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Simões de Souza NF, Broekema AEH, Reneman MF, Koopmans J, van Santbrink H, Arts MP, Burhani B, Bartels RHMA, van der Gaag NA, Verhagen MHP, Tamási K, van Dijk JMC, Groen RJM, Soer R, Kuijlen JMA. Posterior Cervical Foraminotomy Compared with Anterior Cervical Discectomy with Fusion for Cervical Radiculopathy: Two-Year Results of the FACET Randomized Noninferiority Study. J Bone Joint Surg Am 2024; 106:1653-1663. [PMID: 39047120 DOI: 10.2106/jbjs.23.00775] [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] [Indexed: 07/27/2024]
Abstract
BACKGROUND Posterior cervical foraminotomy (posterior surgery) is a valid alternative to anterior discectomy with fusion (anterior surgery) as a surgical treatment of cervical radiculopathy, but the quality of evidence has been limited. The purpose of this study was to compare the clinical outcome of these treatments after 2 years of follow-up. We hypothesized that posterior surgery would be noninferior to anterior surgery. METHODS This multicenter, randomized, noninferiority trial assessed patients with single-level cervical radiculopathy in 9 Dutch hospitals with a follow-up duration of 2 years. The primary outcomes measured reduction of cervical radicular pain and were the success ratio based on the Odom criteria, and arm pain and decrease in arm pain, evaluated with the visual analog scale, with a 10% noninferiority margin, which represents the maximum acceptable difference between the new treatment (posterior surgery) and the standard treatment (anterior surgery), beyond which the new treatment would be considered clinically unacceptable. The secondary outcomes were neck pain, Neck Disability Index, Work Ability Index, quality of life, complications (including reoperations), and treatment satisfaction. Generalized linear mixed effects modeling was used for analyses. The study was registered at the Overview of Medical Research in the Netherlands (OMON), formerly the Netherlands Trial Register (NTR5536). RESULTS From January 2016 to May 2020, 265 patients were randomized (132 to the posterior surgery group and 133 to the anterior surgery group). Among these, 25 did not have the allocated intervention; 11 of these 25 patients had symptom improvement, and the rest of the patients did not have the intervention due to various reasons. At the 2-year follow-up, of 243 patients, primary outcome data were available for 236 patients (97%). Predicted proportions of a successful outcome were 0.81 after posterior surgery and 0.74 after anterior surgery (difference in rate, -0.06 [1-sided 95% confidence interval (CI), -0.02]), indicating the noninferiority of posterior surgery. The between-group difference in arm pain was -2.7 (1-sided 95% CI, 7.4) and the between-group difference in the decrease in arm pain was 1.5 (1-sided 95% CI, 8.2), both confirming the noninferiority of posterior surgery. The secondary outcomes demonstrated small between-group differences. Serious surgery-related adverse events occurred in 9 patients (8%) who underwent posterior surgery, including 9 reoperations, and 11 patients (9%) who underwent anterior surgery, including 7 reoperations (difference in reoperation rate, -0.02 [2-sided 95% CI, -0.09 to 0.05]). CONCLUSIONS This trial demonstrated that, after a 2-year follow-up, posterior surgery was noninferior to anterior surgery with regard to the success rate and arm pain reduction in patients with 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)
- Nádia F Simões de Souza
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne E H Broekema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Koopmans
- Department of Neurosurgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Henk van Santbrink
- Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Bachtiar Burhani
- Department of Neurosurgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Katalin Tamási
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Remko Soer
- Department of Anesthesiology, Groninger Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- mProve Hospitals, Zwolle, The Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vadalà G, Ambrosio L, De Salvatore S, Riew DK, Yoon ST, Wang JC, Meisel HJ, Buser Z, Denaro V. The Role of Osteobiologics in Augmenting Spine Fusion in Unplated Anterior Cervical Discectomy and Fusion Compared to Plated Constructs: A Systematic Review and Meta-analysis. Global Spine J 2024; 14:43S-58S. [PMID: 38421326 PMCID: PMC10913900 DOI: 10.1177/21925682231156865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To compare clinical and radiographic outcomes as well as complications of unplated vs plated anterior cervical discectomy and fusion (ACDF) surgery considering the role of osteobiologics in single- and multi-level procedures. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL, Cochrane and ClinicalTrials.gov databases was performed. Briefly, we sought to identify studies comparing unplated vs. plated ACDF for cervical degenerative disc disease reporting the use of osteobiologics in terms of clinical outcomes, radiographic fusion, and complications. Data on study population, follow-up time, type of cage and plate used, type of osteobiologic employed, number of levels treated, patient-reported outcomes (PROs), radiographic outcomes and complications were collected and compared. Relevant information was pooled for meta-analyses. RESULTS Thirty-eight studies met the inclusion criteria. No significant difference was found in terms of clinical outcomes between groups. Unplated ACDF was characterized by reduced blood loss, operation time and length of hospital stay. Fusion was achieved by the majority of patients in both groups, with no evidence of any specific contribution depending on the osteobiologics used. Dysphagia was more commonly associated with anterior plating, while cage subsidence prevailed in the unplated group. CONCLUSION Unplated and plated ACDF seem to provide similar outcomes irrespective of the osteobiologic used, with minor differences with doubtful clinical significance. However, the heterogeneity and high risk of bias affecting included studies markedly prevent significant conclusions.
