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Chen CM, Yang JJ, Wu CC. Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3203. [PMID: 38892914 PMCID: PMC11173267 DOI: 10.3390/jcm13113203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.
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Affiliation(s)
| | | | - Chia-Chun Wu
- Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
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Hirvonen T, Hämäläinen M, Konsti J, Antinheimo J, Numminen J, Siironen J, Koski-Palkén A, Niemelä M. Comparable long-term outcomes in patients undergoing total disc replacement or anterior cervical discectomy and noninstrumented fusion. Spine J 2023; 23:1817-1829. [PMID: 37660896 DOI: 10.1016/j.spinee.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past 2 decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of developing ASD. However, since the method was first introduced in the early 2000s, the long-term outcome after it is still not completely understood. PURPOSE Our goal was to compare the long-term outcomes of TDR and ACDF procedures. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease. OUTCOME MEASURES The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological outcomes, and employment status. METHODS The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least 2 years after index surgery. RESULTS The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p=.096, ns.). Total disc replacement patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs 1.3%, p=.026). None of the TDR patients underwent further cervical surgery more than 6 years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically nonsignificant. TDR was significantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group. CONCLUSIONS There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically nonsignificant. However, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them.
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Affiliation(s)
- Tuomas Hirvonen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
| | - Mathias Hämäläinen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Juho Konsti
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Antinheimo
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Numminen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jari Siironen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Anniina Koski-Palkén
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Mika Niemelä
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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Preston G, Hoffmann J, Satin A, Derman PB, Khalil JG. Preservation of Motion in Spine Surgery. J Am Acad Orthop Surg 2023; 31:e356-e365. [PMID: 36877764 DOI: 10.5435/jaaos-d-22-00956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 03/07/2023] Open
Abstract
The number of spinal procedures and spinal fusions continues to grow. Although fusion procedures have a high success rate, they have inherent risks such as pseudarthrosis and adjacent segment disease. New innovations in spine techniques have sought to eliminate these complications by preserving motion in the spinal column. Several techniques and devices have been developed in the cervical and lumbar spine including cervical laminoplasty, cervical disk ADA, posterior lumbar motion preservation devices, and lumbar disk ADA. In this review, advantages and disadvantages of each technique will be discussed.
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Affiliation(s)
- Gordon Preston
- From the Cleveland Clinic Akron General Medical Center, Akron, OH (Preston and Hoffmann), Texas Back Institute, Plano, TX (Satin and Derman), and William Beaumont Hospital, Royal Oak, MI (Khalil)
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Tu TH, Wang CY, Chen YC, Wu JC. Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions. J Neurosurg Spine 2023; 38:372-381. [PMID: 36681966 DOI: 10.3171/2022.11.spine22880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.
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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Ching-Ying Wang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Yu-Chun Chen
- 2Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
- 4Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
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Chambers JS, Kropp RG, Gardocki RJ. Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion. Arch Orthop Trauma Surg 2023; 143:265-268. [PMID: 34244874 DOI: 10.1007/s00402-021-04056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purposes of this study were to identify the 2 year rate of reoperation and determine patient-reported outcomes after elective one- and two-level anterior cervical discectomy and fusion (ACDF) with structural allograft and anterior plating using indications similar to cervical disc arthroplasty. MATERIALS AND METHODS A retrospective chart review was performed on 116 consecutive one- and two-level primary ACDF for adult degenerative disease with structural allograft and anterior plating in one surgeon's practice. Patient-reported visual analog score (VAS), Oswestry disability index (ODI) and radiographs, collected prospectively on all operative patients preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years were reviewed. Patient demographics and reoperation rates were obtained from the chart. RESULTS One hundred and four patients were identified with a final reoperation rate of 2.9% at a mean final follow-up 2 years (95% CI 17.2-29.0). No reoperations occurred within 90 days. After 1 year, three patients required reoperation. The mean patient-reported outcomes improved (VAS, 6.6 preoperatively to 3.0 at final follow-up and ODI, 24.3 preoperatively to 12.3 at final follow-up). These improvements were statistically significant (p < 0.01). No significant patient risk factors for reoperation were found. CONCLUSIONS The rate of reoperation for one- and two-level anterior cervical discectomy and fusion at follow-up was found to be lower than those previously published in the literature quoted for CDA. Arthrodesis continues to demonstrate improvements in patient-reported outcomes.
