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Chen CM, Yang JJ, Wu CC. Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3203. [PMID: 38892914 PMCID: PMC11173267 DOI: 10.3390/jcm13113203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.
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Affiliation(s)
| | | | - Chia-Chun Wu
- Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
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Changoor S, Farshchian J, Patel N, Coban D, Abdelmalek G, Sinha K, Hwang K, Emami A. Comparing outcomes between anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) in the treatment of cervical radiculopathy. Spine J 2024; 24:800-806. [PMID: 38185140 DOI: 10.1016/j.spinee.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND CONTEXT Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF. PURPOSE The purpose of this study was to analyze the clinical and functional outcomes of patients undergoing ACDR or MI-PCF for the treatment of unilateral cervical radiculopathy. STUDY DESIGN/SETTING Retrospective Cohort Review. PATIENT SAMPLE A total of 152 patients were included (86 ACDR and 66 MI-PCF). OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS) and Neck Disability Index (NDI) scores. METHODS A retrospective cohort review was performed to identify all patients at a single institution between 2012-2020 who underwent 1- or 2- level ACDR or MI-PCF from C3-C7 with a minimum follow-up of 24 months. Patient demographics, perioperative data, postoperative complications, and revisions were analyzed. Patient reported outcome measures including VAS and NDI scores were compared. RESULTS The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<.001), but comparable estimated blood loss and length of stay following surgical intervention (p=.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=.003) but was largely driven by approach-related dysphagia in 20.9% of ACDR patients. The MI-PCF group had significantly greater revision rates (13.6% vs 1.2%; p=.002) with an average time to revision of 20.7 months in the MI-PCF group compared to 40.3 months in the ACDR group. The ACDR cohort had significantly greater improvements in NDI scores at the final follow-up (25.0 vs 21.3, p<.001). CONCLUSION Our results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds.
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Affiliation(s)
- Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Joseph Farshchian
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Neil Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - George Abdelmalek
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Ki Hwang
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA.
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Gupta P, Hassan FM, Thomas GM, Lombardi JM, Sardar ZM. Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A Propensity-Matched Analysis. Global Spine J 2024; 14:1257-1268. [PMID: 36350144 DOI: 10.1177/21925682221139436] [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] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Retrospective, propensity-matched analysis. OBJECTIVES Cervical disc arthroplasty (CDA) is being increasingly utilized for cervical disc generation. Surgeon specialty has been shown to influence the risk for postoperative complications in spine surgery, but this has not yet been explored for CDA. Thus, the purpose of this study is to determine whether there is any difference in 30-day complications between patients undergoing single-level CDA by neurosurgeons vs by orthopaedic surgeons. METHODS A retrospective, 1:1 propensity score matched analysis was performed using the NSQIP database from 2015 to 2020. Patient demographics, operative characteristics, and postoperative complications were recorded. Independent multivariate logistic regression models were constructed using the propensity-matched dataset to assess surgical specialty influence on any complication, any site complication, any operative infection, and any medical complications. RESULTS 3179 single-level CDAs (28.8% orthopaedic surgery patients, 71.2% neurosurgery patients) were identified that met the inclusion criteria. Well-matched cohorts of 916 patients each were generated. After controlling for all possible confounders, orthopedic surgery specialty was not associated with a higher odds for any complication (OR: .87, 95% CI: .35 - 2.20, P = .7696), any site complication (OR: .32, 95% CI: .08 - 1.32, P = .1359), any operative infection (OR: .31, 95% CI: .07 - 1.34), P = .1172), nor any medical complication (OR: 2.11, 95% CI: .62 - 7.20, P = .2311) vs neurosurgery. CONCLUSION This is the first propensity-matched analysis to show that spine surgeon specialty does not influence the risk for any complication, any site complication, any operative infection, nor any medical complication following single-level CDA within the first 30 days after surgery.
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Affiliation(s)
- Puneet Gupta
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Fthimnir M Hassan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - George M Thomas
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. [Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T168-T178. [PMID: 37995814 DOI: 10.1016/j.recot.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/26/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91° was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
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Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, Spain.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Grup Traumatologic de Catalunya, Barcelona, Spain
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Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:168-178. [PMID: 37423383 DOI: 10.1016/j.recot.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
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Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, España.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Grup Traumatologic de Catalunya, Barcelona, España
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Singh M, Balmaceno-Criss M, Anderson G, Parhar K, Daher M, Gregorczyk J, Liu J, McDonald CL, Diebo BG, Daniels AH. Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021. Spine J 2024:S1529-9430(24)00081-0. [PMID: 38408519 DOI: 10.1016/j.spinee.2024.02.016] [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: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation. PURPOSE To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA DESIGN: Retrospective cohort study. PATIENT SAMPLE A total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study. OUTCOME MEASURES The following data were observed for all cases: patient demographics, complications, and revisions. METHODS The PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined. RESULTS In total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05). CONCLUSIONS While ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.
