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Proal JD, Moon AS, Kwon B. The fragility index and reverse fragility index of FDA investigational device exemption trials in spinal fusion surgery: a systematic review. 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 2024; 33:2594-2603. [PMID: 38802596 DOI: 10.1007/s00586-024-08317-3] [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: 01/09/2024] [Revised: 04/20/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE FDA investigational device exemption (IDE) studies are considered a gold standard of assessing safety and efficacy of novel devices through RCTs. The fragility index (FI) has emerged as a means to assess robustness of statistically significant study results and inversely, the reverse fragility index (RFI) for non-significant differences. Previous authors have defined results as fragile if loss to follow up is greater than the FI or RFI. The aim of this study was to assess the FI, RFI, and robustness of data supplied by IDE studies in spinal surgery. METHODS This was a systematic review of the literature. Inclusion criteria included randomized controlled trials with dichotomous outcome measures conducted under IDE guidelines between 2000 and 2023. FI and RFI were calculated through successively changing events to non-events until the outcome changed to non-significance or significance, respectively. The fragility quotient (FQ) and reverse fragility quotient (RFQ) were calculated by dividing the FI and RFI, respectively, by the sample size. RESULTS Thirty-two studies met inclusion criteria with a total of 40 unique outcome measures; 240 outcomes were analyzed. Twenty-six studies reported 96 statistically significant results. The median FI was 6 (IQR: 3-9.25), and patients lost to follow up was greater than the FI in 99.0% (95/96) of results. The average FQ was 0.027. Thirty studies reported 144 statistically insignificant results and a median RFI of 6 (IQR: 4-8). The average RFQ extrapolated was 0.021, and loss to follow up was greater than the RFI in 98.6% (142/144) of results. CONCLUSIONS IDE studies in spine surgery are surprisingly fragile given their reputations, large sample sizes, and intent to establish safety in investigational devices. This study found a median FI and RFI of 6. The number of patients lost to follow-up was greater than FIand RFI in 98.8% (237/240) of reported outcomes. FQ and RFQ tell us that changes of two to three patients per hundred can flip the significance of reported outcomes. This is an important reminder of the limitations of RCTs. Analysis of fragility in future studies may help clarify the strength of the relationship between reported data and their conclusions.
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Affiliation(s)
- Joshua D Proal
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
| | - Andrew S Moon
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Tufts MC Box #306, Boston, MA, 02111, USA
| | - Brian Kwon
- New England Baptist Hospital, Department of Orthopaedic Surgery, 125 Parker Hill Ave, Boston, MA, 02120, USA
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Zavras AG, Acosta JR, Holmberg KJ, Semenza NC, Jayamohan HR, Cheng BC, Altman DT, Sauber RD. Effect of device constraint: a comparative network meta-analysis of ACDF and cervical disc arthroplasty. Spine J 2024:S1529-9430(24)00267-5. [PMID: 38843960 DOI: 10.1016/j.spinee.2024.05.016] [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: 04/04/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND CONTEXT Clinical trials have demonstrated that cervical disc arthroplasty (CDA) is an effective and safe alternative treatment to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease in the appropriately indicated patient population. Various devices for CDA exist, differing in the level of device constraint. PURPOSE To investigate outcomes following Anterior Cervical Discectomy and Fusion (ACDF) versus CDA stratified based on the level of device constraint: Constrained, Semiconstrained, and Unconstrained. STUDY DESIGN Systematic review and network meta-analysis. PATIENT SAMPLE 2,932 CDA patients (979 Constrained, 1,214 Semiconstrained, 739 Unconstrained) and 2,601 ACDF patients from 41 studies that compared outcomes of patients undergoing CDA or ACDF at a single level at a minimum of 2 years follow-up. OUTCOME MEASURES Outcomes of interest included the development of adjacent segment degeneration (ASD), index and adjacent segment reoperation rates, range of motion (ROM), high-grade heterotopic ossification (HO, McAfee Grades 3/4), and patient-reported outcomes (NDI/VAS). METHODS CDA devices were grouped based on the degrees of freedom (DoF) allowed by the device, as either Constrained (3 DoF), Semiconstrained (4 or 5 DoF), or Unconstrained (6 DoF). A random effects network meta-analysis was conducted using standardized mean differences (SMD) and log relative risk (RR) were used to analyze continuous and categorical data, respectively. RESULTS Semiconstrained (p=.03) and Unconstrained CDA (p=.01) demonstrated a significantly lower risk for ASD than ACDF. All levels of CDA constraint demonstrated a significantly lower risk for subsequent adjacent segment surgery than ACDF (p<.001). Semiconstrained CDA also demonstrated a significantly lower risk for index level reoperation than both ACDF and Constrained CDA (p<.001). Unconstrained devices retained significantly greater ROM than both Constrained and Semiconstrained CDA (p<.001). As expected, all levels of device constraint retained significantly greater ROM than ACDF (p<.001). Constrained and Unconstrained devices both demonstrated significantly lower levels of disability on NDI than ACDF (p=.02). All levels of device constraint demonstrated significantly less neck pain than ACDF (p<.05), while Unconstrained CDA had significantly less arm pain than ACDF (p=.02) at final follow-up greater than 2 years. CONCLUSION Cervical Disc Arthroplasty, particularly the unconstrained and semiconstrained designs, appears to be more effective than ACDF in reducing the risk of adjacent segment degeneration and the need for further surgeries, while also allowing for greater range of motion and better patient-reported outcomes. Less constrained CDA conferred a lower risk for index level reoperation, while also retaining more range of motion than more constrained devices.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Jonathan R Acosta
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kyle J Holmberg
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nicholas C Semenza
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Boyle C Cheng
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan D Sauber
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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Megafu EC, Megafu MN, Nguyen JT, Du Jour EP, Bronson WH, Lin JD, Hecht AC, Parisien RL. The Fragility of Statistical Findings in Cervical Disc Arthroplasty: a Systematic Review of Randomized Controlled Trials. Arch Orthop Trauma Surg 2024; 144:2609-2617. [PMID: 38700676 PMCID: PMC11211173 DOI: 10.1007/s00402-024-05353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/26/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE This study employs both the fragility index (FI) and fragility quotient (FQ) to assess the level of robustness in the cervical disc arthroplasty (CDA) literature. We hypothesize that dichotomous outcomes involving CDA would exhibit statistical vulnerability. METHODS A PubMed search was conducted to evaluate dichotomous data for randomized controlled trials (RCTs) in CDA literature from 2000 to 2023. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. RESULTS Of the 1561 articles screened, 111 met the search criteria, with 35 RCTs evaluating CDA included for analysis. Six hundred and ninety-three outcome events with 130 significant (P < 0.05) outcomes and 563 nonsignificant (P ≥ 0.05) outcomes were identified. The overall FI and FQ for all 693 outcomes were 5 (IQR 3-7) and 0.019 (IQR 0.011-0.043). Fragility analysis of statistically significant outcomes and nonsignificant outcomes both revealed an FI of 5. All of the studies reported loss to follow-up (LTF) data where 65.7% (23) did not report or reported an LTF greater or equal to 5. CONCLUSIONS The literature regarding CDA RCTs lacks statistical robustness and may misrepresent the conclusions with the sole use of the P value. By implementing the FI and FQ along with the P value, we believe the interpretation and contextualization of the clinical data surrounding CDA will be better understood.
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Affiliation(s)
| | - Michael N Megafu
- A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.
| | - Janet T Nguyen
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Wesley H Bronson
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Andrew C Hecht
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Robert L Parisien
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Ortiz-Babilonia CD, Gupta A, Cartagena-Reyes MA, Xu AL, Raad M, Durand WM, Skolasky RL, Jain A. The Statistical Fragility of Trials Comparing Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion: A Meta Analysis. Spine (Phila Pa 1976) 2024; 49:708-714. [PMID: 37368958 DOI: 10.1097/brs.0000000000004756] [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: 01/23/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To assess the robustness of randomized controlled trials (RCTs) that compared cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative cervical pathology by using fragility indices. SUMMARY OF BACKGROUND DATA RCTs comparing these surgical approaches have shown that CDA may be equivalent or even superior to ACDF due to better preservation of normal spinal kinematics. MATERIALS AND METHODS RCTs reporting clinical outcomes after CDA versus ACDF for degenerative cervical disc disease were evaluated. Data for outcome measures were classified as continuous or dichotomous. Continuous outcomes included: Neck Disability Index, overall pain, neck pain, radicular arm pain, and modified Japanese Orthopedic Association scores. Dichotomous outcomes included: any adjacent segment disease (ASD), superior-level ASD, and inferior-level ASD. The fragility index (FI) and continuous FI (CFI) were determined for dichotomous and continuous outcomes, respectively. The corresponding fragility quotient (FQ) and continuous FQ were calculated by dividing FI/CFI by sample size. RESULTS Twenty-five studies (78 outcome events) were included. Thirteen dichotomous events had a median FI of 7 [interquartile range (IQR): 3-10], and the median FQ was 0.043 (IQR: 0.035-0.066). Sixty-five continuous events had a median CFI of 14 (IQR: 9-22) and a median continuous FQ of 0.145 (IQR: 0.074-0.188). This indicates that, on average, altering the outcome of 4.3 patients out of 100 for the dichotomous outcomes and 14.5 out of 100 for continuous outcomes would reverse trial significance. Of the 13 dichotomous events that included a loss to follow-up data, 8 (61.5%) represented ≥7 patients lost. Of the 65 continuous events reporting the loss to follow-up data, 22 (33.8%) represented ≥14 patients lost. CONCLUSION RCTs comparing ACDF and CDA have fair to moderate statistical robustness and do not suffer from statistical fragility.