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Affiliation(s)
- James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee/Campbell Clinic, Memphis, TN, USA
| | - Robert G Kropp
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA
| | - Raymond J Gardocki
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA.
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Shin JJ, Kim KR, Son DW, Shin DA, Yi S, Kim KN, Yoon DH, Ha Y, Riew KD. Cervical disc arthroplasty: What we know in 2020 and a literature review. J Orthop Surg (Hong Kong) 2021; 29:23094990211006934. [PMID: 34581615 DOI: 10.1177/23094990211006934] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA's two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, 37991Yonsei University School of Medicine, Yongin, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, International St Mary's Hospital, 54671Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, 194197Pusan National University Yangsan Hospital, School of Medicine, Yangsan, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Do-Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea.,POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - K Daniel Riew
- Department of Orthopedic Surgery, 5798Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Kim K, Hoffman G, Bae H, Redmond A, Hisey M, Nunley P, Jackson R, Tahernia D, Araghi A. Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial. Neurosurgery 2021; 88:497-505. [PMID: 33372218 DOI: 10.1093/neuros/nyaa459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.
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Affiliation(s)
- Kee Kim
- Department of Neurological Surgery, UC Davis Health, Sacramento, California
| | | | - Hyun Bae
- The Spine Institute, Santa Monica, California
| | | | | | | | - Robert Jackson
- Orange County Neurosurgical Associates, Laguna Hills, California
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Schroeder GD, Vaccaro AR, Divi SN, Reyes AA, Goyal DKC, Phillips FM, Zigler J. 2021 Position Statement From the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement. Int J Spine Surg 2021; 15:37-46. [PMID: 33900955 DOI: 10.14444/8004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ariana A Reyes
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dhruv K C Goyal
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Frank M Phillips
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Deng Y, Li G, Liu H, Hong Y, Meng Y. Mid- to long-term rates of symptomatic adjacent-level disease requiring surgery after cervical total disc replacement compared with anterior cervical discectomy and fusion: a meta-analysis of prospective randomized clinical trials. J Orthop Surg Res 2020; 15:468. [PMID: 33046082 PMCID: PMC7549243 DOI: 10.1186/s13018-020-01957-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background Thus far, no meta-analysis focusing on the mid- to long-term incidence of adjacent segment disease requiring surgery after cervical total disc replacement and anterior cervical discectomy and fusion has been published yet. This study aimed to compare mid- to long-term rates of symptomatic adjacent-level disease requiring surgery after cervical disc replacement and anterior cervical fusion. Methods A meta-analysis was performed, and only randomized controlled trials with a follow-up period of more than 48 months reporting rates of symptomatic adjacent-level disease requiring surgery after cervical total disc replacement and anterior cervical discectomy and fusion were included. Results The analysis revealed that the overall rate of symptomatic adjacent-level disease requiring surgery in the cervical disc replacement group was significantly lower than that of the anterior cervical fusion group at 48–120 months’ follow-up. The subgroup analysis of different follow-up periods also yielded the same results. The rate of symptomatic adjacent-level disease requiring surgery in the cervical disc replacement group using unrestricted prosthesis was significantly lower than that of the anterior cervical fusion group (p < 0.001); however, the cervical disc replacement group using semi-restricted prosthesis showed no statistical difference compared with the fusion group. Conclusions Our review suggests that cervical disc replacement is preferable to anterior cervical fusion in reducing the incidence of symptomatic adjacent-level disease requiring surgery at mid- to long-term follow-up. A review of the literature also demonstrated that randomized controlled trials investigating the rate of symptomatic adjacent-level disease requiring surgery were insufficient; therefore, studies focusing on this subject with longer-term follow-up are warranted.