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Affiliation(s)
- Manjot Singh
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Mariah Balmaceno-Criss
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - George Anderson
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Kanwar Parhar
- Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Mohammad Daher
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Jerzy Gregorczyk
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Jonathan Liu
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA.
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Sasso WR, Ye J, Foley DP, Vinayek S, Sasso RC. 20-year Clinical Outcomes of Cervical Disk Arthroplasty: A Prospective, Randomized, Controlled Trial. Spine (Phila Pa 1976) 2024; 49:1-6. [PMID: 37644726 DOI: 10.1097/brs.0000000000004811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
STUDY DESIGN Prospective, randomized, controlled trial. OBJECTIVE To compare clinical outcomes of anterior cervical discectomy and fusion (ACDF) and cervical disk arthroplasty (CDA) at 20 years. SUMMARY OF BACKGROUND DATA Concern for adjacent-level disease after ACDF prompted the development of CDA. MATERIALS AND METHODS Forty-seven patients with single-level cervical radiculopathy were randomized to either BRYAN CDA or ACDF for a Food and Drug Administration Investigational Device Exemption trial. At 20 years, patient-reported outcomes, including visual analog scales (VAS) for neck and arm pain, neck disability index (NDI), and reoperation rates, were analyzed. RESULTS Follow-up rate was 91.3%. Both groups showed significantly better NDI, VAS arm pain, and VAS neck pain scores at 20 years versus preoperative scores. Comparing CDA versus ACDF, there was no difference at 20 years in mean scores for NDI [11.1 (SD 14.1) vs. 19.9 (SD 17.2), P =0.087], mean VAS arm pain [0.9 (SD 2.4) vs. 2.3 (SD 2.8), P =0.095], or mean VAS neck pain [1.2 (SD 2.5) vs. 2.9 (3.3), P =0.073]. There was a significant difference between CDA versus ACDF groups in the change in VAS neck pain score between 10 and 20 years [respectively, -0.4 (SD 2.5) vs. 1.5 (SD 2.5), P =0.030]. Reoperations were reported in 41.7% of ACDF patients and 10.0% of CDA patients ( P =0.039). CONCLUSIONS Both CDA and ACDF are effective in treating cervical radiculopathy with sustained improvement in NDI, VAS neck and VAS arm pain at 20 years. CDA demonstrates lower reoperation rates than ACDF. There were no failures of the arthroplasty device requiring reoperation at the index level. The symptomatic nonunion rate of ACDF was 4.2% at 20 years. Despite a higher reoperation rate in the CDA group versus ACDF group, there was no difference in the 20-year NDI, VAS Neck, and VAS arm pain scores.
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Affiliation(s)
- Willa R Sasso
- Indiana University School of Medicine, Indianapolis, IN
| | | | - David P Foley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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Lanman TH, Cuellar JM, Mottole N, Wernke M, Carruthers E, Valdevit A. Range of motion after 1, 2, and 3 level cervical disc arthroplasty. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100294. [PMID: 38162168 PMCID: PMC10755821 DOI: 10.1016/j.xnsj.2023.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background Motion of a solid body involves translation and rotation. Few investigations examine the isolated translational and rotational components associated with disc arthroplasty devices. This study investigates single- and multi-level cervical disc arthroplasty with respect to index and adjacent level range of motion. The investigators hypothesized that single- and multilevel cervical disc replacement will lead to comparable or improved motion at implanted and adjacent levels. Methods Seven human cervical spines from C2 to C7 were subjected to displacement-controlled loading in flexion, extension, and lateral bending under intact, 1-Level (C5-C6), 2-Level (C5-C6, C6-C7) and 3-Level (C5-C6, C6-C7, C4-C5) conditions. 3D motions sensors were mounted at C4, C5, and C6. Motion data for translations and rotations at each level for each surgical condition and loading mode were compared to intact conditions. Results 1-Level: The index surgery resulted in statistically increased translations in extension and lateral bending at all levels with statistically increased translation observed in flexion in the superior and inferior levels. In rotation, the index surgeries decreased rotation under flexion, with remaining levels not statistically different to intact conditions. 2-Level A device placed inferiorly resulted in statistically increased translations at all levels in extension with statistically increased translations superior and inferior to the index level in flexion. Lateral bending resulted in increased nonsignificant translations. Rotations were elevated or comparable to the intact level for all loading. 3-Level Translations were statistically increased for all levels in all loading modes while rotations were elevated or were comparable to the intact level for all loading modes and levels. Conclusions Micromotion sensors permitted monitoring and recording of small magnitude angulations and translations using a loading mechanism that did not over constrain cervical segmental motion. Multilevel cervical disc arthroplasty yielded comparable or increased overall motion at the index and adjacent levels compared to intact conditions.