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Affiliation(s)
- Carlos D Ortiz-Babilonia
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
- Department of Orthopedic Surgery, University of Puerto Rico, PR
| | - Arjun Gupta
- Department of Orthopedic Surgery, Rutgers University, New Jersey, NJ
| | | | - Amy L Xu
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Richard L Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
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Federico VP, Zavras AG, Vucicevic RS, Salazar LM, An HS, Colman MW, Phillips FM. Delayed Infection After Cervical Disc Arthroplasty: A Case Report and Review of the Literature. Clin Spine Surg 2024:01933606-990000000-00288. [PMID: 38637917 DOI: 10.1097/bsd.0000000000001618] [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] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Case report and literature review. OBJECTIVE To report the relatively rare complication of delayed infection after cervical disc arthroplasty (CDA). BACKGROUND Delayed infection of the M6 device has been a rarely reported complication, with all cases described outside of the United States. The reliability of positive intraoperative cultures remains an ongoing debate. METHODS Cases were reviewed, and findings were summarized. A literature review was performed and discussed, with special consideration to current reports of delayed M6 infection, etiology, and utility of intraoperative cultures. RESULTS We present a case of delayed infection 6 years after primary 1-level CDA with the M6 device. At revision surgery, gross purulence was encountered. Intraoperative cultures finalized with Staphylococcus epidermidis and Cutibacterium acnes. The patient was revised with removal of the M6 and conversion to anterior cervical discectomy and fusion. A prolonged course of intravenous antibiotics was followed by an oral course for suppression. At the final follow-up, the patient's preoperative symptoms had resolved. CONCLUSION Delayed infection after CDA is a rare complication, with ongoing debate regarding the reliability of positive cultures. We describe an infected M6 and demonstrate the utility of implant removal, conversion to anterior cervical discectomy and fusion, and long-term antibiotics as definitive treatment. LEVEL OF EVIDENCE Level V-case report and literature review.
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Affiliation(s)
- Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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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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Satin AM, Rogers-LaVanne MP, Guyer RD, Zigler JE, Blumenthal SL, Shellock JL, Ohnmeiss DD, Derman PB. Letter to the editor regarding, "Long-term results of the NECK trial-implanting a disc prosthesis after cervical anterior discectomy cannot prevent adjacent segment disease: five-year clinical follow-up of a double-blinded randomised controlled trial" by Goedmakers et al. Spine J 2024; 24:387-388. [PMID: 38246700 DOI: 10.1016/j.spinee.2023.09.025] [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: 08/15/2023] [Accepted: 09/30/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Alexander M Satin
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA.
| | | | - Richard D Guyer
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA; Center for Disc Replacement, Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, USA
| | - Jack E Zigler
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA; Center for Disc Replacement, Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, USA
| | - Scott L Blumenthal
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA; Center for Disc Replacement, Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, USA
| | - Jessica L Shellock
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA; Center for Disc Replacement, Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, USA
| | - Donna D Ohnmeiss
- Texas Back Institute Research Foundation, 6020 W. Parker Rd, Suite 200, Plano, TX, USA
| | - Peter B Derman
- Texas Back Institute, 6020 W. Parker Rd, Suite 200, Plano, TX, 75093 USA
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Zavras AG, Federico VP, Butler AJ, Nolte MT, Dandu N, Phillips FM, Colman MW. Relative Efficacy of Cervical Total Disc Arthroplasty Devices and Anterior Cervical Discectomy and Fusion for Cervical Pathology: A Network Meta-Analysis. Global Spine J 2024; 14:322-346. [PMID: 37099726 PMCID: PMC10676167 DOI: 10.1177/21925682231172982] [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: 04/28/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta Analysis. OBJECTIVE This study sought to compare patient-reported outcomes, success, complications, and radiographic outcomes directly and indirectly between different cervical total disc arthroplasty (TDA) devices and anterior cervical discectomy and fusion (ACDF). METHODS Patients of prospective randomized controlled trials of 1-level cervical TDA with a minimum of 2 years follow up were identified in the literature. A frequentist network meta-analysis model was used to compare each outcome across the different TDA devices included and ACDF using the mixed effect sizes. RESULTS 15 studies were included for quantitative analysis, reporting the outcomes of 2643 patients with an average follow-up was 67.3 months (range: 24-120 months), 1417 of whom underwent TDA and 1226 of whom underwent ACDF. Nine TDA devices were compared to ACDF, including the Bryan, Discover, Kineflex, M6, Mobi-C, PCM, Prestige ST, ProDisc-C, and Secure-C cervical prostheses. Several devices outperformed ACDF for certain outcomes, including Visual Analog Scale (VAS) Arm, Physical Component Score of the Short-Form Health Survey (SF PCS), neurological success, satisfaction, index-level secondary surgical interventions (SSI), and adjacent level surgeries. Cumulative ranking of each intervention assessed demonstrated the highest performance with the M6 prosthesis (P = .70), followed by Secure-C (P = .67), PCM (P = .57), Prestige ST (P = .57), ProDisc-C (P = .54), Mobi-C (P = .53), Bryan (P = .49), Kineflex (P = .49), Discover (P = .39), and ACDF (P = .14). CONCLUSION Cervical TDA was found to be superior on most outcomes assessed in the literature of high-quality clinical trials. While most devices demonstrated similar outcomes, certain prostheses such as the M6 were found to outperform others across several outcomes assessed. These findings suggest that the restoration of near-normal cervical kinematics may lead to improved outcomes.