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Affiliation(s)
- Yifei Deng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Guangzhou Li
- Division of Spine Surgery, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Luzhou, 646000, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Ying Hong
- Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
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Nunley PD, Kerr EJ, Cavanaugh DA, Utter PA, Campbell PG, Wadhwa R, Frank KA, Marshall KE, Stone MB. Adjacent Segment Pathology After Treatment With Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion, Part 2: Clinical Results at 7-Year Follow-Up. Int J Spine Surg 2020; 14:278-285. [PMID: 32699748 DOI: 10.14444/7037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Adjacent segment pathology (ASP) following cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF) is identified by imaging (RASP) or clinical symptoms (CASP). Clinical symptoms of CASP have been broadly defined, but subsequent adjacent-level surgeries are clear indicators of CASP. Current literature remains inconsistent in the incidence and potential predictors of CASP. Here, we will evaluate a robust data set for the incidence of CASP resulting in subsequent surgery, attempt to identify factors that might affect CASP, and analyze the association of CASP with patient-reported outcomes (PROS) and RASP. Methods Data were prospectively collected during a US Food and Drug Administration randomized, multicenter, investigational device exemption trial comparing CDA (Mobi-C, Zimmer Biomet, Westminster, CO) with ACDF. CASP was defined as any adjacent-level subsequent surgical intervention. Post hoc analyses were conducted on the incidence, time to CASP diagnosis, and relationship of CASP with patient demographics. Longitudinal retrospective case-control analysis was used to assess the correlation of CASP to PROs and radiographic adjacent segment pathology (RASP). Results Kaplan-Meier estimates indicated significantly lower probability of CASP over time for 1-level (P = .002) and 2-level (P = .008) CDA patients. Treatment with ACDF and younger age were associated with higher CASP risk. CDA was more effective than ACDF (70.5%; 95% CI = 45.1, 84.2; P < .0001) at preventing CASP. Case-control analysis indicated increased probability of CASP for patients with grade 3/4 RASP, but the difference was not statistically significant. When we pooled CASP patients, the median grade of RASP at the visit prior to surgery was 1, with only 6 patients presenting with grade 3/4 RASP. Conclusions Patients treated with CDA have a lower incidence of CASP than do patients treated with ACDF, although the mechanism remains unclear. CASP and RASP remain uncorrelated in this large data set, but other predictive variables such as treatment, age, and number of levels should be further investigated.
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Affiliation(s)
| | | | | | | | | | - Rishi Wadhwa
- Spine Institute of Louisiana, Shreveport, Louisiana
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Zigler JE, Guyer RD, Blumenthal SL, Ohnmeiss DD. Analysis of re-operations after cervical total disc replacement in a consecutive series of 535 patients receiving the ProDisc-C device. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2683-2687. [DOI: 10.1007/s00586-020-06399-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/27/2020] [Indexed: 12/01/2022]
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Gornet MF, Burkus JK, Shaffrey ME, Schranck FW, Copay AG. Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level. J Neurosurg Spine 2020; 31:317-325. [PMID: 31075769 DOI: 10.3171/2019.2.spine1956] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/25/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Food and Drug Administration-approved investigational device exemption (IDE) studies have provided level I evidence supporting cervical disc arthroplasty (CDA) as a safe and effective alternative to anterior cervical discectomy and fusion (ACDF). Long-term CDA outcomes continue to be evaluated. Here, the authors present outcomes at 10 years postoperatively for the single-level CDA arm of an IDE study (postapproval study). METHODS The primary endpoint was overall success, a composite variable composed of five criteria: 1) Neck Disability Index score improvement ≥ 15 points; 2) maintenance or improvement in neurological status; 3) no decline in anterior or posterior functional spinal unit (FSU) height of more than 2 mm compared to 6 weeks postoperatively; 4) no serious adverse event (AE) caused by the implant or the implant and the surgical procedure; and 5) no additional surgery classified as a failure. Additional safety and effectiveness measures included numeric rating scales for neck pain and arm pain, SF-36 quality-of-life physical and mental components, patient satisfaction, range of motion, and AEs. RESULTS From the reported assessments at 7 years postoperatively to the 10-year postoperative follow-up, the scores for all patient-reported outcomes, rate of overall success (without FSU), and proportion of patients at least maintaining