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Affiliation(s)
- Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniel K Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Wöltje M, Künzelmann L, Belgücan B, Croft AS, Voumard B, Bracher S, Zysset P, Gantenbein B, Cherif C, Aibibu D. Textile Design of an Intervertebral Disc Replacement Device from Silk Yarn. Biomimetics (Basel) 2023; 8:biomimetics8020152. [PMID: 37092404 PMCID: PMC10123607 DOI: 10.3390/biomimetics8020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023] Open
Abstract
Low back pain is often due to degeneration of the intervertebral discs (IVD). It is one of the most common age- and work-related problems in today's society. Current treatments are not able to efficiently restore the full function of the IVD. Therefore, the aim of the present work was to reconstruct the two parts of the intervertebral disc-the annulus fibrosus (AF) and the nucleus pulposus (NP)-in such a way that the natural structural features were mimicked by a textile design. Silk was selected as the biomaterial for realization of a textile IVD because of its cytocompatibility, biodegradability, high strength, stiffness, and toughness, both in tension and compression. Therefore, an embroidered structure made of silk yarn was developed that reproduces the alternating fiber structure of +30° and -30° fiber orientation found in the AF and mimics its lamellar structure. The developed embroidered ribbons showed a tensile strength that corresponded to that of the natural AF. Fiber additive manufacturing with 1 mm silk staple fibers was used to replicate the fiber network of the NP and generate an open porous textile 3D structure that may serve as a reinforcement structure for the gel-like NP.
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Affiliation(s)
- Michael Wöltje
- Institute of Textile Machinery and High-Performance Material Technology, Technische Universität Dresden, 01602 Dresden, Germany
| | - Liesa Künzelmann
- Institute of Textile Machinery and High-Performance Material Technology, Technische Universität Dresden, 01602 Dresden, Germany
| | - Basak Belgücan
- Institute of Textile Machinery and High-Performance Material Technology, Technische Universität Dresden, 01602 Dresden, Germany
| | - Andreas S Croft
- Tissue Engineering for Orthopaedic and Mechanobiology, Bone and Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, 3008 Bern, Switzerland
| | - Benjamin Voumard
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland
| | - Stefan Bracher
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland
| | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedic and Mechanobiology, Bone and Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, 3008 Bern, Switzerland
- Department of Orthopedic Surgery and Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Chokri Cherif
- Institute of Textile Machinery and High-Performance Material Technology, Technische Universität Dresden, 01602 Dresden, Germany
| | - Dilbar Aibibu
- Institute of Textile Machinery and High-Performance Material Technology, Technische Universität Dresden, 01602 Dresden, Germany
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Goedmakers CMW, de Vries F, Bosscher L, Peul WC, Arts MP, Vleggeert-Lankamp CLA. Long-term results of the NECK trial-implanting a disc prosthesis after cervical anterior discectomy cannot prevent adjacent segment disease: five-year clinical follow-up of a double-blinded randomised controlled trial. Spine J 2023; 23:350-360. [PMID: 36396007 DOI: 10.1016/j.spinee.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND CONTEXT Motion preserving anterior cervical disc arthroplasty (ACDA) in patients with cervical radiculopathy was introduced to prevent symptomatic adjacent segment disease as compared to anterior cervical discectomy and fusion (ACDF). PURPOSE To evaluate the long-term outcome in patients with cervical radiculopathy due to a herniated disc undergoing ACDA, ACDF or ACD (no cage, no plate) in terms of clinical outcome measured by the Neck Disability Index (NDI). Likewise, clinically relevant adjacent segment disease is assessed as a long-term result. STUDY DESIGN Double-blinded randomized controlled trial. PATIENT SAMPLE A total of 109 patients with one level herniated disc were randomized to one of the following treatments: ACDA, ACDF with intervertebral cage, ACD without cage. OUTCOME MEASURES Clinical outcome