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Yao M, Wu T, Liu H, Huang K, He J, Chen S, Wang B. More anterior bone loss in middle vertebra after contiguous two-segment cervical disc arthroplasty. J Orthop Surg Res 2024; 19:234. [PMID: 38610023 PMCID: PMC11010387 DOI: 10.1186/s13018-024-04663-6] [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: 10/24/2023] [Accepted: 03/02/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Contiguous two-segment cervical disc arthroplasty (CDA) is safe and effective, while post-operative radiographic change is poorly understood. We aimed to clarify the morphological change of the three vertebral bodies operated on. METHODS Patients admitted between 2015 and 2020 underwent contiguous two-level Prestige LP CDA were included. The follow-up was divided into immediate post-operation (≤ 1 week), early (≤ 6 months), and last follow-up (≥ 12 months). Clinical outcomes were measured by Japanese Orthopedic Association (JOA) score, visual analogue score (VAS), and neck disability index (NDI). Radiographic parameters on lateral radiographs included sagittal area, anterior-posterior diameters (superior, inferior endplate length, and waist length), and anterior and posterior heights. Sagittal parameters included disc angle, Cobb angle, range of motion, T1 slope, and C2-C7 sagittal vertical axis. Heterotopic ossification (HO) and anterior bone loss (ABL) were recorded. RESULTS 78 patients were included. Clinical outcomes significantly improved. Of the three operation-related vertebrae, only middle vertebra decreased significantly in sagittal area at early follow-up. The four endplates that directly meet implants experienced significant early loss in length. Sagittal parameters were kept within an acceptable range. Both segments had a higher class of HO at last follow-up. More ABL happened to middle vertebra. The incidence and degree of ABL were higher for the endplates on middle vertebra only at early follow-up. CONCLUSION Our findings indicated that after contiguous two-segment CDA, middle vertebra had a distinguishing morphological changing pattern that could be due to ABL, which deserves careful consideration before and during surgery.
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Affiliation(s)
- Minghe Yao
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Tingkui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Kangkang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Junbo He
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Shihao Chen
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, China.
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Oezel L, Memtsoudis SG, Moser M, Zhong H, Adl Amini D, Liu J, Poeran J, Shue J, Sama AA. Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006-2019. 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 2023; 32:667-681. [PMID: 36542166 DOI: 10.1007/s00586-022-07465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures. METHODS In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor. RESULTS A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034). CONCLUSION PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research.
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Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stavros G Memtsoudis
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Haoyan Zhong
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jashvant Poeran
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L.Levy Pl, New York, NY, 10029, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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3
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Hui N, Phan K, Lee MY, Kerferd J, Singh T, Mobbs RJ. The Changes in Cervical Biomechanics After CTDR and Its Association With Heterotopic Ossification: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:565-574. [PMID: 32677512 PMCID: PMC8119929 DOI: 10.1177/2192568220922949] [Citation(s) in RCA: 4] [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] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES Cervical total disc replacement (CTDR) can preserve range of motion (ROM) of the operated spinal segment in cadaver studies. Evidence is less clear in clinical trials. The present study aims to investigate the differences in cervical biomechanics before and after CTDR and its association with heterotopic ossification (HO) development. METHOD Articles that reported the rate of HO and ≥1 difference in cervical biomechanics were included in quantitative analyses. We pooled the mean difference (MD) of cervical biomechanics before and after CTDR. Subgroup analyses and metaregression analyses were conducted to identify potential contributors to heterogeneity. RESULTS Of the 599 studies screened, 35 studies were included in the final analysis. In comparison with preoperative values, ROM of the spinal segment inferior (MD: 0.38; 95% CI: 0.02 to 0.74) and superior (MD: 0.43; 95% CI: 0.12 to 0.75) to the surgical spinal segment, functional spinal unit (FSU) angle (MD: 2.23; 95% CI: 1.11 to 3.35), and C2/C7 Cobb angle (MD: 3.49; 95% CI: 1.73 to 5.25) significantly increased after CTDR. In contrast, FSU and cervical ROM at baseline were no different from follow-up. On multivariable meta-regression analyses, HO and ROM-limiting HO were not associated with changes in cervical biomechanics. Single-level CTDR and duration of follow-up were associated with changes in cervical biomechanics. CONCLUSION Our study reported the pooled mean of biomechanics at baseline and final follow-up and their differences. The changes in biomechanics were not associated with the rates of HO and ROM-limiting HO.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Mei-Yi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia,85120Hong Kong Polytechnic
University, Hong Kong
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Telvinderjit Singh
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia,NeuroSpineClinic, Sydney, Australia,Ralph J. Mobbs, NeuroSpineClinic, Suite 7,
Level 7, Prince of Wales Private Hospital, Randwick, New South Wales 2031,
Australia.
