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Yang JJ, Lee JB, Choi JY. Lateral Deviation of the Hyoid Bone and Thyroid Cartilage Influences Prevertebral Soft-Tissue Swelling and Dysphagia After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2024; 95:789-797. [PMID: 38647325 DOI: 10.1227/neu.0000000000002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prevertebral soft-tissue swelling (PSTS) after anterior cervical diskectomy and fusion (ACDF) is known to be influenced by several factors. We considered the effect of lateral deviation on the traction force and attempted to find a relationship with the PSTS. This study was designed to evaluate the preoperative lateral deviation of the hyoid bone and thyroid cartilage and its effect on PSTS, airway collapse, and clinical outcomes after ACDF. METHODS Preoperative lateral deviations of the hyoid bone and thyroid cartilage at the superior cornu and inferior cornu were measured. To assess the effect of lateral deviation, patients who underwent 1 or 2 level ACDF with the left-sided approach were divided into a deviation group (left-sided deviation >5 mm or >10 mm) and a nondeviation group (left-sided deviation <5 mm or <10 mm). Difference of preoperative and postoperative PSTS (dPSTS), airway collapse, dysphagia score, and Neck Disability Index were compared between the 2 groups. RESULTS Lateral deviation was measured in 290 patients, and 145 were enrolled to assess the effect of lateral deviation. Left-sided deviation was more common than right-sided deviation in all 3 structures (the hyoid bone, superior cornu, and inferior cornu of the thyroid cartilage). The deviation group demonstrated a significantly larger dPSTS at the C3 and C4 levels, more airway collapse at the C4 level, and a higher dysphagia score. There was no significant difference in the Neck Disability Index between the 2 groups. Lateral deviation significantly correlated with dPSTS (C3, C4, C5, and C6 levels) and airway collapse (C3 and C4 levels). CONCLUSION A left-sided deviation of more than 5 mm of the hyoid bone or thyroid cartilage discouraged the left-sided approach for ACDF because of the aggravation of dPSTS, airway collapse, and dysphagia postoperatively.
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Affiliation(s)
- Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si , Republic of Korea
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Megafu EC, Megafu MN, Nguyen JT, Du Jour EP, Bronson WH, Lin JD, Hecht AC, Parisien RL. The Fragility of Statistical Findings in Cervical Disc Arthroplasty: a Systematic Review of Randomized Controlled Trials. Arch Orthop Trauma Surg 2024; 144:2609-2617. [PMID: 38700676 PMCID: PMC11211173 DOI: 10.1007/s00402-024-05353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/26/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE This study employs both the fragility index (FI) and fragility quotient (FQ) to assess the level of robustness in the cervical disc arthroplasty (CDA) literature. We hypothesize that dichotomous outcomes involving CDA would exhibit statistical vulnerability. METHODS A PubMed search was conducted to evaluate dichotomous data for randomized controlled trials (RCTs) in CDA literature from 2000 to 2023. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. RESULTS Of the 1561 articles screened, 111 met the search criteria, with 35 RCTs evaluating CDA included for analysis. Six hundred and ninety-three outcome events with 130 significant (P < 0.05) outcomes and 563 nonsignificant (P ≥ 0.05) outcomes were identified. The overall FI and FQ for all 693 outcomes were 5 (IQR 3-7) and 0.019 (IQR 0.011-0.043). Fragility analysis of statistically significant outcomes and nonsignificant outcomes both revealed an FI of 5. All of the studies reported loss to follow-up (LTF) data where 65.7% (23) did not report or reported an LTF greater or equal to 5. CONCLUSIONS The literature regarding CDA RCTs lacks statistical robustness and may misrepresent the conclusions with the sole use of the P value. By implementing the FI and FQ along with the P value, we believe the interpretation and contextualization of the clinical data surrounding CDA will be better understood.
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Affiliation(s)
| | - Michael N Megafu
- A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.
| | - Janet T Nguyen
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Wesley H Bronson
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Andrew C Hecht
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Robert L Parisien
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Nunna RS, Ryoo JS, Ostrov PB, Patel S, Godolias P, Daher Z, Price R, Chapman JR, Oskouian RJ. Single-level cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF): A Nationwide matched analysis of complications, 30- and 90-day readmission rates, and cost. World Neurosurg X 2024; 21:100242. [PMID: 38221950 PMCID: PMC10787284 DOI: 10.1016/j.wnsx.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Ravi S. Nunna
- Department of Neurosurgery, University of Missouri Columbia Health Care, Columbia, MO, USA
| | - James S. Ryoo
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Philip B. Ostrov
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Zeyad Daher
- Swedish Neuroscience Institute, Seattle, WA, USA
- Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
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Clohisy JCF, Maayan O, Asada T, Qureshi SA. Cervical Total Disc Replacement in Athletes: A Systematic Review. Clin Spine Surg 2023; 36:369-374. [PMID: 37735765 DOI: 10.1097/bsd.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes. SUMMARY OF BACKGROUND DATA The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined. METHODS A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed. RESULTS Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively. CONCLUSIONS The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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5
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Clohisy JCF, Abjornson C, Bauer TW, Baral E, Albert TJ. Delayed Failure of M6-C Cervical Disc Arthroplasty After Conversion of Adjacent Cervical Disc Arthroplasty to Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00013. [PMID: 37071739 DOI: 10.2106/jbjs.cc.22.00788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CASE We present a delayed failure of an M6-C cervical disc arthroplasty after conversion of a subjacent failed cervical disc arthroplasty to fusion. The annular component had failed, and the core had been ejected. Histology demonstrated a giant cell reaction to polyethylene debris, and tissue cultures were positive for Cutibacterium acnes. CONCLUSION This is the first report of M6-C failure after conversion of an adjacent arthroplasty to fusion. A growing number of reports surrounding the M6-C failure rate and mechanisms raise concern about the device's durability and underscore the importance of routine clinical and radiographic surveillance for these patients.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Celeste Abjornson
- Integrated Spine Research Program, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Elexis Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Todd J Albert
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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Boddapati V, Lee NJ, Mathew J, Held MB, Peterson JR, Vulapalli MM, Lombardi JM, Dyrszka MD, Sardar ZM, Lehman RA, Riew KD. Respiratory Compromise After Anterior Cervical Spine Surgery: Incidence, Subsequent Complications, and Independent Predictors. Global Spine J 2022; 12:1647-1654. [PMID: 33406919 PMCID: PMC9609542 DOI: 10.1177/2192568220984469] [Citation(s) in RCA: 1] [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] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Respiratory compromise (RC) is a rare but catastrophic complication of anterior cervical spine surgery (ACSS) commonly due to compressive fluid collections or generalized soft tissue swelling in the cervical spine. Established risk factors include operative duration, size of surgical exposure, myelopathy, among others. The purpose of this current study is to identify the incidence and clinical course of patients who develop RC, and identify independent predictors of RC in patients undergoing ACSS for cervical spondylosis. METHODS A large, prospectively-collected registry was used to identify patients undergoing ACSS for spondylosis. Patients with posterior cervical procedures were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate analysis was employed to compare postoperative complications and identify independent predictors of RC. RESULTS 298 of 52,270 patients developed RC (incidence 0.57%). Patients who developed RC had high rates of 30-day mortality (11.7%) and morbidity (75.8%), with unplanned reoperation and pneumonia the most common. The most common reason for reoperations were hematoma evacuation and tracheostomy. Independent patient-specific factors predictive of RC included increasing patient age, male gender, comorbidities such as chronic cardiac and respiratory disease, preoperative myelopathy, prolonged operative duration, and 2-level ACCFs. CONCLUSION This is among the largest cohorts of patients to develop RC after ACSS identified to-date and validates a range of independent predictors, many previously only described in case reports. These results are useful for taking preventive measures, identifying high risk patients for preoperative risk stratification, and for surgical co-management discussions with the anesthesiology team.
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Affiliation(s)
- Venkat Boddapati
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA,Venkat Boddapati, Columbia University Irving
Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA.
| | - Nathan J. Lee
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Mathew
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B. Held
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joel R. Peterson
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Meghana M. Vulapalli
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M. Lombardi
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Marc D. Dyrszka
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan M. Sardar
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald A. Lehman
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - K. Daniel Riew
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Schuermans VNE, Smeets AYJM, Boselie TFM, Candel MJJM, Curfs I, Evers SMAA, Van Santbrink H. Research protocol: Cervical Arthroplasty Cost Effectiveness Study (CACES): economic evaluation of anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy with fusion (ACDF) in the surgical treatment of cervical degenerative disc disease - a randomized controlled trial. Trials 2022; 23:715. [PMID: 36028916 PMCID: PMC9419384 DOI: 10.1186/s13063-022-06574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To date, there is no consensus on which anterior surgical technique is more cost-effective in treating cervical degenerative disc disease (CDDD). The most commonly used surgical treatment for patients with single- or multi-level symptomatic CDDD is anterior cervical discectomy with fusion (ACDF). However, new complaints of radiculopathy and/or myelopathy commonly develop at adjacent levels, also known as clinical adjacent segment pathology (CASP). The extent to which kinematics, surgery-induced fusion, natural history, and progression of disease play a role in the development of CASP remains unclear. Anterior cervical discectomy with arthroplasty (ACDA) is another treatment option that is thought to reduce the incidence of CASP by preserving motion in the operated segment. While ACDA is often discouraged, as the implant costs are higher while the clinical outcomes are similar to ACDF, preventing CASP might be a reason for ACDA to be a more cost-effective technique in the long term. METHODS AND ANALYSIS In this randomized controlled trial, patients will be randomized to receive ACDF or ACDA in a 1:1 ratio. Adult patients with single- or multi-level CDDD and symptoms of radiculopathy and/or myelopathy will be included. The primary outcome is cost-effectiveness and cost-utility of both techniques from a healthcare and societal perspective. Secondary objectives are the differences in clinical and radiological outcomes between the two techniques, as well as the qualitative process surrounding anterior decompression surgery. All outcomes will be measured at baseline and every 6 months until 4 years post-surgery. DISCUSSION High-quality evidence regarding the cost-effectiveness of both ACDA and ACDF is lacking; to date, there are no prospective trials from a societal perspective. Considering the aging of the population and the rising healthcare costs, there is an urgent need for a solid clinical cost-effectiveness trial addressing this question. TRIAL REGISTRATION ClinicalTrials.gov NCT04623593. Registered on 29 September 2020.
