is an established treatment in human medicine, dogs with cervical myelopathy are routinely treated with decompressive surgeries. In veterinary medicine, there is particular interest in innovative therapies, such as disc arthroplasty. Recently, a novel biomimetic artificial intervertebral disc (BioAID) was developed. This artificial disc replicates key features of the natural disc, incorporating a viscoelastic core and a tensile fiber jacket mimicking the nucleus pulposus and annulus fibrosus, respectively. Titanium endplates with keels secure fixation, and the fiber jacket facilitates osseointegration with the adjacent vertebrae to minimize the risk of migration over time.Since goats are a commonly used and readily available animal model for spine research, this study presents a comprehensive, hands-on guide (including the design and fabrication of the implant, selection and enrollment of experimental animals, preoperative management, anesthesia protocols, and postoperative care) for the implantation of the artificial disc device in the goat cervical spine. A detailed, step-by-step surgical methodology is provided, along with the design of custom surgical instruments and the use of imaging techniques required both intra- and post-operatively. This approach bridges the gap between experimental research and clinical application. The surgical procedure was successfully performed in four goats, with post-implantation monitoring over 21 days confirming no migration or complications. These findings suggest that the implantation technique ensures primary stability, supporting its feasibility for further evaluation. Future studies are needed to assess long-term osseointegration and biomechanical performance before translating this approach to clinical applications in both humans and dogs.

A cadaveric goat model was employed to familiarize the surgical team with the procedure before initiating the in vivo study. The cadaver protocol uses a goat cadaver model to allow spine researchers and surgeons to practice the surgical procedure of implanting a novel artificial intervertebral disc into the C4-C5 intervertebral space in a realistic, operating room-like environment. The X-ray imaging was performed on a cadaver to confirm the absence of any significant damage to the artificial disc implant and bony endplates after implantation (Supplementary Figure S1E). To enhance the realism of the surgical training set, a fresh whole goat cadaver was used, allowing for precise placement on the operating table while maintaining the natural color, texture, and firmness of the tissues. Each step of the surgical procedure exposed the region of interest in the cervical vertebrae and was performed according to standard neurosurgical practice22.
The in vivo study of artificial disc implantation in the 4 goats showed the successful execution of this protocol at the C4-C5 level in the goat animal model and yielded predictable outcomes in terms of surgical accuracy and immediate implant stability. Intra- and post-procedure imaging, such as fluoroscopy, radiography and CT, consistently verified precise placement of the prosthesis within the IVD space.
The use of intra-operative fluoroscopy during critical steps, such as insertion of the trial disc, positioning of the saw guide, and placement of the final artificial disc, ensured precision and prevented procedural errors. Upon completion of the sawing procedure, inspection of the prepared keel channels revealed clean and well-aligned keel tracks with no evidence of excessive burring or damage to the surrounding structures. The bone cement plugs adequately served as ventral blockage for keel migration in the channels, creating a stable foundation for the artificial disc prosthesis.
CT proved to be a valuable postoperative imaging method, allowing for multiplanar reconstructions that enabled precise assessment of the three-dimensional positioning of the implant with respect to the IVD space and vertebral endplates (Figure 7). Proper alignment of the artificial disc, restoration of disc height, and symmetrical keel channel preparation were achieved with minimal variation (Figure 7). In addition, the application of titanium locking plates effectively sealed the cemented plugs to prevent cement displacement.
Follow-up fluoroscopic imaging (24 h and 21 days post-implantation) further confirmed the position of the artificial disc and the structural integrity of the surrounding vertebrae (Figure 9).
<img alt="Goat surgery preparation and X-ray imaging; orthopedic procedure; veterinary science study." class="xfigimg" src="/files/ftp_upload/68623/68623fig9.jpg" data-altupdatedat="1783396841000" data-alt="Figure 9"> 
Figure 9: Postoperative follow-up of artificial disc implantation. (A-B) One of the implanted animals observed 24 h post-surgery, along with the corresponding fluoroscopic image, demonstrating signs of adequate pain management and overall well-being, such as normal posture. (C-D) The same animal evaluated 21 days after implantation, with a fluoroscopic image confirming the secure placement of the implant. <a href="https://www.jove.com/files/ftp_upload/68623/68623fig9large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
The functional outcomes, including neurologic recovery and mobility, were evaluated over the 21-day period following implantation in all four goats. Throughout this period, all animals exhibited normal behavior, maintained a good appetite, and showed no signs of pain or neurological deficits or lameness. Furthermore, no signs of surgical site infection were observed in any of the four goats throughout the 21-day post-implantation period based on clinical signs such as normal body temperature, absence of swelling, redness, or discharge at the surgical site, stable appetite, normal behavior, and lack of lameness or systemic illness (Supplementary video S1 and Supplementary video S2).
Supplementary Figure S1: Cadaveric goat cervical disc arthroplasty using the artificial disc implant in the C4-C5 intervertebral disc space to assess the feasibility of the implantation technique. The procedure involved the following steps: (A) Discectomy and creation of channels in the bony endplates in line with the midline ventral vertebral crest (green arrow heads). (B) Implantation of the artificial disc device. (C) Expansion of the created channels using an electrically powered burr (yellow arrow). (D) Insertion of bone cement into the channels (black arrow), followed by coverage with a titanium plate to prevent extrusion of the bone cement plug. (E) Ventrodorsal (left) and lateral (right) radiographic views obtained post-implantation of the artificial disc and application of bone cement, but before placement of the titanium plate over the bone cement plugs. The keels of the titanium endplate (red arrows) of the artificial disc device are positioned in the keel channels in each vertebral endplate. <a href="https://www.jove.com/files/ftp_upload/68623/Supplementary%20Figure%20S1.tif" target="_blank">Please click here to download this File.</a>
Supplementary Video S1: The video footage showcases the animal three days after implantation of artificial disc. <a href="https://www.jove.com/files/ftp_upload/68623/Supplementary%20video%20S1.mp4" target="_blank">Please click here to download this File.</a>
Supplementary Video S2: The video, recorded 21 days after artificial disc implantation, captured the 4 experimental animals exhibiting normal behavior. <a href="https://www.jove.com/files/ftp_upload/68623/Supplementary%20video%20S2.mp4" target="_blank">Please click here to download this File.</a>