was measured by patients' self-reported NDI, Visual Analogue Scale (VAS) neck pain, VAS arm pain, SF36, EQ-5D, perceived recovery and reoperation rate. Radiological outcome was assessed by radiographic cervical curvature and adjacent segment degeneration (ASD) parameters at baseline and up until five years after surgery. METHODS To account for the correlation between repeated measurements of the same individual Generalized Estimated Equations (GEE) were used to calculate treatment effects, expressed in difference in marginal mean values for NDI per treatment group. RESULTS Clinical outcome parameters were comparable in the ACDA and ACDF group, but significantly worse in the ACD group, though not reaching clinical relevance. Annual reoperation rate was 3.6% in the first two years after surgery, declined to 1.9% in the years thereafter. The number of reoperations for ASD was not lower in the ACDA group, while the number of reoperations at the index level was higher after ACD, when compared to ACDF and ACDA. CONCLUSIONS A persisting absence of clinical superiority was demonstrated for the cervical disc prosthesis five years after surgery. Specifically, clinically relevant adjacent level disease was not prevented by implanting a prosthesis. Single level ACD without implanting an intervertebral device provided worse clinical outcome, which was hypothesized to be caused by delayed fusion. This stresses the need for focusing on timely fusion in future research.
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Affiliation(s)
- Caroline M W Goedmakers
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands.
| | - Floor de Vries
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Lisette Bosscher
- Northwest Clinics, Wilhelminalaan 12, Alkmaar, 1815, NH, The Netherlands
| | - Wilco C Peul
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Mark P Arts
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands; Spaarne Gasthuis, Spaarnepoort 1, Hoofddorp, 2134, NH, The Netherlands
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Wang L, Bai M, Li XB, Wang ZR, Wang B, Huang AB. Does the sizing of current cervical disc arthroplasty systems match Chinese cervical anatomic dimensions? Front Bioeng Biotechnol 2022; 10:1036223. [PMID: 36394034 PMCID: PMC9640970 DOI: 10.3389/fbioe.2022.1036223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2023] Open
Abstract
Objective: The objectives of this study were to analyze the computed tomography (CT) scan imaging data of the cervical spine from healthy volunteers and to correlate the measurements to the dimensions of current cervical disc arthroplasty systems. Methods: A total of 130 participants (78 males and 52 females) with a mean age of 41.0 years (range 18.0-66.0 years) who had undergone computed tomography scans of the cervical spine were included. The linear parameters of the C3 to C7 levels, including anterior-posterior diameter (AP), middle disc height (DH), anterior disc height (ADH), posterior disc height (PDH) and center mediolateral diameter (ML), were measured. The analysis was conducted comparing different cervical levels, sexes, and age groups. Known dimensions from eight cervical disc arthroplasty systems were compared with the morphologic data. Results: A total of 520 vertebral segments were measured. The mean values for the measured parameters were as follows: anterior-posterior diameter 16.08 ± 1.84 mm, mediolateral diameter 16.13 ± 1.99 mm, anterior disc height 3.88 ± 1.11 mm, disc height 5.73 ± 1.00 mm, posterior disc height 2.83 ± 0.94 mm, and mediolateral diameter/anterior-posterior diameter 1.01 ± 0.13. All parameters except for posterior disc height were significantly different across the different cervical levels (p < 0.05). There were also significant sex differences in terms of the linear parameters. No differences were found in the majority of parameters among the different age groups (p > 0.05), except for anterior-posterior diameter at the C6/7 level. A comparison of the bone dimensions from the study data and the dimensions of the implants indicated the presence of a size mismatch in the currently available cervical disc prostheses. Conclusion: There is a large discrepancy between the cervical anatomical data of Chinese patients and the sizes of currently available prostheses. The dimensions collected in this study could be used to design and develop appropriate disc prostheses for Chinese patients.