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Affiliation(s)
- Valérie N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands.
| | - Anouk Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Toon F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Peter Debyeplein 1, Maastricht, 6229 HA, The Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Silvia M A A Evers
- Department of Public Health Technology Assessment, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - Henk Van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
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Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris. 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 2022; 31:1273-1282. [PMID: 35020078 DOI: 10.1007/s00586-021-07094-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND According to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses. METHODS This prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated. RESULTS Fifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events. CONCLUSIONS There is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.
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Hardman M, Bhandarkar AR, Jarrah RM, Bydon M. Predictors of Airway, Respiratory, and Pulmonary Complications Following Elective Anterior Cervical Discectomy and Fusion. Clin Neurol Neurosurg 2022; 217:107245. [DOI: 10.1016/j.clineuro.2022.107245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
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Singh RK, Agrawal S, Sahu A, Kazancoglu Y. Strategic issues of big data analytics applications for managing health-care sector: a systematic literature review and future research agenda. TQM JOURNAL 2021. [DOI: 10.1108/tqm-02-2021-0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PurposeThe proposed article is aimed at exploring the opportunities, challenges and possible outcomes of incorporating big data analytics (BDA) into health-care sector. The purpose of this study is to find the research gaps in the literature and to investigate the scope of incorporating new strategies in the health-care sector for increasing the efficiency of the system.Design/methodology/approachFora state-of-the-art literature review, a systematic literature review has been carried out to find out research gaps in the field of healthcare using big data (BD) applications. A detailed research methodology including material collection, descriptive analysis and categorization is utilized to carry out the literature review.FindingsBD analysis is rapidly being adopted in health-care sector for utilizing precious information available in terms of BD. However, it puts forth certain challenges that need to be focused upon. The article identifies and explains the challenges thoroughly.Research limitations/implicationsThe proposed study will provide useful guidance to the health-care sector professionals for managing health-care system. It will help academicians and physicians for evaluating, improving and benchmarking the health-care strategies through BDA in the health-care sector. One of the limitations of the study is that it is based on literature review and more in-depth studies may be carried out for the generalization of results.Originality/valueThere are certain effective tools available in the market today that are currently being used by both small and large businesses and corporations. One of them is BD, which may be very useful for health-care sector. A comprehensive literature review is carried out for research papers published between 1974 and 2021.
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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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Broekema AEH, Groen RJM, Simões de Souza NF, Smidt N, Reneman MF, Soer R, Kuijlen JMA. Surgical Interventions for Cervical Radiculopathy without Myelopathy: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2020; 102:2182-2196. [PMID: 32842045 DOI: 10.2106/jbjs.20.00324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effectiveness of surgical interventions for cervical degenerative disorders has been investigated in multiple systematic reviews. Differences in study population (e.g., patients with myelopathy and/or radiculopathy) were often neglected. Therefore, the objective of this study was to investigate the effectiveness of surgical interventions for patients with symptoms of cervical radiculopathy without myelopathy by conducting a systematic review and meta-analysis based on randomized controlled trials (RCTs). METHODS A comprehensive systematic search was conducted in MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) to identify RCTs that investigated the effectiveness of surgical interventions using an anterior or posterior approach compared with other interventions for patients with pure cervical radiculopathy. Outcomes were success rates (Odom criteria, similar rating scales, or percentage of patients who improved), complication and reoperation rates, work status, disability (Neck Disability Index), and pain (arm and neck). The Cochrane risk-of-bias tool was used to assess the likelihood of the risk of bias. A random-effects model was used. Heterogeneity among study results (I2 ≥ 50% or p < 0.05) was explored by conducting subgroup analyses. Funnel plots were used to assess the likelihood of publication bias. RESULTS A total of 21 RCTs were included, comprising 1,567 patients. For all outcomes, among all surgical techniques, only 1 pooled estimate showed a significant effect on success rate, which was in favor of anterior cervical discectomy with fusion compared with anterior cervical discectomy without an intervertebral spacer (p = 0.02; risk ratio [RR] = 0.87; 95% confidence interval [CI] = 0.77 to 0.98). Complication rates were higher when autologous bone graft from the iliac crest was used as an intervertebral spacer (p < 0.01; RR = 3.40; 95% CI = 1.56 to 7.43), related to donor-site morbidity. CONCLUSIONS This meta-analysis demonstrated consistent results regarding clinical outcome for pure cervical radiculopathy among all studied interventions. Complication and reoperation rates were also similar, with the exception of higher complication rates in patients in whom autologous bone grafts were used. On the basis of clinical outcome and safety, there is no superior surgical intervention for pure cervical radiculopathy. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anne E H Broekema
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob J M Groen
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nádia F Simões de Souza
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nynke Smidt
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michiel F Reneman
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Remko Soer
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Jos M A Kuijlen
- Departments of Neurosurgery (A.E.H.B., R.J.M.G., N.F.S.d.S., and J.M.A.K.), Epidemiology (N.S.), and Rehabilitation (M.F.R.), and Pain Center (R.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Efficacy and Safety of Total Disc Replacement compared with Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Disease: A Meta-analysis. Spine (Phila Pa 1976) 2020; 45:1419-1425. [PMID: 32453243 DOI: 10.1097/brs.0000000000003569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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14
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Scott-Young M, McEntee L, Rathbone E, Hing W, Nielsen D. Clinical Outcomes of Cervical Hybrid Reconstructions: A Prospective Study. Int J Spine Surg 2020; 14:S57-S66. [PMID: 32994307 DOI: 10.14444/7092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The study design was a prospective clinical cohort study. The aim of this study was to assess the patient-reported outcome measures (PROMs), patient satisfaction, as well as complication and reoperation rate of cervical hybrid procedures for symptomatic cervical multilevel degenerative disc disease (MLDDD). Cervical total disc replacement (CTDR) has been shown to be safe and effective for the treatment of degenerative pathologies. However, there is minimal PROMs data on the outcomes of combined CTDR and anterior cervical decompression and fusion procedures, commonly referred to as cervical hybrid surgery. METHODS Prospectively collected PROMs were analyzed from patients receiving cervical hybrid surgery for symptomatic cervical MLDDD. Between 2004 and 2016, data were collected preoperatively and postoperatively at 3, 6, and 12 months, then yearly thereafter. Patient reported outcome measures included patient satisfaction, visual analog score for neck and arm, and Neck Disability Index. Complication and reoperation rates were also assessed. RESULTS A total of 151 patients (80 males, 71 females) who had a minimum of 12 months follow up were included. The mean age was 53 years (range = 24-81), and median follow up was 2 years (range = 1-10). The median number of levels treated was 3, with 29.8%, 49.0%, and 21.2% of patients having 2, 3, and 4 levels treated, respectively. The most common indication for surgery was multilevel cervical spondylotic radiculopathy (52.8%), followed by combined cervical spondylotic radiculomyelopathy (16.7%), axial neck pain (16%), and cervical spondylotic myelopathy (13.9%). Improvement in pain and disability scores were both clinically and statistically significant (P < .001), and these improvements were sustained throughout the course of follow up. There was a 16% incidence of minor adverse events, and 3 (1.9%) reoperations. CONCLUSIONS Cervical hybrid surgery for cervical MLDDD demonstrates favorable and sustained clinical outcomes at short-term to midterm follow up. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Statistically and substantial clinical benefits can be achieved by cervical hybrid surgery, in the treatment of cervical pathologies including radiculopathy and myelopathy. The key principles is to follow strict indications, and to match technology with the pathology.