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Affiliation(s)
- Athan G. Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander J. Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Frank M. Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W. Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, 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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Khalid SI, Mirpuri P, Thomson K, Elsamadicy A, Massaad E, Deysher D, Khilwani H, Adogwa O, Shin JH, Mehta AI. Outcomes Following 2-Level Cervical Interventions with Cage-and-Plate, Zero-Profile, or Arthroplasty Constructs. World Neurosurg 2023; 180:e607-e617. [PMID: 37797683 DOI: 10.1016/j.wneu.2023.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Though cage-and-plate constructs are widely used for disk height restoration in surgery for cervical disc disease, concerns over range of motion limitations and adjacent disc space violations have fueled the development of artificial disc and zero-profile constructs. This study investigated the outcomes of patients undergoing two-level cervical interventions via arthroplasty, cage-and-plate, or zero-profile constructs. METHODS Patients undergoing two-level anterior cervical procedures between 2010 and 2020 were identified using an all-payer claims database. Logistic regression models were utilized to develop criteria for a 1:1:1-exact match procedure. The primary outcome was the need for additional surgery within 30 months, and the secondary outcomes included medical and surgical complications observed within 30 days of index intervention. P values < 0.05 were considered statistically significant. RESULTS 133,831 patients were identified as undergoing two-level anterior cervical interventions. Seven thousand three hundred seventy-one records were analyzed through a 1:1:1 match. Patients who received zero-profile versus cage-and-plate constructs had significantly decreased odds of requiring additional surgery within 30 months (Odds Ratio [OR] 0.64; 95% Confidence Interval [CI] 0.51-0.81). However, postoperative medical complications were increased among patients who received zero-profile constructs compared to cage-and-plate (OR 1.59; 95%CI 1.07-2.37). Patients who underwent arthroplasty also had decreased odds for additional surgery versus cage-and-plate (OR 0.75; 95%CI 0.60-0.93). There was no significant difference between arthroplasty and cage-and-plate constructs in developing postoperative surgical or medical complications. CONCLUSIONS Among patients undergoing two-level interventions, cage-and-plate constructs were associated with increased odds of additional surgery within 30 months following index procedures when compared to zero-profile constructs or arthroplasty.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago, Illinois, USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago, Illinois, USA
| | - Aladine Elsamadicy
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harsh Khilwani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Kim LJY, Mazur MD, Dailey AT. Mid-term and Long-term Outcomes After Total Cervical Disk Arthroplasty Compared With Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Spine Surg 2023; 36:339-355. [PMID: 37735768 DOI: 10.1097/bsd.0000000000001537] [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: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN A meta-analysis of randomized controlled trials (RCTs). OBJECTIVE The aim of this study was to compare mid-term to long-term outcomes of cervical disk arthroplasty (CDA) with those of anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical degenerative disk disease. SUMMARY OF BACKGROUND DATA After ACDF to treat symptomatic cervical degenerative disk disease, the loss of motion at the index level due to fusion may accelerate adjacent-level disk degeneration. CDA was developed to preserve motion and reduce the risk of adjacent segment degeneration. Early-term to mid-term clinical outcomes from RCTs suggest noninferiority of CDA compared with ACDF, but it remains unclear whether CDA yields better mid-term to long-term outcomes than ACDF. MATERIALS AND METHODS Two independent reviewers searched PubMed, Embase, and the Cochrane Library for RCTs with at least 60 months of follow-up. The risk ratio or standardized mean difference (and 95% CIs) were calculated for dichotomous or continuous variables, respectively. RESULTS Eighteen reports of 14 RCTs published in 2014-2023 were included. The pooled analysis demonstrated that the CDA group had a significantly greater improvement in neurological success and Neck Disability Index than the ACDF group. The ACDF group exhibited a significantly better improvement in the Short Form-36 Health Survey Physical Component Summary than the CDA group. Radiographic adjacent segment degeneration was significantly lower in the CDA group at 60- and 84-month follow-ups; at 120-month follow-up, there was no significant difference between the 2 groups. Although the overall rate of secondary surgical procedures was significantly lower in the CDA group, we did not observe any significant difference at 60-month follow-up between the CDA and ACDF group and appreciated statistically significant lower rates of radiographic adjacent segment degeneration, and symptomatic adjacent-level disease requiring surgery at 84-month and 108- to 120-month follow-up. The rate of adverse events and the neck and arm pain scores in the CDA group were not significantly different from those of the ACDF group. CONCLUSIONS In this meta-analysis of 14 RCTs with 5- to 10-year follow-up data, CDA resulted in significantly better neurological success and Neck Disability Index scores and lower rates of radiographic adjacent segment degeneration, secondary surgical procedures, and symptomatic adjacent-level disease requiring surgery than ACDF. ACDF resulted in improved Short Form-36 Health Survey Physical Component Summary scores. However, the CDA and ACDF groups did not exhibit significant differences in overall changes in neck and arm pain scores or rates of adverse events.
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Affiliation(s)
- Leo J Y Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT
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14
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Yee TJ, Mummaneni PV. Biomechanics of Cervical Disk Replacement: Classifying Arthroplasty Implants. Clin Spine Surg 2023; 36:386-390. [PMID: 37735758 DOI: 10.1097/bsd.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
Cervical disk arthroplasty has been employed with increased frequency over the past 2 decades as a motion-preserving alternative to anterior cervical discectomy and fusion in select patients with myelopathy or radiculopathy secondary to degenerative disk disease. As indications continue to expand, an understanding of cervical kinematics and materials science is helpful for optimal implant selection. Cervical disk arthroplasty implants can be classified according to the mode of articulation and df , articulation material, and endplate construction. The incorporation of translational and rotational df allows the implant to emulate the dynamic and coupled centers of movement in the cervical spine. Durable and low-friction interfaces at the articulation sustain optimal performance and minimize particulate-induced tissue reactions. Endplate materials must facilitate osseous integration to ensure implant stability after primary fixation. These cardinal considerations underlie the design of the 9 implants currently approved by the FDA and serve as the foundation for further biomimetic research and development.
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Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA
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15
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Young MW, Abtahi AM. Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement: Current Evidence. Clin Spine Surg 2023; 36:391-397. [PMID: 37798824 DOI: 10.1097/bsd.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES The purpose of this study was to provide a review of the current evidence on the impact of posterior cervical foraminotomy (PCF) performed before or after cervical disk replacement (CDR). SUMMARY OF BACKGROUND DATA The impact of PCF on outcomes in the setting of CDR is an evolving field, given the recent widespread adoption of CDR and the relative rarity of patients who have undergone both procedures. METHODS A literature search was conducted using PubMed to determine current evidence regarding the indications, outcomes, and biomechanical effects of CDR and PCF when performed alone or in combination. RESULTS When radicular symptoms persist following PCF, a CDR can be safely performed to provide further decompression. Conversely, a PCF can be safely performed following CDR for these same indications. The biomechanical effects of these procedures in combination demonstrate maintained stability when the facetectomy is less than 50% of the facet joint. Studies demonstrate that stability is not significantly decreased by the presence, amount, or level of posterior foraminotomies in the setting of CDR. CONCLUSIONS A PCF can be safely performed before or after cervical disk arthroplasty for recurrent radicular symptoms. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Mason W Young
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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16
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Divi SN, Plantz MA, Tegethoff J, Su BW. Current and Expanded Indications for Cervical Disc Arthroplasty: Beyond the FDA IDE Studies. Clin Spine Surg 2023; 36:375-385. [PMID: 37691166 DOI: 10.1097/bsd.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Jason Tegethoff
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Brian W Su
- California Orthopedics & Spine, Novato, CA
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17
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Hsueh LL, Yeh YC, Lu ML, Luo CA, Chiu PY, Lai PL, Niu CC. The impact of over-distraction on adjacent segment pathology and cage subsidence in anterior cervical discectomy and fusion. Sci Rep 2023; 13:18493. [PMID: 37898696 PMCID: PMC10613266 DOI: 10.1038/s41598-023-44998-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023] Open
Abstract
Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical studies have demonstrated increased adjacent segment intradiscal pressure after ACDF. The purpose of this study is to determine if over-distraction of the index disc has an effect on adjacent segment pathology. A consecutive series of 145 patients who received primary ACDF for cervical degenerative pathologies from January 2010 to December 2017 were retrospectively reviewed. The patients were divided into: (1) Over-distraction group (postoperative-preoperative index disc height ≥ 2 mm), and (2) No-distraction group (postoperative-preoperative index disc height < 2 mm). Outcome measures included radiographic parameters, Japanese Orthopaedic Association (JOA) score, and incidences of cage subsidence, radiological and clinical adjacent segment pathologies (RASP and CASP) were compared between the two groups preoperatively, postoperatively, and at the final follow-up. The two groups were comparable with respect to age, follow-up length, JOA score, incidence of CASP, and radiographic parameters. The Over-distraction group (83 patients; 115 levels) had smaller preoperative index disc height (4.5 vs. 5.2 mm, p < 0.001), but taller postoperative index disc height (7.7 vs. 6.6 mm, p < 0.001) than No-distraction group (62 patients; 90 levels) Furthermore, significantly higher incidences of cage subsidence (47% vs. 31%, p = 0.04) and RASP (any progression: 48% vs. 15%, p < 0.001; progress ≥ 2 grades: 25% vs. 7%, p = 0.001) were observed in the Over-distraction group. The multivariate analysis indicated that over-distraction and multilevel fusion were independent risk factors for RASP. There were no clinical outcome differences between the Over-distraction group and the No-distraction group in ACDF. Over-distraction of the index level of ≥ 2 mm should be avoided because it significantly increases the incidences of RASP and cage subsidence.
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Affiliation(s)
- Lan-Li Hsueh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Yu-Cheng Yeh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Meng-Ling Lu
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung Branch, No. 123, DAPI Rd., Niaosong Dist, Kaohsiung City 833, Taiwan, ROC
| | - Chi-An Luo
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Ping-Yeh Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC.
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan, ROC.
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Foley D, Hardacker P, McCarthy M. Emerging Technologies within Spine Surgery. Life (Basel) 2023; 13:2028. [PMID: 37895410 PMCID: PMC10608700 DOI: 10.3390/life13102028] [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: 08/30/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons' understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.