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Affiliation(s)
- Lu Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Meng Bai
- Department of Orthopedics, Xi’an People’s Hospital, Xi’an, Shaanxi, China
| | - Xing-Bin Li
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Zhao-Rui Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Bang Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Ai-Bing Huang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
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Yeni YN, Azad S, Oravec D, Schildcrout A, Basheer A, Bey MJ, Bartol SW, Chang V. Intervertebral kinematics during neck motion 6.5 years after fusion and artificial disc replacement. Clin Biomech (Bristol, Avon) 2022; 99:105756. [PMID: 36063742 DOI: 10.1016/j.clinbiomech.2022.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroplasty with artificial disc replacement for surgical treatment of cervical spine degeneration was introduced with the notion that motion-preserving approaches would prevent development of adjacent segment disease. Though clinical outcomes favor arthroplasty over the commonly used anterior cervical discectomy with fusion approach, clinical studies confirming the biomechanical basis of these results are lacking. The aim of this study was to compare intervertebral kinematics between arthroplasty and fusion patients 6.5 years post-surgery during physiological motion of the neck. METHODS Using a biplane dynamic X-ray system, computed tomography imaging and model based tracking algorithms, three dimensional intervertebral kinematics were measured during neck axial rotation and extension in 14 patients treated for cervical radiculopathy with fusion (n = 8) or arthroplasty (n = 6). The measurements were performed at 2-year (baseline) and 6.5 year post-surgical time points, with the main interest being in the interaction between surgery types and time points. 3 translations and 3 rotations were investigated for the index (C5C6), and upper- (C4C5) and lower adjacent levels (C6C7). FINDINGS Surgery-time interaction was significant for axial rotation (P < 0.04) and flexion-extension rotation (P < 0.005) in C4C5 during neck axial rotation, left-right translation (P < 0.04) in C5C6 and anterior-posterior translation in C6C7 (P < 0.04) during neck extension. In contrast with the expectations, axial rotation and flexion-extension decreased in C4C5 during neck rotation and anterior-posterior translation decreased in C6C7 during neck extension for fusion. INTERPRETATION The findings do not support the notion that adjacent segment motion increases after fusion.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA.
| | - Sherwin Azad
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Daniel Oravec
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Andrew Schildcrout
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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Letter to the Editor Regarding “The Incidence of Adjacent Segment Pathology After Cervical Disc Arthroplasty Compared with Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Randomized Clinical Trials”. World Neurosurg 2022; 164:457-458. [DOI: 10.1016/j.wneu.2022.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
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A meta-analysis comparing the short- and mid- to long-term outcomes of artificial cervical disc replacement(ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. INTERNATIONAL ORTHOPAEDICS 2022; 46:1609-1625. [PMID: 35113188 DOI: 10.1007/s00264-022-05318-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/23/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Anterior cervical discectomy and fusion (ACDF) surgery is commonly performed to treat cervical degenerative disc disease (CDDD). The lost of range of motion (ROM) is also found after ACDF, which contributes to degenerate in adjacent segment disease (ASD). Artificial cervical disc replacement (ACDR), an alternative to ACDF, is developed to preserve the ROM and reduce ASD. This article aims to compare the outcomes between ACDR and ACDF in the short-, mid-, and long-term. METHODS Databases including Cochrane, Embase, PubMed, and Web of Science were searched. Only RCTs were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Handbook. The strength of evidence was assessed using GRADE. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data. RESULTS Thirty prospective RCTs were included. Prolonged operative duration, better overall success, neurological success, and NDI success rates were found in ACDR group in all follow-up periods, with lower dysphagia/dysphonia during short-term follow-up. Moreover, a lower ASD was found in ACDR group during long-term follow-up and overall analysis, with lower reoperation rates in all follow-up periods. Comparable length of hospital stay and blood loss were found in both groups. Moreover, ASD was similar in short- and mid-term follow-ups, while dysphagia/dysphonia incidence was similar in mid- and long-term follow-ups. The incidence of implant events was comparable in all follow-up periods (p > 0.05). CONCLUSIONS ACDR is as effective as ACDF and superior for some success rates. Disc replacement can reduce the risk of dysphagia/dysphonia, ASD, and re-operation.