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Affiliation(s)
- Matthew Scott-Young
- Gold Coast Spine, Gold Coast, Queensland, Australia.,Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Laurence McEntee
- Gold Coast Spine, Gold Coast, Queensland, Australia.,Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Evelyne Rathbone
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
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Guo H, Sheng J, Sheng WB, Liang WD, Wang J, Xun CH. An Eight-Year Follow-Up Study on the Treatment of Single-Level Cervical Spondylosis Through Intervertebral Disc Replacement and Anterior Cervical Decompression and Fusion. Orthop Surg 2020; 12:717-726. [PMID: 32291950 PMCID: PMC7307226 DOI: 10.1111/os.12634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the efficacy and safety of the postoperative long‐term effect of the treatment of single‐level cervical spondylosis through anterior cervical discectomy and fusion (ACDF) and artificial cervical disc replacement (ACDR). Methods This is a retrospective contrastive study, which was conducted for the period of January 2007 and January 2009 at the Department of Spine Surgery of the First Affiliated Hospital of Xinjiang Medical University. A total of 113 patients were divided into two groups depending on the operation method: ACDF group (fusion group, n = 66) and ACDR group (replacement group, n = 47). The ACDR group comprised of 23 males and 24 females. The age of these patients ranged from 31–60 years, with an average age of 42.89 ± 6.30 years. The ACDF group comprised of 38 males and 28 females. The age of these patients ranged from 28–73 years old, with an average age of 49.38 ± 9.89 years old. The evaluation index included the visual analogue scale (VAS), neck disability index (NDI), range of motion, dysphagia, adjacent vertebral disease, and related complications (prosthesis displacement, heterotopic ossification, etc.). Results A total of 113 patients met the inclusion criteria, and these patients receive more than 96 months of follow‐up. The VAS and NDI of these two groups of patients significantly improved, when compared with those before the operation. In the last follow‐up visit, the range of motion in the ACDR group and ACDF group was 43.22 ± 3.58 and 32.54 ± 2.82, respectively, and both are significantly different comparing to the values measured before the operation (P < 0.05). The dysphagia incidence of the ACDR group was higher than that of the ACDF group at the 36th month, but was lower than that of the ACDF group in other points time. In the last follow‐up visit, six patients (12.77%) in the ACDR group and 18 patients (27.27%) in the ACDF suffered from adjacent segment degeneration (ASD). The general complication rate in the replacement group and fusion group was 38.31% and 37.88%, respectively, but the difference between the two groups was not statistically significant (P > 0.05). Conclusion Overall, the clinical efficacy and related complication rate of single‐level cervical spondylosis after an anterior cervical approach operation was superior in the ACDR group when compared to the ACDF group.
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Affiliation(s)
- Hao Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,The Second Department of Orthopedics, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,The Second Department of Orthopedics, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei-Bin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei-Dong Liang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jian Wang
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chuan-Hui Xun
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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16
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Badhiwala JH, Platt A, Witiw CD, Traynelis VC. Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis of rates of adjacent-level surgery to 7-year follow-up. JOURNAL OF SPINE SURGERY 2020; 6:217-232. [PMID: 32309660 DOI: 10.21037/jss.2019.12.09] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is an effective treatment for cervical spondylosis. A limitation of ACDF is the risk of adjacent-segment degeneration (ASD), owing to arthrodesis of a motion segment. Cervical disc arthroplasty (CDA) has hence garnered significant attention; yet, compelling evidence of reduction in ASD requiring surgery is lacking. This systematic review and meta-analysis sought to compare long-term longitudinal adjacent-level operation rates with CDA versus ACDF. Methods An electronic literature search was conducted. Eligible studies were multi-center randomized controlled trials (RCTs) comparing CDA with ACDF for one- or two-level symptomatic cervical spondylosis. The primary outcome was adjacent-level operation. Index-level reoperation was a secondary outcome. Outcomes were evaluated at 1-year intervals from the index operation to last reported follow-up by random-effects meta-analyses. Results Eleven RCTs met criteria. For one-level spondylosis, there was no difference in the rate of adjacent-level operation between CDA (2.3%) and ACDF (3.6%) at 2 years. However, a large difference favoring CDA became evident at 5 years and persisted at 7 years (4.3% vs. 10.8%, P<0.001). Significantly fewer patients who underwent CDA required index-level reoperation at all time points out to 7 years (5.2% vs. 12.7%, P<0.001). Similar to one-level operations, there was no significant difference in adjacent-level operations with two-level CDA (1.7%) versus two-level ACDF (3.4%) at 2 years. At 7 years, a significant difference favoring CDA became apparent (5.1% vs. 10.0%, P=0.014). Two-level CDA resulted in fewer index-level reoperations out to 7 years (4.2% vs. 13.5%, P<0.001). Conclusions In this meta-analysis, the short-term rate of adjacent-level operation was similar with CDA or ACDF. However, around 5 years, a statistically significant divergence emerged, where the rate of adjacent-level surgery rose steeply for ACDF. Index-level reoperations were less frequent with CDA in both the short- and long-term. These data indicate CDA may have a superior longevity to ACDF with regard to need for subsequent adjacent-level operation.
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Affiliation(s)
- Jetan H Badhiwala
- Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew Platt
- Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Christopher D Witiw
- Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Vincent C Traynelis
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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17
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Choi H, Baisden JL, Yoganandan N. A Comparative in vivo Study of Semi-constrained and Unconstrained Cervical Artificial Disc Prostheses. Mil Med 2019; 184:637-643. [PMID: 30901460 DOI: 10.1093/milmed/usy395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/11/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study is to directly compare different types of cervical artificial disc implants using an in vivo model capable of simulating the axial load on a neck that is similar to the human neck. METHODS Cervical arthroplasty was performed at C3-4 in 14 healthy female adult Alpine goats. The goats were divided into three groups. Group A received Bryan (unconstrained one-piece design); Group B received ProDisc-C (semi-constrained two-piece design); and Group C received Mobi-C (unconstrained three-piece design) artificial discs. The goats were monitored in a veterinary unit for 6 months with radiography at regular intervals. RESULTS Each goat tolerated cervical arthroplasty well and had satisfactory placement of their implant per intra-operative radiography. Implants monitored in Group A demonstrated no migration. One out of five implants in Group B experienced anterior migration at 3 months. In Group C, anterior migration and disintegration occurred in all four implants, with migration occurring during the first postoperative week in three implants and after 5 weeks in the fourth. CONCLUSIONS Unconstrained multi-piece artificial cervical discs may be prone to anterior migration and extrusion out of the disc space. This outcome deserves attention in individuals with a hypermobile neck and/or an occupation involving the use of a head-supported mass, such as helmets.
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Affiliation(s)
- Hoon Choi
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
| | - Jamie L Baisden
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
| | - Narayan Yoganandan
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
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Abstract
The most popular approach to treating symptomatic cervical disk disease is anterior cervical discectomy and fusion. Although this procedure has significant long-term clinical success, it is associated with progressive adjacent segment degeneration with an annual incidence of ∼3%. Total disk arthroplasty was designed as an alternative to fusion that could preserve segmental motion at the operative level and potentially delay or prevent adjacent-level breakdown. The etiology of adjacent segment pathology (ASP) is multifactorial, and it is likely that most cases of ASP are unavoidable. When attempting to surgically prevent ASP, it is important to consider nonfusion alternatives, be judicious in one's level selection, and attempt to restore sagittal alignment. When ASP becomes a clinical problem, it is important to have an algorithm for how best to treat it.
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19
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Havey RM, Khayatzadeh S, Voronov LI, Blank KR, Carandang G, Harding DP, Patwardhan AG. Motion response of a polycrystalline diamond adaptive axis of rotation cervical total disc arthroplasty. Clin Biomech (Bristol, Avon) 2019; 62:34-41. [PMID: 30665037 DOI: 10.1016/j.clinbiomech.2018.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical fusion is associated with adjacent segment degeneration. Cervical disc arthroplasty is considered an alternative to reduce risk of adjacent segment disease. Kinematics after arthroplasty should closely replicate healthy in vivo kinematics to reduce adjacent segment stresses. The purpose of this study was to assess the kinematics of a polycrystalline diamond cervical disc prosthesis. METHODS Nine cadaveric C3-T1 spines were tested intact and after one (C5-C6) and two level (C5-C7) arthroplasty (Triadyme-C, Dymicron Inc., Orem, UT, USA). Kinematics were evaluated in flexion-extension, lateral bending, and axial rotation. FINDINGS Prosthesis placement at C5-C6 and C6-C7 was 0.5 mm anterior and 0.6 mm posterior to midline respectively. C5-C6 flexion-extension motion was 12.8° intact and 10.5° after arthroplasty. C6-C7 flexion-extension motion was 10.0 and 11.4° after arthroplasty. C5-C6 lateral bending reduced from 8.5 to 3.7° after arthroplasty and at C6-C7 from 7.5 to 5.1°. C5-C6 axial rotation decreased from 10.4 to 6.2° after arthroplasty and at C6-C7 from 7.8 to 5.3°. Segmental lordosis increased by 4.2°, and middle disc height by 1.4 mm after arthroplasty. Change in center of rotation from intact to arthroplasty averaged 0.9 mm posteriorly and 0.1 mm caudally at C5-C6, and 1.4 mm posteriorly and 0.3 mm cranially at C6-C7. INTERPRETATION The cervical disc arthroplasty evaluated restored flexion-extension motion to intact levels and moderately increased segmental stiffness. Disc height increased by up to 1.5 mm and segmental lordosis by 4.2°. The unique prosthesis design allowed the axis of rotation after arthroplasty to closely mimic the native location.