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Affiliation(s)
- Todd H. Lanman
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd #800 #901, Los Angeles, CA 90048
| | - Jason M. Cuellar
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd #800 #901, Los Angeles, CA 90048
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Hirvonen T, Hämäläinen M, Konsti J, Antinheimo J, Numminen J, Siironen J, Koski-Palkén A, Niemelä M. Comparable long-term outcomes in patients undergoing total disc replacement or anterior cervical discectomy and noninstrumented fusion. Spine J 2023; 23:1817-1829. [PMID: 37660896 DOI: 10.1016/j.spinee.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past 2 decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of developing ASD. However, since the method was first introduced in the early 2000s, the long-term outcome after it is still not completely understood. PURPOSE Our goal was to compare the long-term outcomes of TDR and ACDF procedures. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease. OUTCOME MEASURES The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological outcomes, and employment status. METHODS The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least 2 years after index surgery. RESULTS The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p=.096, ns.). Total disc replacement patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs 1.3%, p=.026). None of the TDR patients underwent further cervical surgery more than 6 years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically nonsignificant. TDR was significantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group. CONCLUSIONS There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically nonsignificant. However, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them.
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Affiliation(s)
- Tuomas Hirvonen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
| | - Mathias Hämäläinen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Juho Konsti
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Antinheimo
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Numminen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jari Siironen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Anniina Koski-Palkén
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Mika Niemelä
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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10
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Roth SG, Robles Ortiz MJ, Vulapalli M, Riew KD. Revision Strategies for Cervical Disc Arthroplasty. Clin Spine Surg 2023; 36:411-418. [PMID: 37752631 DOI: 10.1097/bsd.0000000000001542] [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: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To review indications and strategies for revision of cervical disc arthroplasty (CDA). SUMMARY OF BACKGROUND DATA No data were generated as part of this review. METHODS A narrative review of the literature was performed. RESULTS No results were generated as part of this review. CONCLUSIONS CDA is a proven, motion-sparing surgical option for the treatment of myelopathy or radiculopathy secondary to cervical degenerative disc disease. As is the case with any operation, a small percentage of CDA will require revision, which can be a technically demanding endeavor. Here we review available revision strategies and associated indications, a thorough understanding of which will aid the surgeon in finely tailoring their approach to varying presentations.
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Affiliation(s)
- Steven G Roth
- Department of Neurological Surgery, Weill Cornell Medical Center
- Department of Orthopedic Surgery, Daniel and Jane Och Spine Hospital, Columbia University Medical Center, New York, NY
| | | | - Meghana Vulapalli
- Department of Orthopedic Surgery, Daniel and Jane Och Spine Hospital, Columbia University Medical Center, New York, NY
| | - K Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medical Center
- Department of Orthopedic Surgery, Daniel and Jane Och Spine Hospital, Columbia University Medical Center, New York, NY
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11
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Du JY, Gonzalez GA, Albert TJ, Rhee JM, Riew KD, Vaccaro AR, Harrop JS. Past, Present, and Future of Cervical Disc Arthroplasty: Insights From Presidents of the Cervical Spine Research Society. Clin Spine Surg 2023; 36:331-334. [PMID: 37735760 DOI: 10.1097/bsd.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Jerry Y Du
- Spine Surgery Division, Hospital for Special Surgery, New York City, NY
| | - Glenn A Gonzalez
- Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA
| | - Todd J Albert
- Spine Surgery Division, Hospital for Special Surgery, New York City, NY
| | - John M Rhee
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA
| | - K Daniel Riew
- Department of Neurosurgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York City, NY
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Thomas Jefferson University School of Medicine, Philadelphia, PA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA
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12
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Abudouaini H, Wu T, Meng Y, Ding C, Liu H, Beiyu W. Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study. Front Bioeng Biotechnol 2023; 11:1214877. [PMID: 37711451 PMCID: PMC10497878 DOI: 10.3389/fbioe.2023.1214877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a most frequently used surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration (ASD) rate after ACDF surgery. We creatively designed an elastically deformable cervical implant to reduce the postoperative stress concentration. In this study, we aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical devices. Methods: Biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2-C7) and randomly divided into four groups according to implant types: intact group, Zero-P VA fusion (ACDF) group, the novel cervical implant group and Pretic-I artificial cervical disc (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments and micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments. Results: There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decrease some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups. Conclusion: While the newly developed elastically deformable cervical implant does not completely maintain ROM like the artificial cervical disc, it surpasses the fusion device with regards to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe adjacent segment degeneration after fusion surgery but no indication for artificial cervical disc surgery.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wang Beiyu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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13
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Maharaj RG, Motilal S, Khan R, Rampersad F. A No-Cost, Bedside, Self-Traction Maneuver for Relief From Chronic Cervical Radiculopathy: A Case Report. Cureus 2023; 15:e43963. [PMID: 37746470 PMCID: PMC10515476 DOI: 10.7759/cureus.43963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Cervical radiculopathy secondary to spondylosis is common in the elderly. Systematic reviews suggest that no single treatment modality represents the standard of care. A no-cost, bedside, self-traction intervention can be a useful adjunct to current options. A 60-year-old South Asian male presented with severe cervical radiculopathic pain in April 2019, proven by magnetic resonance imaging to be secondary to spondylosis. Since late 2019, he has been doing a daily self-traction procedure in which he lies prone with the anterior chest and abdomen flat on a bed, shoulders just off the mattress edge, and arms to the side. The position is maintained for 60 seconds, where the weight of the head provides traction. Overhead cervical traction has not been needed for the past three years, and the pain has been bearable. His Neck Disability Index has decreased from 25 to 2. This no-cost, minute-long daily maneuver has provided relief from chronic cervical neuropathic pain due to cervical spondylosis.