This study presents a novel surgical technique for implanting a biomimetic artificial intervertebral disc (BioAID). The method ensures precise placement and stability, aiming to restore cervical spine function using a goat model. This technique shows promise for clinical application in both human and canine patients suffering from cervical spine myelopathy.

Cervical disc arthroplasty (CDA) has emerged as a surgical solution for patients with degenerative compressive cervical myelopathy but faces limitations, ...

This study presents a novel surgical technique for implanting a biomimetic artificial intervertebral disc called the BioAID. The BioAID incorporates a viscoelastic core, a tensile fiber jacket, 3D printed titanium endplates, and unique instruments for disc replacement. To begin, position the anesthetized animal on the surgical table and make a ventral midline skin incision.Dissect through the subcutis and the platysma muscle. Separate and retract the muscle bellies of the sternohyoideus and sternomastoideus in the midline. Then perform blunt dissection to the right side of the trachea and gently retract the trachea with the esophagus to the left side.Now, laterally retract the right carotid sheath to the right side. Identify the sixth cervical vertebrae by palpating its left and right large transverse processes extending lateral-ventrally. Palpate the singular ventral process of the fifth cervical vertebra in the midline.Next, identify the singular ventral process of the fourth cervical vertebrae. Bluntly separate the longus colli muscles to expose the ventral surfaces of the fourth and fifth cervical vertebral bodies. Use two self-retaining Gelpi retractors to retract the longus colli muscle bellies and localize the C4, C5 disc space immediately caudal to the ventral spinous process of the fourth cervical vertebra.Then perform a limited partial discectomy with a beaver knife. Next, place marks on the midline halfway between the vertebral bodies C4 and C5 for the application of the Caspar distractor. Using a two millimeter drill bit attached to a low speed drill, make a pilot hole on the marks, progressing through cis cortex and into the cancellous bone.Insert two 2.5 millimeter K-wires into the pilot holes using a low speed drill. Now, use fluoroscopy to confirm the correct placement of the K-wires, alignment with the C4, C5 disc space, and absence of involvement of the trans cortex. Then connect the Caspar vertebral distractor to the K-wires on the C4 and C5 vertebral bodies.Use a Spinal Curette and Chevalier Jackson grasping forceps to completely empty the dorsoventral central midline portion of the intervertebral disc. Carefully debride the cartilaginous endplates using a Scoville Disc Curette. Next, insert the trial disc without keels to assess the proper artificial disc placement and confirm placement using fluoroscopy.Then remove the trial disc without keels. Connect the saw guide to the holder and insert it into the prepared space. After confirming the correct insertion of the saw guide, disconnect and remove the holder.Line up a 0.6 millimeter thick saw blade with the ventral midline vertebral crest of C4 and C5 within the open slot of the saw guide and start sawing using an oscillating sawing machine. Stop sawing when the blade contacts the closed dorsal titanium side of the slot. With the saw blade inserted, perform fluoroscopy.Next, reconnect the holder to the saw guide and carefully remove the saw guide while maintaining distraction with the Caspar retractor. Insert the trial disc with keels into the disc space and ensure proper placement. Use fluoroscopy to confirm the alignment.Remove the trial disc with keels and unpack the artificial disc device. Now, press the ventral side of the artificial disc fiber jacket firmly into the disc insert holder and push the artificial disc into the prepared disc space. Use fluoroscopy to confirm correct artificial disc placement and seating of the dorsal and ventral keels on both cranial and caudal sides.Then release the distraction on the Caspar distractor. Next, remove the Caspar distractor and the 2.5 millimeter K-wires. With a high speed one to two millimeter burr, create a round hole with a diameter of five millimeters within the ventral saw slit caudally on C4 and cranially on C5.Finally, prepare the bone cement according to the manufacturer's instructions.Apply the bone cement into the channel holes and allow it to cure for approximately 10 minutes. Use two plates of two millimeter titanium with three holes to cover the cemented channels and fixate each plate with two two millimeter locking screws. In vivo implantation of the artificial disc at the C4, C5 level in goats showed accurate placement and immediate stability as confirmed by intra and postoperative imaging.Computed tomography imaging enabled multiplanar views that confirmed proper alignment of the artificial disc with the intervertebral disc space and vertebral endplates, restoration of disc height, and symmetrical keel channel preparation. Follow up fluoroscopy at 24 hours and 21 days post-implantation confirmed the artificial discs maintained position and the integrity of the surrounding vertebrae. Our disc replacement research provides a safe implantation protocol for a biomimetic artificial disc demonstrating secure fixation and rapid recovery.The future research of this novel artificial disc will focus on osseointegration, implant stability, tissue response, and long-term biomechanical performance.

surgical-technique-for-implantation-biomimetic-artificial

Research

JoVE Journal

Biology

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Learn a novel surgical technique for implanting the BioAID biomimetic artificial intervertebral disc using a goat model. This method demonstrates accurate placement, immediate stability, and potential for clinical applications in cervical spine repair.

Surgical Technique for the Implantation of a Biomimetic Artificial Intervertebral Disc in a Goat Animal Model

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