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Toci GR, Canseco JA, Patel PD, Divi SN, Goz V, Shenoy K, Sherman MB, Hilibrand AS, Donnally CJ. The Incidence of Adjacent Segment Pathology Following Cervical Disc Arthroplasty Compared to Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. World Neurosurg 2022; 160:e537-e548. [DOI: 10.1016/j.wneu.2022.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Azad S, Oravec D, Baumer T, Schildcrout A, White P, Basheer A, Bey MJ, Bartol SW, Chang V, Yeni YN. Dynamic foraminal dimensions during neck motion 6.5 years after fusion and artificial disc replacement. PLoS One 2020; 15:e0237350. [PMID: 32780779 PMCID: PMC7418980 DOI: 10.1371/journal.pone.0237350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022] Open
Abstract
Objective To compare changes in foraminal motion at two time points post-surgery between artificial disc replacement (ADR) and anterior cervical discectomy and fusion (ACDF). Methods Eight ACDF and 6 ADR patients (all single-level C5-6) were tested at 2 years (T1) and 6.5 years (T2) post-surgery. The minimum foraminal height (FH.Min) and width (FW.Min) achieved during neck axial rotation and extension, and the range of these dimensions during motion (FH.Rn and FW.Rn, respectively) were measured using a biplane dynamic x-ray system, CT imaging and model-based tracking while patients performed neck axial rotation and extension tasks. Two-way mixed ANOVA was employed for analysis. Results In neck extension, significant interactions were found between year post-surgery and type of surgery for FW.Rn at C5-6 (p<0.006) and C6-7 (p<0.005), and for FH.Rn at C6-7 (p<0.01). Post-hoc analysis indicated decreases over time in FW.Rn for ACDF (p<0.01) and increases in FH.Rn for ADR (p<0.03) at the C6-7 adjacent level. At index level, FW.Rn was comparable between ACDF and ADR at T1, but was smaller for ACDF than for ADR at T2 (p<0.002). In axial rotation, differences were found between T1 and T2 but did not depend on type of surgery (p>0.7). Conclusions Changes were observed in the range of foraminal geometry at adjacent levels from 2 years to 6.5 years post-surgery that were different between ACDF and ADR for neck extension. These changes are contrary to the notion that motion at adjacent levels continue to increase following ACDF as compared to ADR over the long term.
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Affiliation(s)
- Sherwin Azad
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
- School of Medicine, Wayne State University, Detroit, Michigan, United States of America
| | - Daniel Oravec
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Timothy Baumer
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Andrew Schildcrout
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Parnell White
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
- School of Medicine, Wayne State University, Detroit, Michigan, United States of America
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Michael J. Bey
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Stephen W. Bartol
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Yener N. Yeni
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America
- * E-mail:
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11
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Ge CY, Wang J, Zhang BF, Hui H, Shan LQ, Zhao QP, Hao DJ. Spontaneous Fusion After Cervical Disc Arthroplasty: A Case Report and Literature Review. J Pain Res 2020; 13:771-776. [PMID: 32368130 PMCID: PMC7183536 DOI: 10.2147/jpr.s242646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report a rare case of spontaneous fusion (SF) following cervical disc arthroplasty (CDA), to review the related literature, and to propose a new measure to prevent it. Methods The course of a patient with SF is described here. The potential causes, risk factors, and preventive measure of SF after CDA published in previous studies have also been reviewed and discussed. Results A 63-year-old man presented with a 6-month history of progressive neck pain and developed left C-7 radiculopathy 4 years ago. Magnetic resonance imaging revealed disc herniation at the C6–C7 levels resulting in compression of the left C-7 nerve root. The patient underwent CDA at the C6–C7 levels, during which a PRESTIGE cervical disc device was implanted. He failed to follow-up regularly as recommended postoperatively because he was completely free from the pain in his neck and left upper limb. Four years later, he was readmitted with a 2-month history of occasional neck stiffness. Plain radiographs indicated complete radiographic fusion of the C6–C7 levels with trabecular bone bridging surrounding the cervical disc prosthesis, and dynamic imaging showed no motion. He was seen at regular follow-up visits for up to 60 months without special treatment, as his symptoms of neck stiffness were minor and his symptom has not worsened since then. Conclusion SF after CDA is a rare condition that can be attributed to patient- or prosthesis-related causes, and its risk factors are diverse. SF after CDA did not affect the patient’s clinical outcome, and no special treatment was required for it. Practitioners should be aware of this rare complication and advise patients of the risks before performing CDA.
