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Peer-reviewedCC BY 4.0Orthopaedic Surgery

Effect of Keeping Caspar Retractor During Prestige LP Cervical Disc Implantation on Intra‐ and Postoperative Outcomes

  • Xiaoqiang Zhao1
  • Xiao Yang1
  • Minghe Yao1
  • Kangkang Huang1
  • Tingkui Wu1
  • Shihao Chen1
  • Yi Deng1
  • Hao Liu1
  • Beiyu Wang1
  1. 1Department of Orthopedic Surgery, West China Hospital Sichuan University Chengdu Sichuan China
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Abstract

Objectives: Implantation of the Prestige LP prosthesis requires substantial endplate modification and insertion forces, yet the manufacturer's guide recommends relaxing or completely removing the Caspar retractor before implantation, which we observed to cause vertebral instability during endplate preparation and prosthesis insertion. This study aimed to evaluate the effect of retaining the Caspar retractor during Prestige LP cervical disc implantation.

Methods: A total of 55 patients who underwent cervical disc arthroplasty (CDA) between January and December 2025 were retrospectively reviewed. The retractor group maintained the retractor during endplate preparation and prosthesis implantation, while the no‐retractor group removed it after discectomy. Clinical outcomes and radiographic parameters were assessed preoperatively, intraoperatively, and at 1 week, 3 months, and 6 months postoperatively. Statistical analyses were performed using two‐way repeated‐measures ANOVA, paired and independent t‐tests, Mann–Whitney U test, and Chi‐square test.

Results: Clinical outcomes were similar in both groups. The retractor group demonstrated superior intraoperative stability with reduced functional spinal unit (FSU) Cobb angle fluctuations (p = 0.001), fewer fluoroscopy exposures (p = 0.044), and shorter prosthesis implantation times (p = 0.017). The retractor group received significantly larger prostheses (p < 0.001). Postoperatively, the retractor group exhibited greater FSU height, disc height, and larger interfacet distance (all p < 0.005) but these differences diminished by 6 months. The retractor group also showed smaller bone–implant interface gap (p = 0.003) at 1 week, and more segmental range of motion (p < 0.008) and FSU height loss (p = 0.002) at 6 months. Subsidence and heterotopic ossification rates were comparable between groups.

Conclusion: During Prestige LP implantation in CDA, retaining the Caspar retractor enhanced intraoperative stability, improved prosthesis placement accuracy, and reduced fluoroscopy use, achieving comparable clinical outcomes. While associated with greater FSU height loss at 6 months, it did not increase complications, supporting its viability as a standard technical modification for Prestige LP implantation.

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Cite

BibTeXRIS
BibTeX
@article{zhao2026effect,
  title = {{Effect of Keeping Caspar Retractor During Prestige LP Cervical Disc Implantation on Intra‐ and Postoperative Outcomes}},
  author = {Xiaoqiang Zhao and Xiao Yang and Minghe Yao and Kangkang Huang and Tingkui Wu and Shihao Chen and Yi Deng and Hao Liu and Beiyu Wang},
  journal = {Orthopaedic Surgery},
  year = {2026},
  month = sep,
  doi = {10.1111/os.70438},
  url = {https://doi.org/10.1111/os.70438},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Effect of Keeping Caspar Retractor During Prestige LP Cervical Disc Implantation on Intra‐ and Postoperative Outcomes
AU  - Xiaoqiang Zhao
AU  - Xiao Yang
AU  - Minghe Yao
AU  - Kangkang Huang
AU  - Tingkui Wu
AU  - Shihao Chen
AU  - Yi Deng
AU  - Hao Liu
AU  - Beiyu Wang
PY  - 2026
DA  - 2026/09/24
JO  - Orthopaedic Surgery
DO  - 10.1111/os.70438
UR  - https://doi.org/10.1111/os.70438
AB  - Objectives: Implantation of the Prestige LP prosthesis requires substantial endplate modification and insertion forces, yet the manufacturer's guide recommends relaxing or completely removing the Caspar retractor before implantation, which we observed to cause vertebral instability during endplate preparation and prosthesis insertion. This study aimed to evaluate the effect of retaining the Caspar retractor during Prestige LP cervical disc implantation.  Methods: A total of 55 patients who underwent cervical disc arthroplasty (CDA) between January and December 2025 were retrospectively reviewed. The retractor group maintained the retractor during endplate preparation and prosthesis implantation, while the no‐retractor group removed it after discectomy. Clinical outcomes and radiographic parameters were assessed preoperatively, intraoperatively, and at 1 week, 3 months, and 6 months postoperatively. Statistical analyses were performed using two‐way repeated‐measures ANOVA, paired and independent t‐tests, Mann–Whitney U test, and Chi‐square test.  Results: Clinical outcomes were similar in both groups. The retractor group demonstrated superior intraoperative stability with reduced functional spinal unit (FSU) Cobb angle fluctuations (p = 0.001), fewer fluoroscopy exposures (p = 0.044), and shorter prosthesis implantation times (p = 0.017). The retractor group received significantly larger prostheses (p < 0.001). Postoperatively, the retractor group exhibited greater FSU height, disc height, and larger interfacet distance (all p < 0.005) but these differences diminished by 6 months. The retractor group also showed smaller bone–implant interface gap (p = 0.003) at 1 week, and more segmental range of motion (p < 0.008) and FSU height loss (p = 0.002) at 6 months. Subsidence and heterotopic ossification rates were comparable between groups.  Conclusion: During Prestige LP implantation in CDA, retaining the Caspar retractor enhanced intraoperative stability, improved prosthesis placement accuracy, and reduced fluoroscopy use, achieving comparable clinical outcomes. While associated with greater FSU height loss at 6 months, it did not increase complications, supporting its viability as a standard technical modification for Prestige LP implantation.
SN  - 1757-7853
SN  - 1757-7861
ER  -