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Affiliation(s)
- Robert M Havey
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Medical Center, Maywood, IL, USA.
| | | | - Leonard I Voronov
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Avinash G Patwardhan
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Medical Center, Maywood, IL, USA
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20
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The Seven-Year Cost-Effectiveness of Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Markov Analysis. Spine (Phila Pa 1976) 2018; 43:1543-1551. [PMID: 29642136 DOI: 10.1097/brs.0000000000002665] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Markov model analysis. OBJECTIVE The aim of this study was to determine the 7-year cost-effectiveness of single-level anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for the treatment of cervical disc degeneration. SUMMARY OF BACKGROUND DATA Both ACDF and CDR are acceptable surgical options for the treatment of symptomatic cervical disc degeneration. Past studies have demonstrated at least equal effectiveness of CDR when compared with ACDF in large randomized Investigational Device Exemption (IDE) studies. Short-term cost-effectiveness analyses at 5 years have suggested that CDR may be the preferred treatment option. However, adjacent segment disease and other postoperative complications may occur after 5 years following surgery. METHODS A Markov model analysis was used to evaluate data from the LDR Mobi-C IDE study, incorporating five Markov transition states and seven cycles with each cycle set to a length of 1 year. Transition state probabilities were determined from complication rates, as well as index and adjacent segment reoperation rates from the IDE study. Raw SF-12 data were converted to health state utility values using the SF-6D algorithm for 174 CDR patients and 79 ACDF patients. RESULTS Assuming an ideal operative candidate who is 40-years-old and failed appropriate conservative care, the 7-year cost was $103,924 for ACDF and $105,637 for CDR. CDR resulted in the generation of 5.33 quality-adjusted life-years (QALYs), while ACDF generated 5.16 QALYs. Both ACDF and CDR were cost-effective, but the incremental cost-effectiveness ratio (ICER) was $10,076/QALY in favor of CDR, which was less than the willingness-to-pay (WTP) threshold of $50,000/QALY. CONCLUSION ACDF and CDR are both cost-effective strategies for the treatment of cervical disc degeneration. However, CDR is the more cost-effective procedure at 7 years following surgery. Further long-term studies are needed to validate the findings of this model. LEVEL OF EVIDENCE 1.
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21
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Wang LN, Hu BW, Wang L, Song YM, Yang X, Liu LM, Liu H. Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up. BMC Musculoskelet Disord 2018; 19:101. [PMID: 29615017 PMCID: PMC5883531 DOI: 10.1186/s12891-018-2017-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 02/05/2023] Open
Abstract
Background To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. Methods From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. Results The mean follow-up period was 72.3 months (range 68–78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. Conclusions The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.
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Affiliation(s)
- Lin-Nan Wang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Bo-Wen Hu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Lei Wang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China.
| | - Yue-Ming Song
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China.
| | - Xi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Li-Min Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
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Xu JC, Goel C, Shriver MF, Tanenbaum JE, Steinmetz MP, Benzel EC, Mroz TE. Adverse Events Following Cervical Disc Arthroplasty: A Systematic Review. Global Spine J 2018; 8:178-189. [PMID: 29662749 PMCID: PMC5898676 DOI: 10.1177/2192568217720681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Cervical arthroplasty is an increasingly popular treatment of cervical radiculopathy and myelopathy. An understanding of the potential adverse events (AEs) is important to help both clinicians and patients. We sought to provide a comprehensive systematic review of the AEs reported in all randomized controlled trials (RCTs) of cervical disc arthroplasty in an attempt to characterize the quality of reporting. METHODS We conducted a systematic review of MEDLINE and Web of Science for RCTs of cervical disc arthroplasty reporting AEs. We reported the most frequently mentioned AEs, including dysphagia/dysphonia, vascular compromise, dural injury, and infections. We recorded the presence of industry funding and scored the quality of collection methods and reporting of AEs. RESULTS Of the 3734 identified articles, 29 articles met full inclusion criteria. The quality of AE reporting varied significantly between studies, and a combined meta-analysis was not feasible. The 29 articles covered separate 19 RCTs. Eight studies were US Food and Drug Administration (FDA) investigational device exemption (IDE) trials. Rates were recorded for the following AEs: dysphagia/dysphonia (range = 1.3% to 27.2%), vascular compromise (range = 1.1% to 2.4%), cervical wound infection (range = 1.2% to 22.5%), and cerebrospinal fluid leak (range = 0.8% to 7.1%). CONCLUSIONS There is a lack of consistency in reporting of AEs among RCTs of cervical arthroplasty. FDA IDE trials scored better in AE event reporting compared to other studies. Standardized definitions for AEs and standardized data collection methodology are needed to improve future studies.
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Affiliation(s)
- Jordan C. Xu
- Case Western Reserve University, Cleveland, OH, USA,Jordan C. Xu, Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
| | - Chandni Goel
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Joseph E. Tanenbaum
- Case Western Reserve University, Cleveland, OH, USA,Cleveland Clinic, Cleveland, OH, USA
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Badve SA, Nunley PD, Kurra S, Lavelle WF. Review of long-term outcomes of disc arthroplasty for symptomatic single level cervical degenerative disc disease. Expert Rev Med Devices 2018; 15:205-217. [DOI: 10.1080/17434440.2018.1433533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Siddharth A. Badve
- Hartsville Orthopaedics & Sports Medicine, Carolina Pines Regional Medical Center, Hartsville, SC, USA
| | | | - Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - William F. Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
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24
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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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25
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Yang SD, Zhu YB, Yan SZ, Di J, Yang DL, Ding WY. Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up. Sci Rep 2017; 7:16443. [PMID: 29180636 PMCID: PMC5703962 DOI: 10.1038/s41598-017-16670-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023] Open
Abstract
Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.
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Affiliation(s)
- Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yan-Bo Zhu
- Laboratory of Molecular Biology, Center of Experimental Animals, Hebei Medical University, Shijiazhuang, 050017, China
| | - Suo-Zhou Yan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Jun Di
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China. .,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, 050051, China.
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Ament JD, Yang Z, Nunley P, Stone MB, Lee D, Kim KD. Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up. Neurosurgery 2017; 79:135-45. [PMID: 26855020 PMCID: PMC4900425 DOI: 10.1227/neu.0000000000001208] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. BACKGROUND: The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion. OBJECTIVE: Cost-effectiveness of this intervention was established by looking at 2-year follow-up, and this update reevaluates our analysis over 5 years. METHODS: Data were derived from a randomized trial of 330 patients. Data from the 12-Item Short Form Health Survey were transformed into utilities by using the SF-6D algorithm. Costs were calculated by extracting diagnosis-related group codes and then applying 2014 Medicare reimbursement rates. A Markov model evaluated quality-adjusted life years (QALYs) for both treatment groups. Univariate and multivariate sensitivity analyses were conducted to test the stability of the model. The model adopted both societal and health system perspectives and applied a 3% annual discount rate. RESULTS: The cTDR costs $1687 more than anterior cervical discectomy and fusion (ACDF) over 5 years. In contrast, cTDR had $34 377 less productivity loss compared with ACDF. There was a significant difference in the return-to-work rate (81.6% compared with 65.4% for cTDR and ACDF, respectively; P = .029). From a societal perspective, the incremental cost-effective ratio (ICER) for cTDR was −$165 103 per QALY. From a health system perspective, the ICER for cTDR was $8518 per QALY. In the sensitivity analysis, the ICER for cTDR remained below the US willingness-to-pay threshold of $50 000 per QALY in all scenarios (−$225 816 per QALY to $22 071 per QALY). CONCLUSION: This study is the first to report the comparative cost-effectiveness of cTDR vs ACDF for 2-level degenerative disc disease at 5 years. The authors conclude that, because of the negative ICER, cTDR is the dominant modality. ABBREVIATIONS: ACDF, anterior cervical discectomy and fusion AWP, average wholesale price CE, cost-effectiveness CEA, cost-effectiveness analysis CPT, Current Procedural Terminology cTDR, cervical total disc replacement CUA, cost-utility analysis DDD, degenerative disc disease DRG, diagnosis-related group FDA, US Food and Drug Administration ICER, incremental cost-effectiveness ratio IDE, Investigational Device Exemption NDI, neck disability index QALY, quality-adjusted life years RCT, randomized controlled trial RTW, return-to-work SF-12, 12-Item Short Form Health Survey VAS, visual analog scale WTP, willingness-to-pay
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Affiliation(s)
- Jared D Ament
- *University of California Davis, Sacramento, California; ‡Spine Institute of Louisiana, Shreveport, Louisiana
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Bartels RHMA, Donk RD, Verhagen WIM, Hosman AJF, Verbeek ALM. Reporting the results of meta-analyses: a plea for incorporating clinical relevance referring to an example. Spine J 2017; 17:1625-1632. [PMID: 28576501 DOI: 10.1016/j.spinee.2017.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/24/2017] [Accepted: 05/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance. PURPOSE This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis. STUDY DESIGN This study is a review of the literature. PATIENT SAMPLE This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty. OUTCOME MEASURE The outcome measure used in the study was the MCID. METHODS We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature. RESULTS We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance. CONCLUSIONS The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement.