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Affiliation(s)
- David Foley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Pierce Hardacker
- Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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19
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Mills ES, Shelby T, Bouz GJ, Hah RJ, Wang JC, Alluri RK. A Decreasing National Trend in Lumbar Disc Arthroplasty. Global Spine J 2023; 13:2271-2277. [PMID: 35180023 PMCID: PMC10538335 DOI: 10.1177/21925682221079571] [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 Retrospective National Database Study. OBJECTIVES The aim of this study was to investigate the national trend of lumbar disc arthroplasty (LDA) utilization from 2005 to 2017. METHODS Patients undergoing primary LDA between 2005 and 2017 were identified in the National Inpatient Sample (NIS) database. Year of the procedure, demographic, socioeconomic, hospital, and cost parameters were analyzed. The data was weighted using provided weights from the NIS database to generate national estimates of LDA procedure incidence. Lastly, we assessed the incidence of cervical disc arthroplasty (CDA) between 2005 and 2017 to serve as a historical comparison. RESULTS An estimated 20 460 patients underwent primary LDA in the United States between 2005 and 2017. There was an initial decrease in LDA procedures between 2005 and 2006 and then a plateau between 2006 and 2009. From 2010 to 2013, there was a significant year-over-year decrease in annual LDA procedures performed, followed by a second plateau from 2014 to 2017. Overall, LDA procedures decreased 82% from 2005 to 2017. Over the same time, the annual incidence of CDA utilization increased 795% from approximately 474 procedures in 2005 to 4245 procedures in 2017 (P < .01). CONCLUSIONS Lumbar disc arthroplasty utilization decreased 82% from 2005 to 2017, with a significant decrease in the rate of utilization noted after 2010. The utilization of LDA to treat selected degenerative lumbar conditions has not paralleled the increasing popularity of CDA, and, in fact, has demonstrated a nearly opposite utilization trend.
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Affiliation(s)
- Emily S. Mills
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Tara Shelby
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Gabriel J. Bouz
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Raymond J. Hah
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ram K. Alluri
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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20
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Federico VP, Nie JW, Hartman TJ, Zheng E, Oyetayo OO, MacGregor KR, Massel DH, Sayari AJ, Singh K. Differences in Time to Achieve Minimum Clinically Important Difference Between Patients Undergoing Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement. World Neurosurg 2023; 176:e337-e344. [PMID: 37230245 DOI: 10.1016/j.wneu.2023.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for time to minimum clinically important difference (MCID) achievement and predictors of delayed MCID achievement for the patient-reported outcomes (PROs), Patient-Reported Outcomes Measurement Information System Physical Function, Neck Disability Index, Visual Analog Scale (VAS) neck, and VAS arm. METHODS PROs of patients undergoing ACDF or CDR were collected preoperatively and postoperatively at 6-week/12-week/6-month/1-year/2-year periods. MCID achievement was calculated through comparison of changes in Patient-Reported Outcomes Measurement to previously established values in literature. Time to MCID achievement and predictors for delayed MCID achievement were determined through Kaplan-Meier survival analysis and multivariable Cox regression, respectively. RESULTS One hundred ninety-seven patients were identified, with 118 and 79 undergoing ACDF and CDR, respectively. Kaplan-Meier survival analysis demonstrated faster time to achieve MCID for CDR patients in Patient-Reported Outcomes Measurement Information System Physical Function (P = 0.006). Early predictors of MCID achievement through Cox regression were CDR procedure, Asian ethnicity, elevated preoperative PROs of VAS neck and VAS arm (hazard ratio, 1.16-7.28). Workers' compensation was a late predictor of MCID achievement (hazard ratio, 0.15). CONCLUSIONS Most patients achieved MCID in physical function, disability, and back pain outcomes within 2 years of surgery. Patients undergoing CDR achieved MCID faster in physical function. Early predictors of MCID achievement were CDR procedure, Asian ethnicity, and elevated preoperative PROs of pain outcomes. Workers' compensation was a late predictor. These findings may be helpful in managing patient expectations.
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Affiliation(s)
- Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Satin AM, Rogers-LaVanne MP, Derman PB. Cervical Disk Arthroplasty and Range of Motion at 7 Years: Impact on Adjacent Level Degeneration. Clin Spine Surg 2023; 36:83-89. [PMID: 36823704 DOI: 10.1097/bsd.0000000000001446] [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: 09/10/2022] [Accepted: 01/25/2023] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN Secondary analysis of data collected in a prospective, randomized, noninferiority Food and Drug Administration (FDA) Investigational Device Exemption (IDE) clinical trial. OBJECTIVE The objective of this study was to evaluate the impact of range of motion (ROM) following single-level cervical disk arthroplasty (CDA) on the development of radiographic adjacent level degeneration (ALD). SUMMARY OF BACKGROUND DATA The rationale for CDA is that maintenance of index-level ROM will decrease adjacent level stresses and ultimately reduce the development of ALD compared with anterior cervical discectomy and fusion. However, little information is available on the impact of hypermobility on the development of ALD after CDA. MATERIALS AND METHODS Radiographic assessments were evaluated for index-level flexion-extension ROM and ALD. Continuous data was assessed using 1-way analysis of variance. The relationship between ALD progression and ROM was evaluated using χ 2 tests. The α was set at 0.05. RESULTS More ALD progression was observed after anterior cervical discectomy and fusion than CDA ( P =0.002 at the superior and P =0.049 at the inferior level). Furthermore, there was an association between ALD progression and ROM ( P =0.014 at the superior level and P =0.050 at the inferior level) where patients with mid-ROM after CDA experienced the lowest frequency of ALD progression at the superior and inferior levels. Patients with the lowest and highest ROM after CDA experienced a greater increase in ALD score at the inferior level ( P =0.046). Sex and age were associated with ROM groups ( P =0.001 and 0.023, respectively). CONCLUSIONS While maintenance of index-level ROM is protective after CDA, patients with the highest ROM after CDA have similar rates of ALD progression to the lowest ROM and greater increases in ALD compared with mid-ROM after CDA. High ROM after CDA may contribute to ALD progression.
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Clohisy JCF, Abjornson C, Bauer TW, Baral E, Albert TJ. Delayed Failure of M6-C Cervical Disc Arthroplasty After Conversion of Adjacent Cervical Disc Arthroplasty to Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00013. [PMID: 37071739 DOI: 10.2106/jbjs.cc.22.00788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CASE We present a delayed failure of an M6-C cervical disc arthroplasty after conversion of a subjacent failed cervical disc arthroplasty to fusion. The annular component had failed, and the core had been ejected. Histology demonstrated a giant cell reaction to polyethylene debris, and tissue cultures were positive for Cutibacterium acnes. CONCLUSION This is the first report of M6-C failure after conversion of an adjacent arthroplasty to fusion. A growing number of reports surrounding the M6-C failure rate and mechanisms raise concern about the device's durability and underscore the importance of routine clinical and radiographic surveillance for these patients.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Celeste Abjornson
- Integrated Spine Research Program, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Elexis Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Todd J Albert
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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Chambers JS, Kropp RG, Gardocki RJ. Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion. Arch Orthop Trauma Surg 2023; 143:265-268. [PMID: 34244874 DOI: 10.1007/s00402-021-04056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purposes of this study were to identify the 2 year rate of reoperation and determine patient-reported outcomes after elective one- and two-level anterior cervical discectomy and fusion (ACDF) with structural allograft and anterior plating using indications similar to cervical disc arthroplasty. MATERIALS AND METHODS A retrospective chart review was performed on 116 consecutive one- and two-level primary ACDF for adult degenerative disease with structural allograft and anterior plating in one surgeon's practice. Patient-reported visual analog score (VAS), Oswestry disability index (ODI) and radiographs, collected prospectively on all operative patients preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years were reviewed. Patient demographics and reoperation rates were obtained from the chart. RESULTS One hundred and four patients were identified with a final reoperation rate of 2.9% at a mean final follow-up 2 years (95% CI 17.2-29.0). No reoperations occurred within 90 days. After 1 year, three patients required reoperation. The mean patient-reported outcomes improved (VAS, 6.6 preoperatively to 3.0 at final follow-up and ODI, 24.3 preoperatively to 12.3 at final follow-up). These improvements were statistically significant (p < 0.01). No significant patient risk factors for reoperation were found. CONCLUSIONS The rate of reoperation for one- and two-level anterior cervical discectomy and fusion at follow-up was found to be lower than those previously published in the literature quoted for CDA. Arthrodesis continues to demonstrate improvements in patient-reported outcomes.
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Affiliation(s)
- James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee/Campbell Clinic, Memphis, TN, USA
| | - Robert G Kropp
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA
| | - Raymond J Gardocki
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA.