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Affiliation(s)
- Rohan G Maharaj
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Shastri Motilal
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Raveed Khan
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Fidel Rampersad
- Department of Medicine, The University of the West Indies, St. Augustine, TTO
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14
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Sarraj M, Hache P, Foroutan F, Oitment C, Marion TE, Guha D, Pahuta M. Long-Term Survivorship of Cervical Spine Procedures; A Survivorship Meta-Analysis and Meta-Regression. Global Spine J 2023; 13:840-854. [PMID: 36069054 DOI: 10.1177/21925682221125766] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To conduct a meta-analysis on the survivorship of commonly performed cervical spine procedures to develop survival function curves for (i) second surgery at any cervical level, and (ii) adjacent level surgery. METHODS A systematic review of was conducted following PRISMA guidelines. Articles with cohorts of greater than 20 patients followed for a minimum of 36 months and with available survival data were included. Procedures included were anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (ADR), laminoplasty (LAMP), and posterior laminectomy and fusion (PDIF). Reconstructed individual patient data were pooled across studies using parametric Bayesian survival meta-regression. RESULTS Of 1829 initial titles, 16 citations were included for analysis. 73 811 patients were included in the second surgery analysis and 2858 patients in the adjacent level surgery analysis. We fit a Log normal accelerated failure time model to the second surgery data and a Gompertz proportional hazards model to the adjacent level surgery data. Relative to ACDF, the risk of second surgery was higher with ADR and PDIF with acceleration factors 1.73 (95% CrI: 1.04, 2.80) and 1.35 (95% CrI: 1.25, 1.46) respectively. Relative to ACDF, the risk of second surgery was lower with LAMP with deceleration factor .06 (95% CrI: .05, .07). ADR decreased the risk of adjacent level surgery with hazard ratio .43 (95% CrI: .33, .55). CONCLUSIONS In cases of clinical equipoise between fusion procedures, our analysis suggests superior survivorship with anterior procedures. For all procedures, laminoplasty demonstrated superior survivorship.
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Affiliation(s)
- Mohamed Sarraj
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Philip Hache
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, 7989University Health Network, Toronto, ON, Canada
- Department of Health Research, Methods, Impact, 3710McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Travis E Marion
- Department of Orthopaedic Surgery, 26627Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Markian Pahuta
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
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15
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Steib JP, Dufour T, Beaurain J, Bernard P, Huppert J. Observational, Multicenter Study of the Efficacy and Safety of Cervical Disk Arthroplasty With Mobi-C in the Treatment of Cervical Degenerative Disk Disease. Results at 10 years Follow-Up. Spine (Phila Pa 1976) 2023; 48:452-459. [PMID: 36730682 DOI: 10.1097/brs.0000000000004536] [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: 07/11/2022] [Accepted: 10/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical disk arthroplasty replacement (CDA) was developed to avoid specific disadvantages of cervical fusion. The purpose of this paper is to provide 10-year follow-up results of an ongoing prospective study after CDA. METHODS Three hundred eighty-four patients treated using the Mobi-C (ZimVie, Troyes, France) were included in a prospective multicenter study. Routine clinical and radiologic examinations were reported preoperatively and postoperatively with up to 10-year follow-up. Complications and revision surgeries were also documented. RESULTS At 10 years showed significant improvement in all clinical outcomes [Neck Disability Index, visual analog scale (VAS) for arm and neck pain, physical component summary of SF36, and mental component summary of SF36). Motion at the index level increased significantly over baseline (mean range of motion=7.6 vs. 8 degrees at five years and 6.0 degrees preoperatively; P <0.001) and 71.3% of the implanted segments remained mobile (range of motion>3 degrees). Adjacent disks were also mobile at 10 years with the same mobility as preoperatively. At 10 years, 20.9% of the implanted segments demonstrated no heterotopic ossification. Thirty-four patients (8.9%) experienced 41 adverse events, with or without reoperation during the first five years. We found only two additional surgeries after five years. We observed an increased percentage of working patients and a decrease in medication consumption. Regarding the overall outcome, 94% of patients were satisfied. CONCLUSIONS Our 10-year results showed significant improvement in all clinical outcomes, with low rates of revision or failure. This experience in patients with long-term follow-up after CDA endorses durable, favorable outcomes in properly selected patients.