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Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands.
| | - Roland D Donk
- Department of Orthopedic Surgery, Via Sana Clinics, Hoogveldseweg 1, 5451 AA Mill, The Netherlands
| | - Wim I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Allard J F Hosman
- Department of Orthopedic Surgery, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands
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Aydin Y, Çavusoglu H, Yüce I, Özdilmaç A, Kahyaoglu O. A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility. Neurosurgery 2017; 81:627-637. [PMID: 28368476 DOI: 10.1093/neuros/nyx056] [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: 12/22/2015] [Accepted: 02/07/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy. OBJECTIVE To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation. METHODS In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years). RESULTS Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score. CONCLUSION This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.
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Affiliation(s)
- Yunus Aydin
- Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Halit Çavusoglu
- Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Ismail Yüce
- Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Ahmet Özdilmaç
- Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Okan Kahyaoglu
- Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey
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Louie PK, Presciutti SM, Iantorno SE, Bohl DD, Shah K, Shifflett GD, An HS. There is no increased risk of adjacent segment disease at the cervicothoracic junction following an anterior cervical discectomy and fusion to C7. Spine J 2017; 17:1264-1271. [PMID: 28456670 DOI: 10.1016/j.spinee.2017.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/08/2016] [Accepted: 04/24/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is a very common operative intervention for the treatment of cervical spine degenerative disease in those who have failed non-operative measures. However, studies examining long-term follow-up on patients who underwent ACDF reveal evidence of radiographic and clinical degenerative disc disease at the levels adjacent to the fusion construct. Consistent with other junctional regions of the spine, the cervicothoracic junction (CTJ) has significant morphologic variations. As a result, the CTJ undergoes significant static and dynamic stress. Given these findings, there has been some thought that ACDF down to C7 may experience additional risks for adjacent segment degeneration/disease (ASD) when compared with ASDFs that are cephalad to C7. PURPOSE The goal of this study is to evaluate the rate of radiographic and clinical ASD in patients who have undergone single- or multilevel ACDF, down to C7. STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE The sample included consecutive patients from a single orthopedic surgeon at one quaternary referral medical center who underwent an ACDF between January 2008 and November 2014. Indications for surgery included radiculopathy, myelopathy, or myeloradiculopathy in the setting of failed conservative treatments. Patients were excluded if they had an ACDF of which the caudal level was cephalad to C7 or if they had undergone a previous cervical fusion. OUTCOME MEASURES Radiographic diagnosis of ASD was determined by the presence of disc space narrowing >50%, new or enlarged osteophytes, end plate sclerosis, or increased calcification of the anterior longitudinal ligament (ALL). Postoperatively, data were collected on the presence of new radicular or myelopathic symptoms indicative of pathology at C7-T1, indicating a diagnosis of clinical ASD. METHODS Demographic information was collected for all patients, which included age, sex, body mass index, smoking status, and Charleston Comorbidity Index (CCI). Several radiographic parameters were measured preoperatively, immediately postoperatively, and at the last follow-up: C2-C7 lordosis, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and T1 slope C2-C7 lordosis were measured using the Cobb angle between the inferior end plate of C2 to the inferior end plate of C7. Radiographic and clinical factors associated with ASD were analyzed postoperatively. RESULTS Four patients (4.8%) presented with clinical evidence of ASD, all of whom also showed signs of radiographic ASD and improved with conservative measures. No patients underwent reoperation for ASD at the C7-T1 junction. Thirty patients (36.1%) presented radiographic evidence of ASD. These were generally older (54.4 vs. 48.4 years; p=.014). There were neither significant differences in radiographic parameters nor between single- versus multilevel ACDFs and the development of ASD. CONCLUSIONS The cervicothoracic junction may present with vulnerability to ASD given the junctional biomechanics. However, this study provides evidence that an ACDF with the caudal level of C7 does not incur additional risk of ASD, showing similar outcomes to ACDFs at other levels.
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Affiliation(s)
- Philip K Louie
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA.
| | - Steven M Presciutti
- Department of Orthopaedics, Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Stephanie E Iantorno
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA
| | - Kevin Shah
- University of Michigan, 500 S. State St, Ann Arbor, MI 48109, USA
| | - Grant D Shifflett
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA
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30
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Yan SZ, Di J, Shen Y. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty. Med Sci Monit 2017; 23:2692-2700. [PMID: 28574978 PMCID: PMC5466040 DOI: 10.12659/msm.905178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). Material/Methods A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. Results There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005–1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786–0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086–1.193) were significantly correlated with adjacent segment degeneration. Conclusions Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups.
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Affiliation(s)
- Suo-Zhou Yan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jun Di
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, Hebei, China (mainland)
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Comparison of the Clinical and Radiographic Results Between Cervical Artificial Disk Replacement and Anterior Cervical Fusion: A 6-Year Prospective Nonrandomized Comparative Study. Clin Spine Surg 2017; 30:E578-E586. [PMID: 28525481 DOI: 10.1097/bsd.0000000000000206] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Prospective nonrandomized comparative study. OBJECTIVE To compare the long-term clinical and radiographic results of cervical artificial disk replacement (CADR) and anterior cervical discectomy and fusion (ACDF), and to provide our evidence if CADR could reduce adjacent segment degeneration (ASD). SUMMARY OF BACKGROUND DATA CADR is widely used in spine surgery today. Despite the short-term results of it having been ascertained, the long-term results are still under observation. Meanwhile it is still debatable if CADR could reduce ASD in the long run. MATERIALS AND METHODS Sixty-three patients with cervical myelopathy who underwent CADR (28) or ACDF (35) with a minimum follow-up of 68 months were included. Japanese Orthopaedic Association score, neck disability index, and Odom's scale were used to evaluate the clinical outcomes. Radiographs, computed tomography, and magnetic resonance imaging were used to evaluate the radiographic outcomes. RESULTS Both CADR and ACDF groups showed significant improvement on Japanese Orthopaedic Association scores and neck disability index, and there was no significant difference between the 2 groups. The sagittal alignment was maintained for both the groups. The C2-C7 range of motion had no significant change for CADR group, whereas it significantly decreased for ACDF group. The range of motion at index level of CADR patients decreased from 9.5±3.7 degrees before surgery to 7.0±3.0 degrees at 3 months after surgery (P<0.001), and it was maintained to 6.6±4.1 degrees at last follow-up without significant decrease (P=0.448). We used radiographic data to evaluate ASD and we found the incidence of ASD was significantly lower for CADR group than ACDF group. CONCLUSIONS The clinical and radiographic results of CADR over 6-year follow-up are basically satisfying. Compared with ACDF, CADR could better preserve physiological motion and biomechanics of cervical spine, and reduce the occurrence of ASD.
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Indirect meta-analysis comparing clinical outcomes of total cervical disc replacements with fusions for cervical degenerative disc disease. Sci Rep 2017; 7:1740. [PMID: 28496111 PMCID: PMC5431800 DOI: 10.1038/s41598-017-01865-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/04/2017] [Indexed: 01/12/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (TDR) are considered effective treatments for patients with cervical degenerative disc disease (CDDD). An indirect meta-analysis including 19 randomized controlled trials (5343 patients) was conducted to compare the clinical outcomes of ACDF with TDR. Primary outcomes including functional indicators (NDI [neck disability index] score, neurological success and patient satisfaction), secondary outcomes including surgical outcomes (operation time, blood loss and length of stay) and secondary surgical procedures (secondary surgery at an adjacent level, secondary surgery at the index level, secondary surgery at both levels, removal, reoperation, revision and supplemental fixation) were included in the study. TDR using the Bryan disc was associated with a greater improvement in NDI score than ACDF (MD = -5.574, 95% CrIs [credible intervals] -11.73--0.219). For neurological success, the Bryan (odds ratio [OR] = 0.559, 95% CrIs 0.323-0.955) and Prestige (OR = 0.474, 95% CrIs 0.319-0.700) discs were superior to ACDF. However, no differences in the patient satisfaction rate were shown between TDR and ACDF. For patients with CDDD, ACDF using allograft and a plate is most effective for determining the surgical parameters. Moreover, TDR using the ProDisc-C, Mobi-C, Prestige and Bryan discs are good choices for improving functional outcomes and reducing secondary surgeries.