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Takami T, Hara T, Hara M, Inui T, Ito K, Koyanagi I, Mizuno J, Mizuno M, Nakase H, Shimokawa N, Sugawara T, Suzuki S, Takahashi T, Takayasu M, Tani S, Hida K, Kim P, Arai H. Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients. Neurol Med Chir (Tokyo) 2022; 62:489-501. [PMID: 36223947 PMCID: PMC9726179 DOI: 10.2176/jns-nmc.2022-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2023] Open
Abstract
Anterior cervical disc replacement (ACDR) using cervical artificial disc (CAD) has the advantage of maintaining the range of motion (ROM) at the surgical level, subsequently reducing the postoperative risk of adjacent disc disease. Following the approval for the clinical use in Japan, a post-marketing surveillance (PMS) study was conducted for two different types of CAD, namely, Mobi-C (metal-on-plastic design) and Prestige LP (metal-on-metal design). The objective of this prospective observational multicenter study was to analyze the first 2-year surgical results of the PMS study of 1-level ACDR in Japan. A total of 54 patients were registered (Mobi-C, n = 24, MC group; Prestige LP, n = 30, PLP group). Preoperative neurological assessment revealed radiculopathy in 31 patients (57.4%) and myelopathy in 15 patients (27.8%). Preoperative radiological assessment classified the disease category as disc herniation in 15 patients (27.8%), osteophyte in 6 patients (11.1%), and both in 33 patients (61.1%). The postoperative follow-up rates at 6 weeks, 6 months, 1 year, and 2 years after ACDR were 92.6%, 87.0%, 83.3%, and 79.6%, respectively. In both groups, patients' neurological condition improved significantly after surgery. Radiographic assessment revealed loss of mobility at the surgical level in 9.5% of patients in the MC group and in 9.1% of patients in the PLP group. No secondary surgeries at the initial surgical level and no serious adverse events were observed in either group. The present results suggest that 1-level ACDR is safe, although medium- to long-term follow-up is mandatory to further verify the validity of ACDR for Japanese patients.
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Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University
| | | | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
| | - Junichi Mizuno
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | | | | | | | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center
| | - Shinsuke Suzuki
- Department of Spinal Surgery, Sendai East Neurosurgical Hospital
| | | | | | - Satoshi Tani
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital
| | - Phyo Kim
- Neurologic Surgery, Symphony Clinic
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University
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Wang X, Lin Y, Wang Q, Gao L, Feng F. A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion. J Pain Res 2022; 15:3137-3156. [PMID: 36311292 PMCID: PMC9604433 DOI: 10.2147/jpr.s375720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Study design A bibliometric analysis. Objective To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion. Summary of Background Data Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends. Methods We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis. Results The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF". Conclusion ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.
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Affiliation(s)
- Xun Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Yanze Lin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Qiongtai Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Liqing Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Correspondence: Fabo Feng, Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China, Email
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Zavras AG, Dandu N, Nolte MT, Butler AJ, Federico VP, Sayari AJ, Sullivan TB, Colman MW. Segmental range of motion after cervical total disc arthroplasty at long-term follow-up: a systematic review and meta-analysis. J Neurosurg Spine 2022; 37:579-587. [PMID: 35453108 DOI: 10.3171/2022.2.spine2281] [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: 01/18/2022] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As an alternative procedure to anterior cervical discectomy and fusion, total disc arthroplasty (TDA) facilitates direct neural decompression and disc height restoration while also preserving cervical spine kinematics. To date, few studies have reported long-term functional outcomes after TDA. This paper reports the results of a systematic review and meta-analysis that investigated how segmental range of motion (ROM) at the operative level is maintained with long-term follow-up. METHODS PubMed and MEDLINE were queried for all published studies pertaining to cervical TDA. The methodology for screening adhered strictly to the PRISMA guidelines. All English-language prospective studies that reported ROM preoperatively, 1 year postoperatively, and/or at long-term follow-up of 5 years or more were included. A meta-analysis was performed using Cochran's Q and I2 to test data for statistical heterogeneity, in which case a random-effects model was used. The mean differences (MDs) and associated 95% confidence intervals (CIs) were reported. RESULTS Of the 12 studies that met the inclusion criteria, 8 reported the long-term outcomes of 944 patients with an average (range) follow-up of 99.86 (60-142) months and were included in the meta-analysis. There was no difference between preoperative segmental ROM and segmental ROM at 1-year follow-up (MD 0.91°, 95% CI -1.25° to 3.07°, p = 0.410). After the exclusion of 1 study from the comparison between preoperative and 1-year ROM owing to significant statistical heterogeneity according to the sensitivity analysis, ROM significantly improved at 1 year postoperatively (MD 1.92°, 95% CI 1.04°-2.79°, p < 0.001). However, at longer-term follow-up, the authors again found no difference with preoperative segmental ROM, and no study was excluded on the basis of the results of further sensitivity analysis (MD -0.22°, 95% CI -1.69° to -1.23°, p = 0.760). In contrast, there was a significant decrease in ROM from 1 year postoperatively to final long-term follow-up (MD -0.77°, 95% CI -1.29° to -0.24°, p = 0.004). CONCLUSIONS Segmental ROM was found to initially improve beyond preoperative values for as long as 1 year postoperatively, but then ROM deteriorated back to values consistent with preoperative motion at long-term follow-up. Although additional studies with further longitudinal follow-up are needed, these findings further support the notion that cervical TDA may successfully maintain physiological spinal kinematics over the long term.
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Colman MW, Zavras AG, Federico VP, Nolte MT, Butler AJ, Singh K, Phillips FM. Longitudinal assessment of segmental motion of the cervical spine following total disc arthroplasty: a comparative analysis of devices. J Neurosurg Spine 2022; 37:556-562. [PMID: 35426820 DOI: 10.3171/2022.2.spine22143] [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: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Total disc arthroplasty (TDA) has been shown to be an effective and safe treatment for cervical degenerative disc disease at short- and midterm follow-up. However, there remains a paucity of literature reporting the differences between individual prosthesis designs with regard to device performance. In this study, the authors evaluated the long-term maintenance of segmental range of motion (ROM) at the operative cervical level across a diverse range of TDA devices. METHODS In this study, the authors retrospectively evaluated all consecutive patients who underwent 1- or 2-level cervical TDA between 2005 and 2020 at a single institution. Patients with a minimum of 6 months of follow-up and lateral flexion/extension radiographs preoperatively, 2 months postoperatively, and at final follow-up were included. Radiographic measurements included static segmental lordosis, segmental range of motion (ROM) on flexion/extension, global cervical (C2-7) ROM on flexion/extension, and disc space height. The paired t-test was used to evaluate improvement in radiographic parameters. Subanalysis between devices was performed using one-way ANCOVA. Significance was determined at p < 0.05. RESULTS A total of 85 patients (100 discs) were included, with a mean patient age of 46.01 ± 8.82 years and follow-up of 43.56 ± 39.36 months. Implantations included 22 (22.00%) M6-C, 51 (51.00%) Mobi-C, 14 (14.00%) PCM, and 13 (13.00%) ProDisc-C devices. There were no differences in baseline radiographic parameters between groups. At 2 months postoperatively, PCM provided significantly less segmental lordosis (p = 0.037) and segmental ROM (p = 0.039). At final follow-up, segmental ROM with both the PCM and ProDisc-C devices was significantly less than that with the M6-C and Mobi-C devices (p = 0.015). From preoperatively to 2 months postoperatively, PCM implantation led to a significant loss of lordosis (p < 0.001) and segmental ROM (p = 0.005) relative to the other devices. Moreover, a significantly greater decline in segmental ROM from 2 months postoperatively to final follow-up was seen with ProDisc-C, while segmental ROM increased significantly over time with Mobi-C (p = 0.049). CONCLUSIONS Analysis by TDA device brand demonstrated that motion preservation differs depending on disc design. Certain devices, including M6-C and Mobi-C, improve ROM on flexion/extension from preoperatively to postoperatively and continue to increase slightly at final follow-up. On the other hand, devices such as PCM and ProDisc-C contributed to greater segmental stiffness, with a gradual decline in ROM seen with ProDisc-C. Further studies are needed to understand how much segmental ROM is ideal after TDA for preservation of physiological cervical kinematics.
