**2.1 Prestige**

The technology from the early designs of Cummins et al was acquired by Medtronic Sofamor Danek (Memphis, Tennessee) and rebadged Prestige. With Prestige I, the initial ball and socket design which was entirely fabricated from stainless steel, was converted to a ball and trough design, allowing limited translation. The anterior flanges were diminished in size and a locking screw added to prevent bone screw backout. Prestige II was further modified by again reducing the anterior flange and modifying the endplates to allow bone ingrowth. Prestige ST was the design evaluated in the United States as part of the Food and Drug Administration (FDA) investigational device evaluational (IDE) study. This arthroplasty incorporates the features of Prestige II with further shortened anterior flanges. The final design is Prestige LP, a major change from its predecessors. Instead of stainless steel, the Prestige LP is made from a titanium ceramic composite, preserving the ball and trough bearing design. It has a titanium plasma spray on the endplates for bone ingrowth, as well as two pairs of rails allowing immediate fixation. The flange and locking bone screws have been removed. The Prestige LP, being made of titanium, has a better compatibility than stainless steel in MRI imaging. (Figure 1)

(Courtesy of Medtronic Sofamor Danek, Memphis, Tennessee)

Fig. 1. Prestige Cervical Disc evolution

these first three devices have been developed, the number of cervical disc arthroplasties has

It is beyond the scope of this chapter to catalogue all of the cervical disc arthroplasties

The technology from the early designs of Cummins et al was acquired by Medtronic Sofamor Danek (Memphis, Tennessee) and rebadged Prestige. With Prestige I, the initial ball and socket design which was entirely fabricated from stainless steel, was converted to a ball and trough design, allowing limited translation. The anterior flanges were diminished in size and a locking screw added to prevent bone screw backout. Prestige II was further modified by again reducing the anterior flange and modifying the endplates to allow bone ingrowth. Prestige ST was the design evaluated in the United States as part of the Food and Drug Administration (FDA) investigational device evaluational (IDE) study. This arthroplasty incorporates the features of Prestige II with further shortened anterior flanges. The final design is Prestige LP, a major change from its predecessors. Instead of stainless steel, the Prestige LP is made from a titanium ceramic composite, preserving the ball and trough bearing design. It has a titanium plasma spray on the endplates for bone ingrowth, as well as two pairs of rails allowing immediate fixation. The flange and locking bone screws have been removed. The Prestige LP, being made of titanium, has a better

proliferated. The literature in this nascent field is limited, but growing each year.

available; the devices with the most clinical experience will be discussed.

compatibility than stainless steel in MRI imaging. (Figure 1)

**PRESTIGE® II**

**PRESTIGE® ST**

1998 1999 2002 2003 2004

**PRESTIGE® STLP**

**PRESTIGE® LP**

**PRESTIGE ® I**

1991 1998

Fig. 1. Prestige Cervical Disc evolution

(Courtesy of Medtronic Sofamor Danek, Memphis, Tennessee)

**2. Types of cervical disc arthroplasty** 

**2.1 Prestige** 

**Bristol/Cummins**