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Affiliation(s)
| | - Thierry Dufour
- Parisian Institute, Geoffroy Saint-Hilaire Clinic, Paris, France
| | | | - Pierre Bernard
- Orthopaedic Department, Back Aquitain Center, Mérignac, France
| | - Jean Huppert
- Neuro-Surgery Department, Clinic of Parc, St-Priest-en-Jarez, France
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16
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Wang Z, Luo G, Yu H, Zhao H, Li T, Yang H, Sun T. Comparison of discover cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical degenerative disc diseases: A meta-analysis of prospective, randomized controlled trials. Front Surg 2023; 10:1124423. [PMID: 36896262 PMCID: PMC9989026 DOI: 10.3389/fsurg.2023.1124423] [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: 12/15/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Objective This study aims to evaluate the clinical efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) in Cervical degenerative disc diseases. Methods Two researchers independently conducted a search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails (CENTRAL) for randomized controlled trials (RCTs) following the Cochrane methodology guidelines. A fixed-effects or random-effects model was applied based on different heterogeneity. Review Manager (Version 5.4.1) software was used to perform data analysis. Results A total of 8 RCT studies were included in this meta-analysis. The results indicate that the DCDA group had a higher incidence of reoperation (P = 0.03) and a lower incidence of ASD (P = 0.04) than the CDA group. There was no significant difference between two groups regarding NDI score (P = 0.36), VAS ARM score (P = 0.73), VAS NECK score (P = 0.63), EQ-5D score (P = 0.61) and dysphagia incidence (0.18). Conclusion DCDA and ACDF have similar results in terms of NDI scores, VAS scores, EQ-5D scores, and dysphagia. In addition, DCDA can reduce the risk of ASD but increases the risk of reoperation.
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Affiliation(s)
- Ziqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Gan Luo
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Hongwei Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Hui Zhao
- School of Medicine, Nankai University, Tianjin, China
| | - Tianhao Li
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Houzhi Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Tianwei Sun
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
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17
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Kwok WCH, Wong CYY, Law JHW, Tsang VWT, Tong LWL, Samartzis D, An HS, Wong AYL. Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion with Plate Fixation: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2022; 104:1915-1945. [PMID: 36321969 DOI: 10.2106/jbjs.21.01494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and clinical ASD (CASD) after ACDF-P. METHODS Six electronic databases were searched from inception to October 30, 2021. Four reviewers independently screened titles, abstracts, and full-text articles to identify relevant studies. Methodological quality of the included studies was evaluated. Meta-analyses for risk factors were conducted, if possible. RESULTS Sixteen cohort and 3 case-control studies (3,563 participants) were included. These studies showed low (n = 2), moderate (n = 9), and high (n = 8) risk of bias. One risk factor for RASD was pooled for 2 meta-analyses based on the follow-up period. Four different risk factors for CASD at ≥4 years were pooled for meta-analyses. Limited evidence showed that multi-level fusion, greater asymmetry in total or functional cross-sectional area of the cervical paraspinal muscle, and preoperative degeneration in a greater number of segments were associated with a higher RASD incidence <4 years after ACDF-P. In contrast, no significant risk factors were identified for CASD <4 years after ACDF-P. At ≥4 years after ACDF-P, limited evidence supported that both cephalad and caudal plate-to-disc distances of <5 mm were associated with a higher RASD incidence, and very limited evidence supported that developmental canal stenosis, preoperative RASD, unfused C5-C6 or C6-C7 adjacent segments, use of autogenous bone graft, and spondylosis-related ACDF-P were associated with a higher CASD incidence. CONCLUSIONS Although several risk factors for RASD and CASD development after ACDF-P were identified, the supporting evidence was very limited to limited. Future prospective studies should extend the existing knowledge by more robustly identifying risk factors for RASD and CASD after ACDF-P to inform clinical practice. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wallace C H Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Christina Y Y Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Jason H W Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Vy W T Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Leo W L Tong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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Leonard SE, Song H, Edwards CC. Is C7-T1 cervical disc replacement a viable technique: A case series. Int J Surg Case Rep 2022; 98:107454. [PMID: 35964370 PMCID: PMC9399142 DOI: 10.1016/j.ijscr.2022.107454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Cervical disc replacement (CDR) surgery is well established for the treatment of disc degeneration from C3-C7, but there is little data regarding the safety and efficacy of CDR at the cervicothoracic junction, C7-T1. CDR is an appealing option, in terms of range of motion preservation, symptom relief, and absence of risk for nonunion. Currently, C7-T1 CDR is not approved by the Food and Drug Administration, and the existing literature is limited to two case reports that describe the results of a combined two patients. This series explores whether C7-T1 CDR is a reasonable treatment and alternative to fusion. Methods We present a case series of seven consecutive patients who underwent CDR at C7-T1 by a single surgeon from January to December of 2019. There were five females and two males with an average age of 61.3 ± 6.4 years. Results Average follow up was 18.9 ± 2.5 months. The average postoperative NDI score was 22.6 % ± 14.0. We also recorded qualitative data regarding patient satisfaction and revision surgery status. There was one complication of disc subsidence following three months of complete pain resolution. The six other patients reported being very satisfied with their surgical outcome. Conclusion These seven cases dramatically increase the volume of data in the literature on clinical outcomes and patient satisfaction following CDR at the cervicothoracic junction. Additionally, the heterogeneity of cases shows the effectiveness of this treatment in many real-world cases. A greater volume of cases with longer follow up will be necessary to better establish long-term clinical success. Cervical disc replacement as an emerging treatment option for preserving motion Seven patients with pathology at C7-T1 successfully received disc replacement. All resolved symptoms, measured by NDI and survey of patient satisfaction CDR as viable treatment option at the cervicothoracic junction
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Affiliation(s)
- Sarah E Leonard
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America
| | - Hyun Song
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America.
| | - Charles C Edwards
- The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202, United States of America
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Platt A, Fessler RG, Traynelis VC, O’Toole JE. Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1573-1582. [PMID: 34879736 PMCID: PMC9393980 DOI: 10.1177/21925682211055094] [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: 11/22/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority. METHODS This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty. RESULTS In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I2 = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I2 = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group. CONCLUSIONS There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.
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Affiliation(s)
- Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA,Andrew Platt, Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, IL 60612 USA.
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John E. O’Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Burkhardt BW, Baumann L, Simgen A, Wagenpfeil G, Hendrix P, Reith W, Oertel JM. Long-term follow-up MRI shows no hastening of adjacent segment degeneration following cervical disc arthroplasty. Sci Rep 2022; 12:13318. [PMID: 35922473 PMCID: PMC9349281 DOI: 10.1038/s41598-022-17652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022] Open
Abstract
Cervical disc arthroplasty is an established procedure, but studies with data on long-term clinical outcome, reoperation for symptomatic adjacent segment degeneration (sASD), and degenerative changes based on MRI findings are rare. Thus, a file review was performed and patients with complete documentation of neurological status at preoperative, postoperative, 12 month, 3–4 years follow-up including surgical reports for reoperation with a minimum follow-up of 9 years were included. Final follow-up assessment included a physical examination, assessment of pain levels, Odoms criteria, Neck disability index. The degeneration of each cervical segment at preoperative and at final follow-up was assessed using an MRI. Forty-six out of 68 included patients participated, the mean follow-up was 11 (range 9–15) years, at which 71.7% of patients were free of arm pain, 52.2% of patients were free of neck pain, 63% of patients had no sensory dysfunction, and full motor strength was noted in 95.6% of patients. The clinical success rate was 76.1%, the mean NDI was 12%. Overall repeated procedure rate was 17%, the reoperation rate for sASD was 9%, and removal of CDA was performed in 4%. MRI showed progressive degeneration but no significant changes of SDI from preoperative to final follow-up.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. .,Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstrasse 100, Gebäude 90.5, 66421, Homburg-Saar, Germany.