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Parish JM, Asher AM, Coric D. Complications and Complication Avoidance With Cervical Total Disc Replacement. Int J Spine Surg 2020; 14:S50-S56. [PMID: 32994306 DOI: 10.14444/7091] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Complications with cervical arthroplasty can be generalized to errors in patient selection or surgical technique. Patients with advanced spondylosis or osteophytic disease, severe facet arthropathy, osteoporosis, sagittal deformity, or preoperative instability are poor candidates for arthroplasty and are more prone to complications. Poor surgical technique can result in subsidence, expulsion, and kyphosis, and it can contribute to heterotopic ossification. Additionally, all of the inherent complications from an anterior cervical approach may occur with cervical artificial disc placement. This article will focus on the complications uniquely associated with cervical arthroplasty.
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Affiliation(s)
- Jonathan M Parish
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Anthony M Asher
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Domagoj Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
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Liang XJ, Zhong WY, Tang K, Quan ZX, Luo XJ, Jiang DM. Implant complications after one-level or two-level cervical disc arthroplasty: A retrospective single-centre study of 105 patients. Medicine (Baltimore) 2020; 99:e22184. [PMID: 32957345 PMCID: PMC7505342 DOI: 10.1097/md.0000000000022184] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022] Open
Abstract
The aim of study was to investigate the complications of cervical disc arthroplasty (CDA) and to discuss the factors affecting the mobility of the prosthesis and the measures to prevent these complications. Hundred and five patients who underwent CDA between 2009 and 2016 were enrolled. The clinical and radiographic outcomes were used to assess and the complications were recorded as well.All the patients were followed-up with an average of 41.30 ± 16.90 months with an average age of 47.90 ± 9.22 years. The visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores improved significantly at the final follow-up (FU) compared with the preoperative values. At the final FU, the overall incidence of heterotopic ossification (HO) was 51.42%. The distribution of different grades of HO was low-level HO (53.7%) and high-level HO (46.3%). No significant differences were found in the NDI, VAS, or JOA scores between patients with HO and those without HO (P > .05). In the high-level HO patients, the range of mobility (ROM) was significantly reduced compared with the low-level HO patients and those without HO (P < .05). The anterior displacement, subsidence, and instability were observed in 1 patient respectively and the segmental kyphosis, adjacent segment degeneration in 3 patients respectively. The patient of CDA instability also suffered severe neck pain and the revision surgery was performed.Postoperative complications in CDA such as HO, segmental kyphosis, and prosthesis displacement are prone to occur, affecting prosthesis mobility. Surgical indications should be strictly controlled, and intraoperative and postoperative treatments should be given great attention in order to reduce prosthesis-related complications.
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Affiliation(s)
| | - Wei-yang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-xue Quan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-ji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dian-ming Jiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hui N, Phan K, Cheng HMK, Lin YH, Mobbs RJ. Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and 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 2020; 29:2688-2700. [DOI: 10.1007/s00586-020-06400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 12/23/2022]
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Reinas R, Kitumba D, Pereira L, Baptista AM, Alves ÓL. Multilevel cervical arthroplasty-clinical and radiological outcomes. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:233-242. [PMID: 32309661 PMCID: PMC7154349 DOI: 10.21037/jss.2020.01.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is a valid option for single-level cervical disc disease (CDD) as an alternative to fusion. However, the use in 3- and 4-level disc disease is under scrutiny with scarce data published so far. Our aim was to study clinical and radiological outcomes of arthroplasty in patients with multilevel CDD. METHODS Retrospective analysis of clinical records, pre- and post-operative neutral/dynamic X-rays of patients who underwent CDA in multilevel CDD (2-4 levels). We evaluated sagittal balance parameters (C2-7 and index angle, SVA), global and segmental range of motion (ROM)), neck and arm VAS, Odom's criteria, re-operation rate, adjacent segment disease (ASD), willingness to undertake the same procedure again. Rate of heterotopic ossification (HO) was studied for follow-up >2 years. A subgroup analysis was performed regarding 2-level versus 3- or 4-level arthroplasty. RESULTS Thirty-two patients were included, 6 males and 26 females, mean age of 46 years (range, 30-63). Seventy-seven cervical disc levels were treated with the same artificial disc. Twenty-one patients were operated on 2 levels, nine in 3 levels, and 2 patients in 4 levels. Post-operatively, there was a decrease in SVA (-2.2±8.36 mm, P=0.098) and an increase in global (3.7±9.6º, P=0.042) and index (1.3±6.1º, P=0.071) ROM. Mean nVAS and aVAS decreased (7.5±1.1 to 2.5±1.5; 6.3±1.9 to 2.2±1.7, P<0.05). Two-level versus 3-4 level patient subgroups showed a lower SVA (-1.3±8.1 mm P=0.47; -3.4±6.3 mm P=0.107), a slight increase in global (1.6±9.4º P=0.44; 7.2±11.7º P=0.07) and index (1.1±4.7º P=0.12; 1.3±8.1º P=0.35) ROM. HO was present in 9.9% (7/71) of disc levels operated, none of them with grade 3 or 4. CONCLUSIONS Multilevel CDA provides good clinical and radiological outcomes, preserving global and segmental cervical mobility, while having a beneficial effect on sagittal balance. These results hold for 2 to 4 levels, making this technique a valuable option in selected patients with cervical multilevel CDD.