their neurological function remained stable for the CDA group. Nine patients had secondary surgery at the index level, increasing the secondary surgery cumulative rate from 6.6% to 10.3%. In that same time frame, four patients experienced a serious implant or implant/surgical procedure-related AE, for a 10-year cumulative rate of 7.8%. Seven patients had any second surgery at adjacent levels, for a 10-year cumulative rate of 13.8%. Average angular motion at both the index and adjacent levels was well maintained without creating hypermobility. Class IV heterotopic ossification increased from 1.2% at 2 years to 4.6% at 7 years and 9.0% at 10 years. Patient satisfaction was > 90% at 10 years. CONCLUSIONS CDA remained safe and effective out to 10 years postoperatively, with results comparable to 7-year outcomes and with high patient satisfaction.Clinical trial registration no.: NCT00667459 (clinicaltrials.gov).
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Kuai S, Guan X, Li Y, Liu W, Xu Y, Zhou W. Influence of Deviated Centers of Rotation on Kinematics and Kinetics of a Lumbar Functional Spinal Unit: An In Vitro Study. Med Sci Monit 2019; 25:4751-4758. [PMID: 31280279 PMCID: PMC6610472 DOI: 10.12659/msm.915614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Center of rotation (COR) has been used for assessing spinal motion quality. However, the biomechanical influence of COR deviation towards different directions during flexion-extension (FE) remains largely unknown. This study aimed to investigate the alteration in the range of motion (ROM), compressive force, shear force, and neutral zone size (NZ) in a lumbar functional spinal unit (FSU), caused by the deviated COR in different directions during FE. Material/Methods Twelve human cadaveric lumbar FSUs (6 for L2–L3, 6 for L4–L5) were tested in a 6-degree-of-freedom servo-hydraulic load frame. These FSUs were firstly applied a 7.5 Nm pure moment to perform FE to obtain their natural COR during FE. Subsequently, they were subjected to FE around 9 established deviated CORs with 6 Nm cyclical loading. Results It was found that the ROM and NZ increased significantly when the COR moved from the superior plane to the inferior plane for the L2–L3 unit and when the COR located in the superior plane compared with the inferior plane for the L4–L5 unit. The compressive forces for both FSUs demonstrated significant changes caused by COR shift in the same horizontal plane, while the shear forces demonstrated significant changes caused by COR shift in the same vertical plane. Conclusions The ROM, NZ, and shear force of FSU are sensitive to the vertical COR shift, while the compressive force of FSU is highly sensitive to the horizontal COR shift. Additionally, the kinematics and kinetics of the L2–L3 unit are more sensitive to COR location than those of the L4–L5 unit.
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Affiliation(s)
- Shengzheng Kuai
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Department of Orthopedics, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China (mainland).,Department of Spine Surgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland).,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China (mainland)
| | - Xinyu Guan
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland)
| | - Yang Li
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland)
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing, China (mainland)
| | - Yunfeng Xu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Wenyu Zhou
- Department of Orthopedics, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China (mainland).,Department of Spine Surgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland)
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14
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Buser Z, Chung AS, Abedi A, Wang JC. The future of disc surgery and regeneration. INTERNATIONAL ORTHOPAEDICS 2018; 43:995-1002. [PMID: 30506089 DOI: 10.1007/s00264-018-4254-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/25/2018] [Indexed: 12/21/2022]
Abstract
Low back and neck pain are among the top contributors for years lived with disability, causing patients to seek substantial non-operative and operative care. Intervertebral disc herniation is one of the most common spinal pathologies leading to low back pain. Patient comorbidities and other risk factors contribute to the onset and magnitude of disc herniation. Spine fusions have been the treatment of choice for disc herniation, due to the conflicting evidence on conservative treatments. However, re-operation and costs have been among the main challenges. Novel technologies including cage surface modifications, biologics, and 3D printing hold a great promise. Artificial disc replacement has demonstrated reduced rates of adjacent segment degeneration, need for additional surgery, and better outcomes. Non-invasive biological approaches are focused on cell-based therapies, with data primarily from preclinical settings. High-quality comparative studies are needed to evaluate the efficacy and safety of novel technologies and biological therapies.