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Cervical facet force analysis after disc replacement versus fusion. Clin Biomech (Bristol, Avon) 2017; 44:52-58. [PMID: 28340364 DOI: 10.1016/j.clinbiomech.2017.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/31/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical total disc replacement was developed to preserve motion and reduce adjacent-level degeneration relative to fusion, yet concerns remain that total disc replacement will lead to altered facet joint loading and long-term facet joint arthrosis. This study is intended to evaluate changes in facet contact force, pressure and surface area at the treated and superior adjacent levels before and after discectomy, disc replacement, and fusion. METHODS Ten fresh-frozen human cadaveric cervical spines were potted from C2 to C7 with pressure sensors placed into the facet joints of C3-C4 and C4-C5 via slits in the facet capsules. Moments were applied to the specimens to produce axial rotation, lateral bending and extension. Facet contact force and pressure were measured at both levels for intact, discectomy at C4-C5, disc replacement with ProDisc-C (Synthes Spine, West Chester, Pennsylvania, USA) at C4-C5, and anterior discectomy and fusion with Cervical Spine Locking Plate (Synthes Spine, West Chester, Pennsylvania, USA) at C4-C5. Facet contact area was calculated from the force and pressure measurements. An analysis of variance was used to determine significant differences with P-values <0.05 indicating significance. FINDINGS Facet contact force was elevated at the treated level under extension following both discectomy and disc replacement, while facet contact pressure and area were relatively unchanged. Facet contact force and area were decreased at the treated level following fusion for all three loading conditions. INTERPRETATION Total disc replacement preserved facet contact force for all scenarios except extension at the treated level, highlighting the importance of the anterior disco-ligamentous complex. This could promote treated-level facet joint disease.
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Kotsias A, Mularski S, Kühn B, Hanna M, Suess O. Does partial coating with titanium improve the radiographic fusion rate of empty PEEK cages in cervical spine surgery? A comparative analysis of clinical data. Patient Saf Surg 2017; 11:13. [PMID: 28465722 PMCID: PMC5410055 DOI: 10.1186/s13037-017-0127-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/12/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment. Several types of intervertebral spacers can be used, but there is increasing evidence that PEEK cages yield insufficient fusion and thus less clinical improvement. The study aim was to assess the outcomes of single-level ACDF with an empty PEEK cage partially coated with titanium. METHODS This prospective multicenter single-arm clinical study collected follow-up data at 6, 12, and 18 months. A post hoc comparison was made to closely matched patients from another similar trial treated with identically designed, empty, uncoated PEEK cages. RESULTS There were 49 of 50 patients (98%) who met the MCID of 3+ points of improvement on VAS pain or had an 18-month VAS ≤ 1. Yet even by 18 months post-op, only 40 of 50 (80%) PEEK + Ti patients achieved complete bony fusion. The PEEK + Ti group (n = 49) seemed to have somewhat better fusion scores and significantly better pain relief at 6 M than the matched controls (n = 49), but these differences did not persist at 12 M or 18 M. Patients (with either implant) who achieved complete bony fusion had significantly better improvement of pain at 6 M and disability at 6 M and 12 M than patients that remained unfused. CONCLUSIONS ACDF is effective treatment for cervical myelopathy and radiculopathy. Although this and other studies show that titanium fuses better, partial coating of a PEEK cage does not improve the fusion rate sufficiently or confer other lasting clinical benefit. PEEK cages fully coated with titanium should be tested in prospective randomized comparative trials. TRIAL REGISTRATION Prospective, multicenter, single-arm clinical observational study without an individual Trial registration number. Study design and post hoc data analysis according to the "PIERCE-PEEK study", ISRCTN42774128, retrospectively registered 14 April 2009.
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Affiliation(s)
- Andreas Kotsias
- Department of Orthopaedics and Traumatology, Helios Klinikum Emil von Behring, Berlin, Germany
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Sven Mularski
- Spine and Neurotrauma Center, DRK Kliniken Westend, Spandauer Damm 130, 14050 Berlin, Germany
| | - Björn Kühn
- Spine and Neurotrauma Center, DRK Kliniken Westend, Spandauer Damm 130, 14050 Berlin, Germany
| | - Michael Hanna
- Mercury Spine Healthcare Consulting, New York, NY USA
| | - Olaf Suess
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
- Spine and Neurotrauma Center, DRK Kliniken Westend, Spandauer Damm 130, 14050 Berlin, Germany
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35
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Suess O, Schomaker M, Cabraja M, Danne M, Kombos T, Hanna M. Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter "PIERCE-PEEK" study. Patient Saf Surg 2017; 11:12. [PMID: 28465721 PMCID: PMC5410058 DOI: 10.1186/s13037-017-0128-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Anterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment for radiculopathy and myelopathy. Previous studies showed that empty PEEK cages have lower radiographic fusion rates, but the clinical relevance remains unclear. This paper’s aim is to provide high-quality evidence on the outcomes of ACDF with empty PEEK cages and on the relevance of radiographic fusion for clinical outcomes. Methods This large prospective multicenter clinical trial performed single-level ACDF with empty PEEK cages on patients with cervical radiculopathy or myelopathy. The main clinical outcomes were VAS (0–10) for pain and NDI (0–100) for functioning. Radiographic fusion was evaluated by two investigators for three different aspects. Results The median (range) improvement of the VAS pain score was: 3 (1–6) at 6 months, 3 (2–8) at 12 months, and 4 (2–8) at 18 months. The median (range) improvement of the NDI score was: 12 (2–34) at 6 months, 18 (4–46) at 12 months, and 22 (2–44) at 18 months. Complete radiographic fusion was reached by 126 patients (43%) at 6 months, 214 patients (73%) at 12 months, and 241 patients (83%) at 18 months. Radiographic fusion was a highly significant (p < 0.001) predictor of the improvement of VAS and NDI scores. Conclusion This study provides strong evidence that ACDF is effective treatment, but the overall rate of radiographic fusion with empty PEEK cages is slow and insufficient. Lack of complete radiographic fusion leads to less improvement of pain and disability. We recommend against using empty uncoated pure PEEK cages in ACDF. Trial registration ISRCTN42774128. Retrospectively registered 14 April 2009.
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Affiliation(s)
- Olaf Suess
- Spine and Neurotrauma Center, DRK Kliniken Berlin Westend, Spandauer Damm 130, Berlin, Germany.,Department of Neurosurgery, Charité University Hosptial, Berlin, Germany
| | - Martin Schomaker
- Department of Neurosurgery, Charité University Hosptial, Berlin, Germany
| | - Mario Cabraja
- Department of Neurosurgery, Charité University Hosptial, Berlin, Germany.,Spine Center, Vivantes AVK, Berlin, Germany
| | - Marco Danne
- Department of Neurosurgery, Unfallkrankenhaus Marzahn, Berlin, Germany
| | - Theodoros Kombos
- Department of Neurosurgery, Charité University Hosptial, Berlin, Germany.,Department of Neurosurgery, Schloßpark Klinik, Berlin, Germany.,Lemessos Medical Center, Limassol, Cyprus
| | - Michael Hanna
- Mercury Spine Healthcare Consulting, New York, NY USA
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Wu TK, Wang BY, Meng Y, Ding C, Yang Y, Lou JG, Liu H. Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion: A meta-analysis. Medicine (Baltimore) 2017; 96:e6503. [PMID: 28422837 PMCID: PMC5406053 DOI: 10.1097/md.0000000000006503] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical disc replacement (CDR) has been developed as an alternative surgical procedure to anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease. However, patients with multilevel cervical degenerative disc disease (MCDDD) are common in our clinic. Multilevel CDR is less established compared with multilevel ACDF. This study aims to compare the outcomes and evaluate safety and efficacy of CDR versus ACDF for the treatment of MCDDD. METHODS A meta-analysis was performed for articles published up until August 2016. Randomized controlled trials (RCTs) and prospective comparative studies associated with the use of CDR versus ACDF for the treatment of MCDDD were included in the current study. Two reviewers independently screened the articles and data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. RESULTS Seven studies with 702 enrolled patients suffering from MCDDD were retrieved. Patients who underwent CDR had similar operative times, blood loss, Neck Disability Index (NDI) scores, and Visual Analog Scale (VAS) scores compared to patients who underwent ACDF. Patients who underwent CDR had greater overall motion of the cervical spine and the operated levels than patients who underwent ACDF. Patients who underwent CDR also had lower rates of adjacent segment degeneration (ASD). The rate of adverse events was significantly lower in the CDR group. CONCLUSION CDR may be a safe and effective surgical strategy for the treatment of MCDDD. However, there is insufficient evidence to draw a strong conclusion due to relatively low-quality evidence. Future long-term, multicenter, randomized, and controlled studies are needed to validate the safety and efficacy of multilevel CDR.
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Cervical disc replacement surgery: biomechanical properties, postoperative motion, and postoperative activity levels. Curr Rev Musculoskelet Med 2017; 10:177-181. [PMID: 28353143 DOI: 10.1007/s12178-017-9400-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Cervical disc arthroplasty (CDA) is an evolving technique used in the treatment of cervical disc disease. To remain up to date on studies regarding its efficacy, we sought to answer three questions: What do biomechanical studies demonstrate in regard to the kinematics of CDA? How does CDA affect cervical motion? What are the postoperative activity levels of patients after cervical disc arthroplasty? RECENT FINDINGS 1) In regard to biomechanics, recent data suggests that CDA maintains motion while possibly altering facet biomechanics. 2) Radiographic data indicates a reliable maintenance of motion in the short and medium term. 3) Postoperative activity levels are assessed with clinical outcome data which demonstrate reliable improvement in pain and function. The data reviewed here establishes CDA as an efficacious treatment in the relief of symptoms from CDD. It is important to note however that an evaluation of CDA would benefit from more robust data, specifically in regards to long-term clinical outcomes.