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Affiliation(s)
- Rui Reinas
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Djamel Kitumba
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
- Department of Neurosurgery, Hospital Américo Boavida, Luanda, Angola
| | - Leopoldina Pereira
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - António M. Baptista
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Óscar L. Alves
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
- Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal
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Hui N, Phan K, Kerferd J, Lee M, Mobbs RJ. Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics. Asian Spine J 2020; 15:127-137. [PMID: 32050310 PMCID: PMC7904491 DOI: 10.31616/asj.2019.0234] [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: 07/24/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meiyi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ralph Jasper Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Sydney, Australia
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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: 17] [Impact Index Per Article: 3.4] [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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10
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Outpatient and Inpatient Single-level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes. Spine (Phila Pa 1976) 2019; 44:79-83. [PMID: 29894451 DOI: 10.1097/brs.0000000000002739] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement (TDR) surgery. SUMMARY OF BACKGROUND DATA Cervical TDR is a motion-sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce health care costs are driving spine surgery to be performed in the outpatient setting. As cervical TDR surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006 and 2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data were compared between the inpatient and outpatient cohort using univariate analysis. RESULTS There were 531 (34.2%) patients treated as outpatients and 1022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. CONCLUSION There was no difference between 30-day complications, readmission, and reoperation rates between inpatients and outpatients who underwent a single-level cervical TDR. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. LEVEL OF EVIDENCE 3.
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11
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Cervical disc arthroplasty: tips and tricks. INTERNATIONAL ORTHOPAEDICS 2018; 43:777-783. [PMID: 30519869 DOI: 10.1007/s00264-018-4259-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/26/2018] [Indexed: 12/26/2022]
Abstract
Cervical disc arthroplasty (CDA) is a powerful, motion-sparing treatment option for managing cervical radiculopathy or myelopathy. While CDA can be an excellent surgery for properly indicated patients, it is also less forgiving than cervical fusion. Optimally resolving patient symptoms while maintaining range of motion relies on near perfection in the surgical technique. Different CDA options exist on the market, with some having long-term proven success and others in early stages of clinical trials. We discuss the different options available for use, as well as strategies of positioning, approach, disc space preparation, implantation, and fusion prevention that we believe can help improve performance and outcomes of CDA.
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12
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Meng Y, Wang X, Zhao Z, Wang B, Wu T, Liu H. Intraoperative Anterior Migration of the Prestige-LP Cervical Disc Owing to an Inappropriate Implantation Sequence During Continuous 2-Level Artificial Cervical Disc Replacement: A Case Report with 8-Year Follow-Up. World Neurosurg 2018; 116:194-200. [PMID: 29803062 DOI: 10.1016/j.wneu.2018.05.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Owing to its unique advantages, 2-level artificial cervical disc replacement (ACDR) is gaining attention. Among artificial discs designed for use in ACDR, the Food and Drug Administration-approved Prestige-LP Cervical Disc is widely used. There are no standard implantation sequences for 2-level ACDR using the Prestige-LP disc, and complications resulting from inappropriate implantation sequences remain unknown. CASE DESCRIPTION A 45-year-old woman underwent continuous 2-level ACDR using the Prestige-LP disc and experienced anterior migration of a previously inserted artificial disc after secondary disc implantation at an upper segment owing to an inappropriate implantation sequence during surgery. Intraoperative radiographs showed stable index levels and artificial discs. We tapped the migrated disc back into its correct position and recommended a postoperative functional exercise plan to the patient. We followed the patient for 8 years to verify the safety of our solution. We developed an implantation strategy for 2-level ACDR to avoid this complication in the future. CONCLUSIONS During 2-level ACDR, a top-down sequence should be used to implant prostheses. When anterior disc migration occurs, intraoperative radiographs should be obtained to ensure stability of the index levels. If there is no instability, the migrated tab can be tapped back into its correct position. In addition, limiting motion rather than allowing intermittent movement of the neck for at least 3 months is important to promote union between bone and prosthesis.
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Affiliation(s)
- Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyang Zhao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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