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Ding Z, Ren Y, Cao H, Li J. Top 100 most cited articles on anterior cervical discectomy and fusion. Front Surg 2022; 9:1000360. [PMID: 36147696 PMCID: PMC9485582 DOI: 10.3389/fsurg.2022.1000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design Bibliometric analysis. Objective Anterior cervical discectomy and fusion (ACDF) is a typical surgical method in spine surgery and has progressed significantly in the last several decades. The purpose of this study is to determine how the 100 most-cited original articles on ACDF have been the most influential in this field by identifying and analyzing them. Methods The articles on ACDF were identified by searching the Thomson ISI Web of Science database on 30 May 2022. The 100 most-cited articles were selected according to specific criteria. The data extracted from the articles included title, publication date, total citations, journal name, first author, institutions, and keywords. Results The total number of citations was 13,181, with a mean number of 131.81 ± 100.18. The publication dates ranged from 1994 to 2018. Most of these articles originated in the United States (68%) and were published in the 2000s (32%) and 2010s (48%). Spine published most of the articles (30%), followed by the Journal of Neurosurgery-Spine (16%), Spine Journal (14%), and European Spine Journal (13%). The most prolific author was Dr. Todd J Albert (n = 7), with 1,312 citations. The Texas Back Institute was the most productive institution (n = 10). The keywords ACDF, cervical spine, cervical spine, and fusion showed the highest degree of centrality. Conclusion One hundred top-cited articles on ACDF were identified and analyzed in this study. We demonstrate that ACDF is a growing and popular area of research, with the focus of research varying through timeline trends. This will provide a comprehensive and detailed basis for spine surgeons to make clinical decisions and assimilate the research focus of cervical spine surgery.
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Affiliation(s)
- Zhiyu Ding
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jinsong Li
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Schuermans VNE, Smeets AYJM, Boselie TFM, Candel MJJM, Curfs I, Evers SMAA, Van Santbrink H. Research protocol: Cervical Arthroplasty Cost Effectiveness Study (CACES): economic evaluation of anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy with fusion (ACDF) in the surgical treatment of cervical degenerative disc disease - a randomized controlled trial. Trials 2022; 23:715. [PMID: 36028916 PMCID: PMC9419384 DOI: 10.1186/s13063-022-06574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction To date, there is no consensus on which anterior surgical technique is more cost-effective in treating cervical degenerative disc disease (CDDD). The most commonly used surgical treatment for patients with single- or multi-level symptomatic CDDD is anterior cervical discectomy with fusion (ACDF). However, new complaints of radiculopathy and/or myelopathy commonly develop at adjacent levels, also known as clinical adjacent segment pathology (CASP). The extent to which kinematics, surgery-induced fusion, natural history, and progression of disease play a role in the development of CASP remains unclear. Anterior cervical discectomy with arthroplasty (ACDA) is another treatment option that is thought to reduce the incidence of CASP by preserving motion in the operated segment. While ACDA is often discouraged, as the implant costs are higher while the clinical outcomes are similar to ACDF, preventing CASP might be a reason for ACDA to be a more cost-effective technique in the long term. Methods and analysis In this randomized controlled trial, patients will be randomized to receive ACDF or ACDA in a 1:1 ratio. Adult patients with single- or multi-level CDDD and symptoms of radiculopathy and/or myelopathy will be included. The primary outcome is cost-effectiveness and cost-utility of both techniques from a healthcare and societal perspective. Secondary objectives are the differences in clinical and radiological outcomes between the two techniques, as well as the qualitative process surrounding anterior decompression surgery. All outcomes will be measured at baseline and every 6 months until 4 years post-surgery. Discussion High-quality evidence regarding the cost-effectiveness of both ACDA and ACDF is lacking; to date, there are no prospective trials from a societal perspective. Considering the aging of the population and the rising healthcare costs, there is an urgent need for a solid clinical cost-effectiveness trial addressing this question. Trial registration ClinicalTrials.gov NCT04623593. Registered on 29 September 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06574-5.
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Affiliation(s)
- Valérie N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands. .,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands.
| | - Anouk Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Toon F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Peter Debyeplein 1, Maastricht, 6229 HA, The Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Silvia M A A Evers
- Department of Public Health Technology Assessment, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - Henk Van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
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Núñez JH, Escudero B, Omiste I, Martínez-Peñas J, Surroca M, Alonzo-González F, Bosch-García D. Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03365-1. [PMID: 35986813 DOI: 10.1007/s00590-022-03365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Compare the outcomes of randomized clinical trials of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF), with a minimum follow-up of 7 years. METHODS Nine randomized clinical trials were selected. The clinical, radiological, and surgical outcomes were analyzed, including functional and pain scores, range of motion, adjacent segment degeneration, adverse events, and need for reoperation. RESULTS 2664 patients were included in the study. Pooled results indicated that the CDA group had a significantly higher overall success rate (p < 0.001), a higher improvement in the neck disability index (NDI) (p = 0.002), less VAS arm pain (p = 0.01), and better health questionnaire SF-36 physical component (p = 0.01) than ACDF group. Likewise, the pooled results indicated a significantly higher motion rate (p < 0.001), less adjacent syndrome (p < 0.05), and a lower percentage of reoperation (p < 0.001) in the CDA group. There were no significant differences between the CDA and ACDF groups in the neck pain scale (p = 0.11), the health questionnaire SF-36 mental component (p = 0.10), and in adverse events (p = 0.42). CONCLUSION In long-term follow-up, CDA showed a better overall success rate, better improvement in NDI, less VAS arm pain, better health questionnaire SF-36 physical component, a higher motion rate, less adjacent syndrome, and less reoperation rate than ACDF. No significant differences were found in the neck pain scale, SF-36 mental component, and in adverse events.
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Affiliation(s)
- Jorge H Núñez
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
- Spine Unit, Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022, Barcelona, Spain.
| | - Berta Escudero
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Irene Omiste
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Judith Martínez-Peñas
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Maria Surroca
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Francisco Alonzo-González
- Hospital Ceibal de Accidentes Del Instituto Guatemalteco de Seguridad Social, Cuidad de Guatemala, Guatemala
| | - David Bosch-García
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
- Grup Traumatologic de Catalunya, Barcelona, Spain
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Schuermans VNE, Smeets AYJM, Boselie AFM, Zarrouk O, Hermans SMM, Droeghaag R, Curfs I, Evers SMAA, van Santbrink H. Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations. 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; 31:1206-1218. [PMID: 35224672 DOI: 10.1007/s00586-022-07137-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/06/2021] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE No clear consensus exists on which anterior surgical technique is most cost-effective for treating cervical degenerative disk disease (CDDD). One of the most common treatment options is anterior cervical discectomy with fusion (ACDF). Anterior cervical discectomy with arthroplasty (ACDA) was developed in an effort to reduce the incidence of clinical adjacent segment pathology and associated additional surgeries by preserving motion. This systematic review aims to evaluate the evidence regarding the cost-effectiveness of anterior surgical decompression techniques used to treat radiculopathy and/or myelopathy caused by CDDD. METHODS The search was conducted in PubMed, EMBASE, Web of Science, CINAHL, EconLit, NHS-EED and the Cochrane Library. Studies were included if healthcare costs and utility or effectivity measurements were mentioned. RESULTS A total of 23 studies were included out of the 1327 identified studies. In 9 of the 13 studies directly comparing ACDA and ACDF, ACDA was the most cost-effective technique, with an incremental cost effectiveness ratio ranging from $2.900/QALY to $98.475/QALY. There was great heterogeneity between the costs of due to different in- and exclusion criteria of costs and charges, cost perspective, baseline characteristics, and calculation methods. The methodological quality of the included studies was moderate. CONCLUSION The majority of studies report ACDA to be a more cost-effective technique in comparison with ACDF. The lack of uniform literature impedes any solid conclusions to be drawn. There is a need for high-quality cost-effectiveness research and uniformity in the conduct, design and reporting of economic evaluations concerning the treatment of CDDD. TRIAL REGISTRATION PROSPERO Registration: CRD42020207553 (04.10.2020).
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Affiliation(s)
- V N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - A Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - A F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - O Zarrouk
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - S M M Hermans
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - R Droeghaag
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - I Curfs
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - S M A A Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research, Focusing on Value-Based Care and Ageing and Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Center of Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - H van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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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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Carrera DA, Ricks CB. Catastrophic delayed cervical arthroplasty failure: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21731. [PMID: 36209405 PMCID: PMC9379625 DOI: 10.3171/case21731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease. While more studies have suggested favorability of CDR over fusion procedures, limited data exist regarding implant fatigability. Here, the authors present a unique and previously unreported failure of the M6-C prosthesis causing spinal cord injury. OBSERVATIONS A 49-year-old female with history of cervical degenerative disease and prior C4–7 M6-C arthroplasty presented 9 years later after a minor fall from standing. She endorsed bilateral hand numbness ascending to forearms and shoulders, with dysesthesias and weakness. Imaging showed fractured arthroplasty penetrating the spinal cord. Revision surgery found a ruptured arthroplasty annulus with metal piece piercing the spinal cord. Partial C4 and C5 corpectomy was performed to remove the integrated fins of the arthroplasty and inspect the cord and dura. This was reconstructed with a corpectomy cage and plate. The patient made an excellent recovery, with improvement in her weakness and resolution of her sensory symptoms. LESSONS Possibility of fatigue-related failures presenting years after implantation have only been infrequently reported but can be catastrophic for patients. The authors encourage further discussions in this area, increased counseling with patients, and recommend a patient registry to better document adverse events.