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Gornet MF, Lanman TH, Burkus JK, Hodges SD, McConnell JR, Dryer RF, Copay AG, Nian H, Harrell FE. Cervical disc arthroplasty with the Prestige LP disc versus anterior cervical discectomy and fusion, at 2 levels: results of a prospective, multicenter randomized controlled clinical trial at 24 months. J Neurosurg Spine 2017; 26:653-667. [PMID: 28304237 DOI: 10.3171/2016.10.spine16264] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The authors compared the efficacy and safety of arthroplasty using the Prestige LP cervical disc with those of anterior cervical discectomy and fusion (ACDF) for the treatment of degenerative disc disease (DDD) at 2 adjacent levels. METHODS Patients from 30 investigational sites were randomized to 1 of 2 groups: investigational patients (209) underwent arthroplasty using a Prestige LP artificial disc, and control patients (188) underwent ACDF with a cortical ring allograft and anterior cervical plate. Patients were evaluated preoperatively, intraoperatively, and at 1.5, 3, 6, 12, and 24 months postoperatively. Efficacy and safety outcomes were measured according to the Neck Disability Index (NDI), Numeric Rating Scales for neck and arm pain, 36-Item Short-Form Health Survey (SF-36), gait abnormality, disc height, range of motion (investigational) or fusion (control), adverse events (AEs), additional surgeries, and neurological status. Treatment was considered an overall success when all 4 of the following criteria were met: 1) NDI score improvement of ≥ 15 points over the preoperative score, 2) maintenance or improvement in neurological status compared with preoperatively, 3) no serious AE caused by the implant or by the implant and surgical procedure, and 4) no additional surgery (supplemental fixation, revision, or nonelective implant removal). Independent statisticians performed Bayesian statistical analyses. RESULTS The 24-month rates of overall success were 81.4% for the investigational group and 69.4% for the control group. The posterior mean for overall success in the investigational group exceeded that in the control group by 0.112 (95% highest posterior density interval = 0.023 to 0.201) with a posterior probability of 1 for noninferiority and 0.993 for superiority, demonstrating the superiority of the investigational group for overall success. Noninferiority of the investigational group was demonstrated for all individual components of overall success and individual effectiveness end points, except for the SF-36 Mental Component Summary. The investigational group was superior to the control group for NDI success. The proportion of patients experiencing any AE was 93.3% (195/209) in the investigational group and 92.0% (173/188) in the control group, which were not statistically different. The rate of patients who reported any serious AE (Grade 3 or 4) was significantly higher in the control group (90 [47.9%] of 188) than in the investigational group (72 [34.4%] of 209) with a posterior probability of superiority of 0.996. Radiographic success was achieved in 51.0% (100/196) of the investigational patients (maintenance of motion without evidence of bridging bone) and 82.1% (119/145) of the control patients (fusion). At 24 months, heterotopic ossification was identified in 27.8% (55/198) of the superior levels and 36.4% (72/198) of the inferior levels of investigational patients. CONCLUSIONS Arthroplasty with the Prestige LP cervical disc is as effective and safe as ACDF for the treatment of cervical DDD at 2 contiguous levels and is an alternative treatment for intractable radiculopathy or myelopathy at 2 adjacent levels. Clinical trial registration no.: NCT00637156 ( clinicaltrials.gov ).
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Affiliation(s)
| | - Todd H Lanman
- California Spine Group, Century City Hospital, Los Angeles, California
| | - J Kenneth Burkus
- Wilderness Spine Services, The Hughston Clinic, Columbus, Georgia
| | - Scott D Hodges
- Center for Sports Medicine and Orthopaedics, Chattanooga
| | | | | | | | - Hui Nian
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Affiliation(s)
- Domagoj Coric
- Carolina Neurosurgery and Spine Associates and.,Carolinas Medical Center, Charlotte, North Carolina
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vincent Traynelis
- Department of Neurosurgery, Rush Medical Center, Chicago, Illinois; and
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, California
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Cervical disc arthroplasty for symptomatic cervical disc disease: Traditional and Bayesian meta-analysis with trial sequential analysis. Int J Surg 2016; 35:111-119. [PMID: 27693477 DOI: 10.1016/j.ijsu.2016.09.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been designed as a substitute for anterior cervical discectomy and fusion (ACDF) in the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Using recently published evidence, this meta-analysis was conducted to further verify the benefits and harms of using CDA for treatment of symptomatic CDD. METHODS Relevant trials were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Outcomes were reported as odds ratio or standardized mean difference. Both traditional frequentist and Bayesian approaches were used to synthesize evidence within random-effects models. Trial sequential analysis (TSA) was applied to test the robustness of our findings and obtain more conservative estimates. RESULTS Nineteen trials were included. The findings of this meta-analysis demonstrated better overall, neck disability index (NDI), and neurological success; lower NDI and neck and arm pain scores; higher 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores; more patient satisfaction; greater range of motion at the operative level; and fewer secondary surgical procedures (all P < 0.05) in the CDA group compared with the ACDF group. CDA was not significantly different from ACDF in the rate of adverse events (P > 0.05). TSA of overall success suggested that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, indicating sufficient and conclusive evidence had been ascertained. CONCLUSIONS For treating symptomatic CDD, CDA was superior to ACDF in terms of overall, NDI, and neurological success; NDI and neck and arm pain scores; SF-36 PCS and MCS scores; patient satisfaction; ROM at the operative level; and secondary surgical procedures rate. Additionally, there was no significant difference between CDA and ACDF in the rate of adverse events. However, as the CDA procedure is a relatively newer operative technique, long-term results and evaluation are necessary before CDA is routinely used in clinical practice.
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Ma Z, Ma X, Yang H, Guan X, Li X. Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis. 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 2016; 26:998-1008. [DOI: 10.1007/s00586-016-4779-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
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Yang Y, Ma L, Liu H, Liu Y, Hong Y, Wang B, Ding C, Deng Y, Song Y, Liu L. Comparison of the incidence of patient-reported post-operative dysphagia between ACDF with a traditional anterior plate and artificial cervical disc replacement. Clin Neurol Neurosurg 2016; 148:72-8. [DOI: 10.1016/j.clineuro.2016.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/05/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
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Meisel HJ. Challenging the state of the art. JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 2:240-241. [PMID: 27757441 PMCID: PMC5067275 DOI: 10.21037/jss.2016.09.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
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Staudt MD, Das K, Duggal N. Does design matter? Cervical disc replacements under review. Neurosurg Rev 2016; 41:399-407. [PMID: 27465393 DOI: 10.1007/s10143-016-0765-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/30/2016] [Accepted: 06/23/2016] [Indexed: 01/11/2023]
Abstract
The present article reviews the design rationale of currently available cervical disc replacements. Recent prospective randomized control trials comparing cervical disc replacement and anterior fusion have demonstrated safety as well as equal or superior clinical results. Increasingly, more devices are becoming available on the market. Understanding design rationale will provide context for the surgeon to optimize decision making for the most appropriate prosthesis. Cervical arthroplasty is a technique that is undergoing rapid design refinement and development. Further improvements in device design will enable patient-specific device selection. Understanding the design rationale and complication profile of each device will improve clinical and radiographic outcomes.
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Affiliation(s)
- Michael D Staudt
- Department of Clinical Neurological Sciences, Division of Neurosurgery, Western University, London, Ontario, Canada
| | - Kaushik Das
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Neil Duggal
- Department of Clinical Neurological Sciences, Division of Neurosurgery, Western University, London, Ontario, Canada.
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Meisel HJ, Jurák L, Antinheimo J, Arregui R, Bruchmann B, Čabraja M, Caroli F, Kroppenstedt S, Kryl J, Pohjola J, Shackleford I, Sola S, Stosberg P, Stulik J, Woiciechowsky C, Suchomel P. Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome. J Neurosurg Spine 2016; 25:556-565. [PMID: 27258476 DOI: 10.3171/2016.3.spine15810] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from -2.4° preoperatively to -6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 ( clinicaltrials.gov ).