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Affiliation(s)
- Zorica Buser
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
| | | | - Aidin Abedi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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15
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Mojica‐Santiago JA, Lang GM, Navarro‐Ramirez R, Hussain I, Hӓrtl R, Bonassar LJ. Resorbable plating system stabilizes tissue-engineered intervertebral discs implanted ex vivo in canine cervical spines. JOR Spine 2018; 1:e1031. [PMID: 31463449 PMCID: PMC6686817 DOI: 10.1002/jsp2.1031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022] Open
Abstract
Total disc replacement using tissue-engineered intervertebral discs (TE-IVDs) may offer a biological alternative to treat radiculopathy caused by disc degeneration. A composite TE-IVD was previously developed and evaluated in rat tail and beagle cervical spine models in vivo. Although cell viability and tissue integration into host tissue were promising, significant implant displacement occurred at multiple spinal levels. The goal of the present study was to assess the effects of a resorbable plating system on the stiffness of motion segments and stability of tissue-engineered implants subjected to axial compression. Canine motion segments from levels C2/C3 to C5/C6 were assessed as intact (CTRL), after discectomy (Dx), with an implanted TE-IVD only (PLATE-), and with a TE-IVD combined with an attached resorbable plate (PLATE+). Segments under PLATE+ conditions fully restored separation between endplates and showed significantly higher compressive stiffness than segments under PLATE- conditions. Plated segments partially restored more than 25% of the CTRL motion segment stiffness. Plate attachment also prevented implant extrusion from the disc space at 50% compressive strain, and this effect was more significant in segments from levels C3/C4 when compared to segments from level C5/C6. These results suggest that stabilization of motion segments via resorbable plating assists TE-IVD retention in the disc space while allowing the opportunity for implants to fully integrate into the host tissue and achieve optimal restoration of spine biomechanics.
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Affiliation(s)
| | - Gernot M. Lang
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
- Department of Orthopaedic and Trauma SurgeryMedical Center‐Albert Ludwig University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Rodrigo Navarro‐Ramirez
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Roger Hӓrtl
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew York
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew York
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16
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Complications of Full-Endoscopic Versus Microendoscopic Foraminotomy for Cervical Radiculopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 114:217-227. [DOI: 10.1016/j.wneu.2018.03.099] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/19/2022]
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17
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Ghobrial GM, Lavelle WF, Florman JE, Riew KD, Levi AD. Symptomatic Adjacent Level Disease Requiring Surgery: Analysis of 10-Year Results From a Prospective, Randomized, Clinical Trial Comparing Cervical Disc Arthroplasty to Anterior Cervical Fusion. Neurosurgery 2018; 84:347-354. [DOI: 10.1093/neuros/nyy118] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- George M Ghobrial
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - William F Lavelle
- Department of Orth-opedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | | | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Allan D Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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18
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Biomechanical evaluation of cervical disc replacement with a novel prosthesis based on the physiological curvature of endplate. J Orthop Surg Res 2018; 13:41. [PMID: 29482611 PMCID: PMC5828121 DOI: 10.1186/s13018-018-0748-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/21/2018] [Indexed: 02/05/2023] Open
Abstract