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Affiliation(s)
- Diego A. Carrera
- Department of Neurological Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Christian B. Ricks
- Department of Neurological Surgery, University of New Mexico, Albuquerque, New Mexico
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Zavras AG, Sullivan TB, Singh K, Phillips FM, Colman MW. Failure in cervical total disc arthroplasty: single institution experience, systematic review of the literature, and proposal of the RUSH TDA failure classification system. Spine J 2022; 22:353-369. [PMID: 34419625 DOI: 10.1016/j.spinee.2021.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving motion of the spinal unit and decreasing the risk for degenerative changes at adjacent segments. However, due to its more recent introduction in clinical practice and low complication rates, the modes by which TDA may fail remain to be described. PURPOSE This study sought to identify the modes and frequencies of cervical TDA failure in order to propose a novel classification system. STUDY DESIGN Retrospective cohort and systematic review. PATIENT SAMPLE Patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution and in the literature of medium and large prospective studies. OUTCOME MEASURES Cervical TDA failure, defined as subsequent surgical intervention at the index segment. METHODS This study retrospectively reviewed patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution to identify the potential implant failure modes. A systematic review and meta-analysis of prospective data in the literature was then performed to further supplement failure mode identification and to describe the rates at which the various failure types occurred. Statistical analysis included between-group comparisons of Non-Failed and Failed patients and frequencies of each failure type among Failed patients. RESULTS A retrospective review at our institution of 169 patients (201 levels) identified eight failures, for a failure rate of 4.7%. Additionally, seven patients were revised who had the primary surgery at an outside institution. The systematic review of 3976 patients (4525 levels) identified 165 (4.1%) additional failures. Using this data, six primary failure types were classified, with several subtypes. These include recurrent or persistent index-level stenosis (Type I); migration (Type II) presenting as gross extrusion (A) or endplate failure with subsidence/acute fracture (B); instability (Type III) due to mechanical loosening (A), septic loosening (B), or device fracture (C); device motion loss (Type IV) such as "locking" of the device in kyphosis; implantation error (Type V) due to malposition (A) or improper sizing (B); and wear (Type VI) either without osteolysis (A) or with wear-particle-induced osteolysis (B). Stenosis (Type I) was the most common mode of failure found both through retrospective review and in the literature. CONCLUSIONS Cervical TDA fails through six primary mechanisms. While rates of certain failures requiring subsequent surgical intervention are low, it is possible that these complications may become more prevalent upon further longitudinal observation. Thus, future application and validation of this classification system is warranted to evaluate how failure frequencies change over time and with larger patient samples.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Thomas Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA.
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Shin JJ, Kim KR, Son DW, Shin DA, Yi S, Kim KN, Yoon DH, Ha Y. Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty. Yonsei Med J 2022; 63:72-81. [PMID: 34913286 PMCID: PMC8688375 DOI: 10.3349/ymj.2022.63.1.72] [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: 04/07/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty. MATERIALS AND METHODS A total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up. RESULTS The mean follow-up period was 38 months (range, 25-114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis. CONCLUSION CDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Yongin, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do-Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Korea.
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Goedmakers CMW, Bartels RHMA, Donk RD, Arts MP, van Zwet EW, Vleggeert-Lankamp CLA. The Clinical Relevance of the Cervical Disc Prosthesis: Combining Clinical Results of Two RCTs. Spine (Phila Pa 1976) 2022; 47:67-75. [PMID: 34474447 DOI: 10.1097/brs.0000000000004113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis was performed on data from 251 patients that were included in two randomized, double-blinded clinical trials comparing clinical results of anterior cervical discectomy and arthroplasty (ACDA) to anterior cervical discectomy and fusion (ACDF), and anterior cervical discectomy (ACD), for single-level disc herniation. OBJECTIVE This study aimed to investigate whether the ACDA procedure offers superior clinical results 2 years after surgery, to either ACDF or ACD without instrumentation, in the entire group of patients or in a particular subgroup of patients. SUMMARY OF BACKGROUND DATA The cervical disc prosthesis was introduced to provide superior clinical outcomes after ACD. METHODS Neck Disability Index (NDI), and subscales of the 36-item short-form health survey (SF-36) and McGill pain score were collected at baseline, 1 year and 2 years after surgery. Reoperations and complications were also evaluated. A preliminary subgroup analysis was performed for age, disc height, body mass index (BMI), smoking, and sex. RESULTS The NDI decreased comparably in all treatment arms to circa 50% of the baseline value and marginal mean NDI differences varied from 0.4 to 1.1 on a 100 point NDI scale, with confidence intervals never exceeding the 20-point minimal clinical important difference (MCID). Secondary outcome parameters showed comparable results. Preliminary subgroup analysis could not demonstrate clinically relevant differences in NDI between treatments after 2 years. CONCLUSION After combining data from two Randomized Controlled Trials it can be concluded that there is no clinical benefit for ACDA, when compared with ACDF or ACD 2 years after surgery. Preliminary subgroup analysis indicated outcomes were similar between treatment groups, and that no subgroup could be appointed that benefited more from either ACD, ACDF, or ACDA.Level of Evidence: 1.
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Affiliation(s)
- Caroline M W Goedmakers
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roland D Donk
- Department of Orthopaedics, Via Sana Clinics, Nijmegen, the Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Chin KR, Gohel NN, Aloise DM, Seale JA, Pandey DK, Pencle FJ. Effectiveness of a Fully Impregnated Hydroxyapatite Polyetheretherketone Cage on Fusion in Anterior Cervical Spine Surgery. Cureus 2021; 13:e17457. [PMID: 34603859 PMCID: PMC8475745 DOI: 10.7759/cureus.17457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Anterior cervical discectomy and fusion (ACDF) is the gold standard for the treatment of cervical spondylosis. However, new techniques, technologies, and improved implants have aided surgeons in reducing operative time with enhanced patient outcomes. Impregnated hydroxyapatite polyetheretherketone (HA PEEK) cages (Arena-C HA®, LESspine Inc. Malden, MA) are one such option that has aimed to increase the fusion rate. The authors herein aimed to assess the use of HA PEEK interbody cages by looking at outcomes, complications, and radiographic fusion. Methods The medical records of 41 consecutive patients undergoing single-level ACDF with impregnated HA PEEK cages (group 1) were compared to the control group of 47 patients who had single-level ACDF without impregnated HA PEEK cages (group 2). Outcomes assessed included Visual Analog Scale (VAS) neck, Neck Disability Index (NDI) scores, radiographic fusion, and complication rates. Results Of the 41 patients in group 1 (HA PEEK), 48% were female population with a mean age of 58.5+/- 1.7 years and BMI 29.7+/-1.2 kg/m2. Of the 47 patients in group 2 (non-HA PEEK), 53% were female with a mean age of 54.3+/- 1.2 years and BMI 27.8+/-0.8 kg/m2. Using t-test, there was a statistically significant intergroup difference in two-year VAS neck and NDI scores, p=0.007, and p=0.001, respectively. Radiographic fusion occurred as early as three months in the HA PEEK group. Conclusions This study has demonstrated the equivalence of impregnated HA PEEK cages in single-level ACDF. Significant improvements were seen in VAS and NDI scores in the HA PEEK group. There was no incidence of heterotopic bone formation or reaction to HA PEEK cages. Additionally, a trend toward fusion was seen in HA PEEK patients as early as three to five months compared to seven to eight months for the ACDF group. We conclude that HA PEEK cages can be safely placed with excellent outcomes. However, further studies are required to look at added benefits.