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Affiliation(s)
- Hans-Jörg Meisel
- Department of Neurosurgery, BG Clinic Bergmannstrost, Halle, Germany
| | - Lubomír Jurák
- Neurocentre, Regional Hospital Liberec, Czech Republic
| | | | | | | | - Mario Čabraja
- Zentrum für Wirbelsäulenchirurgie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Fabrizio Caroli
- Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Stefan Kroppenstedt
- Abteilung für Wirbelsäulenchirurgie, Sana Kliniken Sommerfeld, Kremmen, Germany
| | - Jan Kryl
- Center for Spine Surgery, Motol University Hospital, Prague, Czech Republic
| | - Juha Pohjola
- Department of Neurosurgery, University of Helsinki, Finland
| | - Ian Shackleford
- Spinal Surgery, Warrington District General Hospital, Warrington, United Kingdom; and
| | - Steffen Sola
- Department of Neurosurgery, University of Rostock, Germany; and
| | - Peter Stosberg
- Department of Neurosurgery, BG Clinic Bergmannstrost, Halle, Germany
| | - Jan Stulik
- Center for Spine Surgery, Motol University Hospital, Prague, Czech Republic
| | | | - Petr Suchomel
- Neurocentre, Regional Hospital Liberec, Czech Republic
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Aragonés M, Hevia E, Barrios C. Polyurethane on titanium unconstrained disc arthroplasty versus anterior discectomy and fusion for the treatment of cervical disc disease: a review of level I-II randomized clinical trials including clinical outcomes. 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 2015; 24:2735-45. [PMID: 26363559 DOI: 10.1007/s00586-015-4228-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To contrast the clinical and radiologic outcomes and adverse events of anterior cervical discectomy and fusion (ACDF) with a single cervical disc arthroplasty design, the polyurethane on titanium unconstrained cervical disc (PTUCD). METHODS This is a systematic review of randomized clinical trials (RCT) with evidence level I-II reporting clinical outcomes. After a search on different databases including PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE, a total of 10 RCTs out of 51 studies found were entered in the study. RTCs were searched from the earliest available records in 2005 to November 2014. RESULTS Out of a total of 1101 patients, 562 were randomly assigned into the PTUCD arthroplasty group and 539 into the ACDF group. The mean follow-up was 30.9 months. Patients undergoing arthroplasty had lower Neck Disability Index, and better SF-36 Physical component scores than ACDF patients. Patients with PTUCD arthroplasty had also less radiological degenerative changes at the upper adjacent level. Overall adverse events were twice more frequent in patients with ACDF. The rate of revision surgery including both adjacent and index level was slightly higher in patients with ACDF, showing no statistically significant difference. CONCLUSIONS According to this review, PTUCD arthroplasty showed a global superiority to ACDF in clinical outcomes. The impact of both surgical techniques on the cervical spine (radiological spine deterioration and/or complications) was more severe in patients undergoing ACDF. However, the rate of revision surgeries at any cervical level was equivalent for ACDF and PTUCD arthroplasty.
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Affiliation(s)
- María Aragonés
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain
| | - Eduardo Hevia
- Spine Surgery Unit, Hospital La Fraternidad, Paseo de la Habana 83-85, 28036, Madrid, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
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Matgé G, Buddenberg P, Eif M, Schenke H, Herdmann J. Dynamic cervical stabilization: a multicenter study. 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 2015; 24:2841-7. [DOI: 10.1007/s00586-015-4218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/28/2022]
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Evaniew N, van der Watt L, Bhandari M, Ghert M, Aleem I, Drew B, Guyatt G. Strategies to improve the credibility of meta-analyses in spine surgery: a systematic survey. Spine J 2015; 15:2066-76. [PMID: 26002725 DOI: 10.1016/j.spinee.2015.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/09/2015] [Accepted: 05/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. These studies have become increasingly popular in the spine surgery literature, but the rigor with which they are being conducted has not yet been evaluated. PURPOSE Our primary objectives were to evaluate the methodological quality (credibility) of spine surgery meta-analyses and to propose strategies to improve future research. Our secondary objectives were to evaluate completeness of reporting and identify factors associated with higher credibility and completeness of reporting. STUDY DESIGN This study is based on a systematic survey of meta-analyses. OUTCOME MEASURES We evaluated credibility according to the Users' Guide to the Medical Literature and completeness of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS We systematically searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently assessed eligibility, credibility, and completeness of reporting. We used multivariable linear regression to evaluate potential associations. Interrater agreement was quantified using kappa and intraclass correlation (ICC) coefficients. RESULTS We identified 132 eligible meta-analyses of spine surgery interventions. The mean credibility score was 3 of 7 (standard deviation [SD], 1.4; ICC, 0.86), with agreement for each item ranging from 0.54 (moderate) to 0.83 (almost perfect). Clinical questions were judged as sensible in 125 (95%), searches were exhaustive in 102 (77%), and risk of bias assessments were undertaken in 91 (69%). Seven (5%) meta-analyses addressed possible explanations for heterogeneity using a priori subgroup hypotheses and 24 (18%) presented results that were immediately clinically applicable. Investigators undertook duplicate assessments of eligibility, risk of bias, and data extraction in 46 (35%) and rated overall confidence in the evidence in 24 (18%). Later publication year, increasing Journal Impact Factor, increasing number of databases, inclusion of Randomized Controlled Trials, and inclusion of non-English studies were significantly associated with higher credibility scores (p<.05). The mean score for reporting was 18 of 27 (SD, 4.4; ICC, 0.94). CONCLUSIONS The credibility of many current spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the pooled effect estimates, and adhering to guidelines for complete reporting.
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Affiliation(s)
- Nathan Evaniew
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7.
| | - Leon van der Watt
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Mohit Bhandari
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Michelle Ghert
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Ilyas Aleem
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Brian Drew
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Gordon Guyatt
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
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Tashani OA, El-Tumi H, Aneiba K. Quality of systematic reviews: an example of studies comparing artificial disc replacement with fusion in the cervical spine. Libyan J Med 2015; 10:28857. [PMID: 26205640 PMCID: PMC4513180 DOI: 10.3402/ljm.v10.28857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/28/2015] [Indexed: 01/08/2023] Open
Abstract
Cervical artificial disc replacement (C-ADR) is now an alternative to anterior cervical discectomy and fusion (ACDF). Many studies have evaluated the efficacy of C-ADR compared with ACDF. This led to a series of systematic reviews and meta-analyses to evaluate the evidence of the superiority of one intervention against the other. The aim of the study presented here was to evaluate the quality of these reviews and meta-analyses. Medline via Ovid, Embase, and Cochrane Library were searched using the keywords: (total disk replacement, prosthesis, implantation, discectomy, and arthroplasty) AND (cervical vertebrae, cervical spine, and spine) AND (systematic reviews, reviews, and meta-analysis). Screening and data extraction were conducted by two reviewers independently. Two reviewers then assessed the quality of the selected reviews and meta-analysis using 11-item AMSTAR score which is a validated measurement tool to assess the methodological quality of systematic reviews. Screening of full reports of 46 relevant abstracts resulted in the selection of 15 systematic reviews and/or meta-analyses as eligible for this study. The two reviewers' inter-rater agreement level was high as indicated by kappa of >0.72. The AMSTAR score of the reviews ranged from 3 to 11. Only one study (a Cochrane review) scored 100% (AMSTAR 11). Five studies scored below (AMSTAR 5) indicating low-quality reviews. The most significant drawbacks of reviews of a score below 5 were not using an extensive search strategy, failure to use the scientific quality of the included studies appropriately in formulating a conclusion, not assessing publication bias, and not reporting the excluded studies. With a significant exception of a Cochrane review, the methodological quality of systematic reviews evaluating the evidence of C-ADR versus ACDF has to be improved.
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Affiliation(s)
- Osama A Tashani
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK;
| | - Hanan El-Tumi
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Khaled Aneiba
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
- Orthopaedics Department, University Hospital of North Tees, Stockton-on-Tees, UK
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Wu W, Lyu J, Liu H, Rong X, Wang B, Hong Y, Gong Q, Li T, Liu L, Song Y, Cai Y, Xu W. Wear assessments of a new cervical spinal disk prosthesis: Influence of loading and kinematic patterns during in vitro wear simulation. Proc Inst Mech Eng H 2015; 229:619-28. [PMID: 26163521 DOI: 10.1177/0954411915594829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/01/2015] [Indexed: 02/05/2023]
Abstract
Surgical treatment is one of the effective methods of treatment in cervical spondylosis. The traditional method of operation is decompression fusion; however, this surgery results in restricted movement of cervical vertebra and adjacent segment degeneration. Due to the deficiency of traditional surgery, scholars have widely carried out artificial cervical disk replacement surgery and have achieved good clinical effects. Comparing to the characteristics of the common artificial cervical disk which is used frequently, we developed a new artificial cervical intervertebral disk prosthesis. The purpose of this study was to determine the wear behavior in a cervical total disk replacement system. The total disk replacement system tested consists of a ultra-high-molecular-weight polyethylene inlay articulating between a Ti6Al4V alloy superior plate and an inferior plate, using a spine wear simulator, per the ISO 18192-1:2011 standard test methods. Three rotations and axial force were applied on each station. The specimens were removed at 5 × 10(5) and 10(6) cycles and at intervals of 10(6) cycles thereafter to determine the actual mass loss. The serum was replaced every 5 × 10(5) cycles. The specimens were changed periodically among the different stations. A mean ultrahigh molecular weight polyethylene inlay wear rate of 0.53 mg per million cycles (standard = 0.13 mg per 10(6) cycles) was found after 10(7) cycles. All inferior plates showed slight scratching after 10(7) cycles. The impingement wear simulation introduced here proved to be suitable to predict in vivo impingement behavior in regard to the contact pattern seen on retrieved devices of the Pretic-I disk arthroplasty design in a preclinical test.
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Affiliation(s)
- Wenjie Wu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Jingtong Lyu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Hao Liu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Xin Rong
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Beiyu Wang
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Ying Hong
- Operating Room Chengdu, West China Hospital, Chengdu, China
| | - Quan Gong
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Tao Li
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Limin Liu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Yueming Song
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Yong Cai
- The Chuang Sheng Medical (China) of Yangtze River Test Center, Changzhou, China
| | - Wenli Xu
- The Chuang Sheng Medical (China) of Yangtze River Test Center, Changzhou, China
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