Background Most of the current available cervical disc prostheses present a flat surface instead of an arcuate surface which is most similar to the morphology of cervical endplate. Therefore, we designed a novel prosthesis (Pretic-I, Trauson) based on the physiological curvature of the cervical endplate. Biomechanical evaluation of cervical disc replacement (CDR) with this novel prosthesis was performed and compared with the Prestige LP prosthesis. Methods Three motion segments of 18 cadaveric cervical specimens (C2-C7) were evaluated with a 75 N follower load. Overall, the biomechanics of three models, intact specimen, CDR with the novel prosthesis and CDR with the Prestige LP prosthesis, were studied to gain insight into the effective function of the novel prosthesis. The range of motion (ROM) of all three segments and intradiscal pressure (IDP) on adjacent levels were measured and analysed. Results Compared to the intact condition, the ROM of all three segments showed no significant difference in the replacement group. Moreover, there was also no significant difference in the ROM between the two prostheses. Besides, the IDP on the cranial adjacent level showed no obvious difference between the two prostheses; nevertheless, the IDP on the caudal adjacent level of the novel prosthesis was significantly less than the Prestige LP prosthesis. Conclusions In summary, the novel disc prosthesis was effective to maintain the ROM at the target segment and adjacent segments. Besides, CDR with the novel prosthesis could reduce the IDP on the caudal adjacent level to a certain extent, compared with the Prestige LP prosthesis. Electronic supplementary material The online version of this article (10.1186/s13018-018-0748-7) contains supplementary material, which is available to authorized users.
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19
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Wang Z, Zhou L, Lin B, Song K, Niu Q, Ren D, Tang J. Risk factors for non-fusion segment disease after anterior cervical spondylosis surgery: a retrospective study with long-term follow-up of 171 patients. J Orthop Surg Res 2018; 13:27. [PMID: 29394936 PMCID: PMC5797381 DOI: 10.1186/s13018-018-0717-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to investigate the incidence and causes of non-fusion segment disease (NFSD), both adjacent and non-adjacent to a fused segment, after anterior cervical arthrodesis. Methods This is a single-center study. Between January 1998 and January 2011, two surgeons’ 171 patients who had an anterior cervical decompression and fusion were followed clinically for more than 5 years. The correlation between the incidence of symptomatic non-fusion segment disease and the following clinical parameters (age at operation, fusion levels,) and radiological parameters (number of patients who had a plate, anterior cervical decompression and fusion (ACDF) or corpectomies, preoperative and postoperative cervical spine alignment, Pavlov’s ratio at the C5 level, and preoperative existence of a non-fusion segment degeneration on magnetic resonance imaging) was evaluated. Results Of the 171 patients reviewed, 16 patients had non-fusion segment disease (9.36%), of which 12 had adjacent segment disease and 4 had non-adjacent segment disease. Postoperative cervical lordosis in the non-fusion segment disease group was significantly smaller than that of the disease-free group (P < 0.001). Fusion levels in the NFSD group were 1.69 whereas 2.26 in disease-free group (P = 0.005). The incidences of disc degeneration in unfused segments was more severe in the NFSD group than in the disease-free group (P = 0.004). The results of binary logistic regression showed that the major factor affecting NFSD is postoperative cervical lordosis (P = 0.000) followed by disc degeneration (P = 0.024). The other parameters did not show a statistically significant difference. Conclusions The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. Postoperative cervical lordosis and disc degeneration in non-fusion segments were major factors in the incidence of NFSD.
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Affiliation(s)
- Ziqiang Wang
- Jinzhou Medical University, Jinzhou, 121001, People's Republic of China.,Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Liangliang Zhou
- Jinzhou Medical University, Jinzhou, 121001, People's Republic of China.,Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Bin Lin
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Keran Song
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Qinghe Niu
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Dongfeng Ren
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China.
| | - Jiaguang Tang
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China.