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Affiliation(s)
- Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Jing Wang
- Department of Ophthalmology, Xi'an Fourth Hospital, Xi'an 710004, Shaanxi Province, People's Republic of China
| | - Bin-Fei Zhang
- Department of Trauma Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Hao Hui
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Le-Qun Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Qin-Peng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
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12
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Yang X, Donk R, Arts MP, Arnts H, Walraevens J, Zhai Z, Depreitere B, Bartels RHMA, Vleggeert-Lankamp CLA. Maintaining range of motion after cervical discectomy does not prevent adjacent segment degeneration. Spine J 2019; 19:1816-1823. [PMID: 31326630 DOI: 10.1016/j.spinee.2019.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Motion preservation prostheses were introduced to prevent adjacent disc degeneration (ASD) and to diminish neck disability in the postsurgical follow-up. However, it is still a controversial issue, and the relationship between range of motion (ROM) and ASD has not been studied. PURPOSE To compare the correlation between ROM of the cervical spine and the presence of radiological ASD after anterior discectomy. Clinical outcome was also correlated to ROM and ASD. STUDY DESIGN Retrospective cohort study. METHODS In all, 253 patients who underwent anterior discectomy for cervical radiculopathy due to a herniated disc were analyzed for segmental and global cervical ROM and the presence of ASD both preoperatively, and 12 and 24 months postoperatively. Patients who were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty, anterior cervical discectomy with intervertebral cage, or anterior cervical discectomy without intervertebral cage for one level disc herniation were analyzed. ROM was defined by a custom-developed image analysis tool. ASD was defined by decrease in disc height and anterior osteophyte formation on X-rays. Clinical outcome was evaluated by means of the Neck Disability Index (NDI). RESULTS Two years postoperatively, no correlation was demonstrated between ROM and ASD. The incidence of ASD was comparable in the three groups, being 34% at baseline, and 58% at 2-year follow-up. Likewise, ASD progression was comparable in the three treatment arms. No correlation was demonstrated between ROM and NDI or ASD and NDI. CONCLUSIONS Since ROM is not correlated to ASD, and clinical outcome is not correlated to ROM either, the relevance of continued ROM at the target level seems absent.
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Affiliation(s)
- Xiaoyu Yang
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Roland Donk
- Department of Orthopaedic Surgery, Via Sana Clinics, Mill, the Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Centre, the Hague, the Netherlands
| | - Hisse Arnts
- Department of Neurosurgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - Joris Walraevens
- Division of Biomechanics and Engineering Design, KU Leuven, Heverlee, Belgium
| | - Zhiwei Zhai
- Division of Image processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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13
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Wahood W, Yolcu YU, Kerezoudis P, Goyal A, Alvi MA, Freedman BA, Bydon M. Artificial Discs in Cervical Disc Replacement: A Meta-Analysis for Comparison of Long-Term Outcomes. World Neurosurg 2019; 134:598-613.e5. [PMID: 31627001 DOI: 10.1016/j.wneu.2019.10.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cervical disc replacement (CDR) has emerged as an alternative to anterior cervical discectomy and fusion for the surgical treatment of degenerative cervical disc disease. Although comparison of the 2 techniques has been studied in the literature, a thorough assessment of all artificial discs between each has not been performed. The objective of the present study was to examine the long-term outcomes of 5 artificial discs. METHODS An electronic literature search was conducted for studies of CDR devices for all years available. Only articles in English were included. Heterotopic ossification, adjacent segment disease, and reoperation comprised the primary outcomes of interest. Pooled descriptive statistics with effect size (ES) and 95% confidence interval were used to synthesize the outcomes for each device. RESULTS Sixty-five studies (n = 5785) were included in the analysis. Comparison of the incidence of grade III/IV heterotopic ossification showed a significant variability between the 5 devices (P < 0.001) with ProDisc-C (ES, 38%; 95% confidence interval [CI], 24%-54%) having the highest incidence rate. Overall rate of adjacent segment disease was 14% (95% CI, 7%-23%) with significant associated heterogeneity (P < 0.001). Regarding 2-year reoperation risk, the overall incidence rate was 2% (95% CI, 1%-3%), with nonsignificant variability between devices (P = 0.63). The highest rate was observed in the Discover group (ES, 4%; 95% CI, 0%-13%). CONCLUSIONS The results of the present meta-analysis indicate that surgical and clinical outcomes may differ among different CDR devices. These findings may assist surgeons in tailoring their decision making to specific patient profiles. Future multicenter efforts are needed to validate associations found in this study.
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Affiliation(s)
- Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Yang X, Donk R, Arts MP, Vleggeert-Lankamp CL. Are Modic Vertebral End-Plate Signal Changes Associated with Degeneration or Clinical Outcomes in the Cervical Spine? World Neurosurg 2019; 129:e881-e889. [DOI: 10.1016/j.wneu.2019.06.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 02/02/2023]
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