| | - Lukas Baumann
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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21
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Iyer S. In Patients with Cervical Radiculopathy, Arthroplasty and Fusion Surgical Treatment Did Not Differ for Disability at 5 Years. J Bone Joint Surg Am 2022; 104:942. [PMID: 35383662 DOI: 10.2106/jbjs.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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22
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Kumar N, Liu ZJ, Poon WS, Park CK, Lin RM, Cho KS, Niu CC, Chen HY, Madhu S, Shen L, Sun Y, Mak WK, Lin CL, Lee SB, Park CK, Lee DC, Tung FI, Wong HK. ProDisc–C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre 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 2022; 31:1260-1272. [DOI: 10.1007/s00586-021-07055-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
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23
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Peng Y. CORR Insights®: A Dynamic Interbody Cage Improves Bone Formation in Anterior Cervical Surgery: A Porcine Biomechanical Study. Clin Orthop Relat Res 2021; 479:2559-2561. [PMID: 34491974 PMCID: PMC8510000 DOI: 10.1097/corr.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Yun Peng
- Staff Engineer, NuVasive Inc, Research and Testing, San Diego, CA, USA
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24
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Metal-on-metal versus metal-on-plastic artificial discs in two-level anterior cervical disc replacement: a meta-analysis with follow-up of 5 years or more. Spine J 2021; 21:1830-1838. [PMID: 33940171 DOI: 10.1016/j.spinee.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites, such as metal-on-metal (MoM) and metal-on-plastic (MoP) in anterior cervical disc replacement (ACDR) have not been thoroughly investigated. PURPOSE The purpose of this study was to evaluate the patient-reported clinical outcomes, overall reoperation rates, complications, and rates of ASD of MoM versus MoP artificial discs in two-level ACDR for the treatment of cervical DDD. STUDY DESIGN/SETTING Meta-analysis and systematic review. PATIENT SAMPLE Nine hundred eighty patients (442 MoM, 538 MoP) across seven studies. OUTCOME MEASURES Patient reported clinical outcomes (NDI, VAS-n, VAS-a), overall reoperation rates, complications, and rates of ASD. METHODS A systematic search strategy of three electronic databases (PubMed, CINAHL Plus, and SCOPUS) was conducted utilizing terms related to two-level ACDR. All studies included had a sample size of >10 patients, had a minimum 5-year follow-up, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts, articles with less than 5-year follow-up and studies in which only single-level ACDR was investigated were excluded. A total of seven studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck, and VAS-arm), overall reoperation rates, complications, and rates of ASD. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level. RESULTS Seven studies were included with data on 980 patients (442 MoM, 538 MoP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MoM and MoP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MoM and MoP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MoM and MoP groups, respectively. 3.85% (95% CI, 2.40-6.10) of patients who underwent ACDR with a MoM implant required reoperation compared to 5.33% (95% CI, 3.68-7.65) of patients with a MoP implant. Heterotopic ossification and dysphagia were the most common complications in both groups. The MoM cohort showed a higher incidence of HO (72.62% vs. 21.07%), but a lower incidence of dysphagia (0.96% vs. 16.31%) compared to the MoP cohort. The MoM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MoM versus 1.91% MoP). CONCLUSIONS Our present meta-analysis suggests that the use of MoM artificial discs in two-level ACDR results in superior clinical outcome score improvement, but higher rates of ASD requiring secondary surgery compared to MoP discs after a follow-up period of 5 years or more.
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Boddapati V, Lee NJ, Mathew J, Vulapalli MM, Lombardi JM, Dyrszka MD, Sardar ZM, Lehman RA, Riew KD. Hybrid Anterior Cervical Discectomy and Fusion and Cervical Disc Arthroplasty: An Analysis of Short-Term Complications, Reoperations, and Readmissions. Global Spine J 2021; 11:1183-1189. [PMID: 32705903 PMCID: PMC8453682 DOI: 10.1177/2192568220941453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Although cervical disc arthroplasty (CDA) has become a well-established and effective treatment for symptomatic cervical degeneration, many patients with multilevel disease are not good candidates for CDA at all levels. For such patients, hybrid surgery (HS)-a combination of adjacent anterior cervical discectomy and fusion (ACDF) and CDA-may be more appropriate. Given the novelty of HS and the relative dearth of studies adequately assessing short-term perioperative complications, this current study sought to assess the short-term morbidity profile of HS, differences in operative duration, length of stay (LOS), and readmission and reoperation rates and reasons relative to a 2-level ACDF cohort. METHODS All patients who underwent HS and 2-level ACDF were identified between 2011 and 2018 using a large, prospectively collected registry. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis. RESULTS A total of 390 patients undergoing HS were identified. Two-level procedures were the most common (74.9%). Patients undergoing HS were more likely to be younger, male, and have fewer comorbidities. There were no differences between HS and 2-level ACDF in rates of any postoperative complication, transfusion, readmissions, and operative duration. However, HS had a decreased LOS (0.5 days), relative to a 2-level ACDF. HS patients had low rates of reoperation (1.28%) with 1 case for hematoma evacuation and another for revision CDA. CONCLUSIONS This study represents one of the largest cohorts of patients undergoing HS reported to date. Patients undergoing HS are not at increased risk of perioperative complications relative to a 2-level ACDF and may benefit from shorter LOS.