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20
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Nunley PD, Coric D, Frank KA, Stone MB. Cervical Disc Arthroplasty: Current Evidence and Real-World Application. Neurosurgery 2018; 83:1087-1106. [DOI: 10.1093/neuros/nyx579] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/07/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | | | - Marcus B Stone
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
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21
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Yang P, Li Y, Li J, Shen Y. Impact of T1 slope on surgical and adjacent segment degeneration after Bryan cervical disc arthroplasty. Ther Clin Risk Manag 2017; 13:1119-1125. [PMID: 28894375 PMCID: PMC5584913 DOI: 10.2147/tcrm.s138990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This retrospective study investigated an association between preoperative T1 slope and surgical and adjacent segment degeneration (SASD) after Bryan cervical disc arthroplasty (BCDA) in patients with cervical degenerative disc disease. METHODS Based on preoperative standing lateral radiographs, 90 patients were classified according to T1 slope that was higher or lower than the 50th percentile (high T1 or low T1, 28 and 62 patients, respectively). Patients were also classified as SASD or non-SASD (38 and 52 patients, respectively) determined by radiographs at final follow-up. Visual analog scale (VAS) and Neck Disability Index (NDI) scores for neck and arm pain were noted, and changes in the sagittal alignment of the cervical spine (SACS), functional spinal unit (FSU) angle, and FSU range of motion (ROM) were also noted. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for SASD. RESULTS The overall rate of SASD was 42.2% (38/90). The SACS, FSU angle, FSU ROM, and SASD rates of the high T1 and low T1 slope groups were significantly different at the last follow-up. The NDI and VAS scores of the high T1 slope group were significantly greater than those of the low T1 slope. The multivariate logistic regression analysis showed that high T1 slope and endplate coverage discrepancy (ie, residual space behind the prosthesis) were significant risk factors for SASD after BCDA. CONCLUSION High T1 slope and endplate coverage discrepancy were associated with SASD after BCDA. Patients with a high preoperative T1 slope have a smaller FSU angle and more neck pain after BCDA.
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Affiliation(s)
- Peng Yang
- Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan
| | - Yongqian Li
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Jia Li
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yong Shen
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
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22
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Skeppholm M, Henriques T, Tullberg T. Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2434-2440. [PMID: 28718168 DOI: 10.1007/s00586-017-5218-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate rates of secondary surgical interventions in a cohort treated with fusion (ACDF), artificial disc replacement (ADR) or a posterior surgical procedure (PP) because of a cervical degenerative pathology. METHODS 715 patients treated with any primary cervical surgical intervention between the years 2000 and 2010 were retrospectively evaluated regarding frequency of secondary surgery between the years 2000 and 2015, thus giving a follow-up time of minimum 5 years. Reasons for secondary surgery as well as choice of new intervention were evaluated. Data were collected from a single-center setting. RESULTS Follow-up rate was 94%. 79 (11%) patients in total underwent a new operation during follow-up. 50/504 (10%), 27/172 (15%), and 2/39 (5%) of the patients had a second surgical intervention in the ACDF, ADR, and PP groups, respectively. There was a statistically significant higher rate of repeated surgery in the ADR group compared to the ACDF group, OR 1.7 (CI 1.06-2.8), p = 0.03. Risk for repeated surgery at index level was even higher for ADR, OR 5.1 (CI 2.4-10.7), p < 0.001. Reoperation rate because of ASD in the whole cohort did not differ between ACDF and ADR groups, p = 0.40. CONCLUSION The group initially treated with artificial disc replacement showed higher rate of reoperations and more implant-related complications. In this cohort, artificial disc replacement was not protective against reoperation because of adjacent segment pathology.
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Affiliation(s)
- Martin Skeppholm
- Karolinska Institute, Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre, Health Economics and Economic Evaluation Research Group, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden. .,Center for Spine Surgery in Stockholm, Södra Fiskartorpsvägen 15 H, 114 85, Stockholm, Sweden.
| | - Thomas Henriques
- Center for Spine Surgery in Stockholm, Södra Fiskartorpsvägen 15 H, 114 85, Stockholm, Sweden
| | - Tycho Tullberg
- Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89, Upplands Väsby, Sweden
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