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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 West 168th Street, 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
| | - 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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26
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Johansen TO, Sundseth J, Fredriksli OA, Andresen H, Zwart JA, Kolstad F, Pripp AH, Gulati S, Nygaard ØP. Effect of Arthroplasty vs Fusion for Patients With Cervical Radiculopathy: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2119606. [PMID: 34351401 PMCID: PMC8343489 DOI: 10.1001/jamanetworkopen.2021.19606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Surgical treatment for cervical radiculopathy is increasing. Treatment with motion preserving anterior cervical disc arthroplasty was introduced to prevent symptomatic adjacent segment disease, and there is need to evaluate results of this treatment compared with standard anterior cervical discectomy and fusion. OBJECTIVE To investigate clinical outcomes at 5 years for arthroplasty vs fusion in patients who underwent surgical treatment for cervical radiculopathy. DESIGN, SETTING, AND PARTICIPANTS This multicenter, single-blinded, randomized clinical trial included patients aged 25 to 60 years with C6 or C7 radiculopathy referred to study sites' outpatient clinics from 2008 to 2013. Data were analyzed from December 2019 to December 2020. INTERVENTIONS Patients were randomly assigned to arthroplasty or fusion. Patients were blinded to which treatment they received. The surgical team was blinded until nerve root decompression was completed. MAIN OUTCOMES AND MEASURES The primary end point was change in Neck Disability Index (NDI) score. Secondary outcomes were arm and neck pain, measured with numeric rating scales (NRS); quality of life, measured with the EuroQol-5D (EQ-5D); reoperation rates; and adjacent segment disease. RESULTS Among 147 eligible patients, 4 (2.7%) declined to participate and 7 (4.8%) were excluded. A total of 136 patients were randomized (mean [SD] age, 44.1 [7.0] years; 73 (53.7%) women), with 68 patients randomized to arthroplasty and 68 patients randomized to fusion. A total of 114 patients (83.8%) completed the 5-year follow-up. In the arthroplasty group, the mean NDI score was 45.9 (95% CI, 43.3 to 48.4) points at baseline and 22.2 (95% CI, 18.0 to 26.3) points at 5 years follow-up, and in the fusion group, mean NDI score was 51.3 (95% CI, 48.1 to 54.4) points at baseline, and 21.3 (95% CI, 17.0 to 25.6) points at 5 years follow-up. The changes in mean NDI scores between baseline and 5 years were statistically significant for arthroplasty (mean change, 24.8 [95% CI, 19.8 to 29.9] points; P < .001) and fusion (mean change, 29.9 [95% CI, 24.0 to 35.9] points; P < .001), but the change in mean NDI scores was not significantly different between groups (difference, 5.1 [95% CI, -2.6 to 12.7] points; P = .19). There were no significant differences in changes in arm pain (mean [SE] change, 3.5 [0.5] vs 3.1 [0.4]; P = .47), neck pain (mean [SE] change, 3.0 [0.5] vs 3.4 [0.5]; P = .50), EQ-5D (mean [SE] change, 0.39 [0.4] vs 0.45 [0.6]; P = .46), patients requiring reoperation (10 patients [14.7%] vs 8 patients [11.8%]; P = .61), and adjacent segment disease (0 patients vs 1 patient [1.5%]; P = .32) between the arthroplasty and fusion groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, patients treated with arthroplasty and fusion reported similar and substantial clinical improvement at 5 years. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00735176.
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Affiliation(s)
- Tonje Okkenhaug Johansen
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jarle Sundseth
- Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Oddrun Anita Fredriksli
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege Andresen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Are Hugo Pripp
- Research Support Services, Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øystein Petter Nygaard
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
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Joaquim AF, Lee NJ, Riew KD. Revision Surgeries at the Index Level After Cervical Disc Arthroplasty - A Systematic Review. Neurospine 2021; 18:34-44. [PMID: 33819934 PMCID: PMC8021828 DOI: 10.14245/ns.2040454.227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To perform a systematic literature review on revision surgeries at the index level after cervical disc arthroplasty (CDA) failure.
Methods A systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Prospective studies on patients who required a secondary surgery after CDA failure were included for analysis. The minimum follow-up for these studies was 5 years.
Results Out of 864 studies in the original search group, a total of 20 studies were included. From a total of 4,087 patients, 161 patients required a reoperation at the index level. A total of 170 surgeries were performed, as some patients required multiple surgeries. The most common secondary procedures were anterior cervical discectomy and fusion (ACDF) (68%, N = 61) and posterior cervical fusion (15.5%, N = 14), followed by other reoperation (13.3%, N = 12). The associated outcomes for those who required a revision surgery were rarely mentioned in the included literature.
Conclusion The long-term revision rate at the index level of failed CDA surgery was 3.9%, with a minimum 5-year follow-up. ACDF was the most commonly performed procedure to salvage a failed CDA. Some patients who required a new surgery after CDA failure may require a more extensive salvage procedure and even subsequent surgeries.
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Affiliation(s)
| | - Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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