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Affiliation(s)
- Kingsley R Chin
- Orthopedics, Florida International University, Miami, USA.,Orthopedics, Less Exposure Surgery (LES) Clinic, Hollywood, USA.,Faculty of Science and Sports, University of Technology, Kingston, JAM
| | - Nishant N Gohel
- Orthopedic Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Daniel M Aloise
- Orthopedics, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Jason A Seale
- Orthopedics, Less Exposure Surgery (LES) Clinic, Hollywood, USA
| | - Deepak K Pandey
- Orthopedics, Less Exposure Surgery (LES) Society, Hollywood, USA
| | - Fabio J Pencle
- Faculty of Science and Sports, University of Technology, Kingston, JAM.,Orthopedics, Less Exposure Surgery (LES) Society, Hollywood, USA
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38
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Goedmakers CMW, Lak AM, Duey AH, Senko AW, Arnaout O, Groff MW, Smith TR, Vleggeert-Lankamp CLA, Zaidi HA, Rana A, Boaro A. Deep Learning for Adjacent Segment Disease at Preoperative MRI for Cervical Radiculopathy. Radiology 2021; 301:664-671. [PMID: 34546126 DOI: 10.1148/radiol.2021204731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Patients who undergo surgery for cervical radiculopathy are at risk for developing adjacent segment disease (ASD). Identifying patients who will develop ASD remains challenging for clinicians. Purpose To develop and validate a deep learning algorithm capable of predicting ASD by using only preoperative cervical MRI in patients undergoing single-level anterior cervical diskectomy and fusion (ACDF). Materials and Methods In this Health Insurance Portability and Accountability Act-compliant study, retrospective chart review was performed for 1244 patients undergoing single-level ACDF in two tertiary care centers. After application of inclusion and exclusion criteria, 344 patients were included, of whom 60% (n = 208) were used for training and 40% for validation (n = 43) and testing (n = 93). A deep learning-based prediction model with 48 convolutional layers was designed and trained by using preoperative T2-sagittal cervical MRI. To validate model performance, a neuroradiologist and neurosurgeon independently provided ASD predictions for the test set. Validation metrics included accuracy, areas under the curve, and F1 scores. The difference in proportion of wrongful predictions between the model and clinician was statistically tested by using the McNemar test. Results A total of 344 patients (median age, 48 years; interquartile range, 41-58 years; 182 women) were evaluated. The model predicted ASD on the 93 test images with an accuracy of 88 of 93 (95%; 95% CI: 90, 99), sensitivity of 12 of 15 (80%; 95% CI: 60, 100), and specificity of 76 of 78 (97%; 95% CI: 94, 100). The neuroradiologist and neurosurgeon provided predictions with lower accuracy (54 of 93; 58%; 95% CI: 48, 68), sensitivity (nine of 15; 60%; 95% CI: 35, 85), and specificity (45 of 78; 58%; 95% CI: 56, 77) compared with the algorithm. The McNemar test on the contingency table demonstrated that the proportion of wrongful predictions was significantly lower by the model (test statistic, 2.000; P < .001). Conclusion A deep learning algorithm that used only preoperative cervical T2-weighted MRI outperformed clinical experts at predicting adjacent segment disease in patients undergoing surgery for cervical radiculopathy. © RSNA, 2021 An earlier incorrect version appeared online. This article was corrected on September 22, 2021.
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Affiliation(s)
- Caroline M W Goedmakers
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Asad M Lak
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Akiro H Duey
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Alexander W Senko
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Omar Arnaout
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Michael W Groff
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Timothy R Smith
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Carmen L A Vleggeert-Lankamp
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Hasan A Zaidi
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Aakanksha Rana
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Alessandro Boaro
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
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Abstract
The first US Food and Drug Administration (FDA) approval for cervical total disc replacement (CTDR) was issued in 2007. Since then, 8 more artificial discs have been granted FDA approval for single-level CTDR. Two of these have also been approved for 2-level CTDR. All devices are indicated for levels C3 to C7 for symptomatic patients with radiculopathy or myelopathy caused by disc herniation or spondylosis unresponsive to conservative management. Trials have shown noninferiority of CTDR compared with anterior cervical decompression and fusion in their overall success. Hybrid surgery and CTDR of 3 or more levels are not FDA approved.
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Nunley P, Schouwen KFV, Stone M. Cervical Total Disc Replacement: Indications and Technique. Neurosurg Clin N Am 2021; 32:419-424. [PMID: 34538468 DOI: 10.1016/j.nec.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cervical total disc replacement devices have been marketed in the United States (US) since 2007, with abundant level 1 evidence published on the treatment. Adherence to the strict inclusion/exclusion criteria and the surgical technique training of the US clinical trials remains the consistent and conservative approach to patient selection and implantation technique. However, patient selection and surgical technique remain debated among US surgeons as the published data and available cervical total disc replacements continue to grow.
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Affiliation(s)
- Pierce Nunley
- Spine Institute of Louisiana, 1500 Line Avenue, Suite 200, Shreveport, LA 71101, USA.
| | | | - Marcus Stone
- Spine Institute of Louisiana, 1500 Line Avenue, Suite 200, Shreveport, LA 71101, USA
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Shin JJ, Kim KR, Son DW, Shin DA, Yi S, Kim KN, Yoon DH, Ha Y, Riew KD. Cervical disc arthroplasty: What we know in 2020 and a literature review. J Orthop Surg (Hong Kong) 2021; 29:23094990211006934. [PMID: 34581615 DOI: 10.1177/23094990211006934] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA's two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, 37991Yonsei University School of Medicine, Yongin, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, International St Mary's Hospital, 54671Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, 194197Pusan National University Yangsan Hospital, School of Medicine, Yangsan, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Do-Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea.,POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - K Daniel Riew
- Department of Orthopedic Surgery, 5798Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Ku J, Ku J, Chang HK, Wu JC. Cervical disc arthroplasty at C2–3: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21320. [PMID: 36131581 PMCID: PMC9563647 DOI: 10.3171/case21320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation.
OBSERVATIONS
In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level.
LESSONS
To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.
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Affiliation(s)
- Jason Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Johnson Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Department of Biomedical Imaging and Radiological Sciences, and
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Kim K, Hoffman G, Bae H, Redmond A, Hisey M, Nunley P, Jackson R, Tahernia D, Araghi A. Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial. Neurosurgery 2021; 88:497-505. [PMID: 33372218 DOI: 10.1093/neuros/nyaa459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.
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Affiliation(s)
- Kee Kim
- Department of Neurological Surgery, UC Davis Health, Sacramento, California
| | | | - Hyun Bae
- The Spine Institute, Santa Monica, California
| | | | | | | | - Robert Jackson
- Orange County Neurosurgical Associates, Laguna Hills, California
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Choi H, Purushothaman Y, Baisden JL, Rajasekaran D, Jebaseelan D, Yoganandan N. Comparative Finite Element Modeling Study of Anterior Cervical Arthrodesis Versus Cervical Arthroplasty With Bryan Disc or Prodisc C. Mil Med 2021; 186:737-744. [PMID: 33499493 DOI: 10.1093/milmed/usaa378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/04/2020] [Accepted: 12/15/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Cervical disc arthroplasty (CDA), a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), is used in military patients for the treatment of disorders such as spondylosis. Since 2007, the FDA has approved eight artificial discs. The objective of this study is to compare the biomechanics after ACDF and CDA with two FDA-approved devices of differing designs under head and head supported mass loadings. MATERIALS AND METHODS A previously validated osteoligamentous C2-T1 finite element model was used to simulate ACDF and two types of CDA (Bryan and Prodisc C) at the C5-C6 level. The hybrid loading protocol associated with in vivo head and head supported mass was used to apply flexion and extension loading. First, intact spine was subjected to 2 Nm of flexion extension and the range of motion (ROM) was measured. Next, for each surgical option, flexion-extension moments duplicating the same ROM as the intact spine were determined. Under these surgery-specific moments, ROM and facet force were obtained at the index level, and ROM, facet force, and intradiscal pressure at the rostral and caudal adjacent levels. RESULTS ACDF led to increased motion, force and pressures at the adjacent levels. Prodisc C led to increased motion and facet force at the index level, and decreased motion, facet force, and intradiscal pressure at both adjacent levels. Bryan produced less dramatic biomechanical alterations compared with ACDF and Prodisc C. Numerical results are given in the article. CONCLUSIONS Recognizing that ROM is a clinical measure of spine stability/performance, CDA demonstrates a more physiological biomechanical response than ACDF, although the exact pattern depends on the implant design. Anterior and posterior column load-sharing patterns were different between the two implants and may affect implant selection based on the anatomical and pathological state at the index and adjacent levels.
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Affiliation(s)
- Hoon Choi
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Yuvaraj Purushothaman
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- School of Mechanical Engineering, Vellore Institute of Technology, Chennai Campus, Chennai, Tamil Nadu 600127, India
| | - Jamie L Baisden
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Deepak Rajasekaran
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Davidson Jebaseelan
- School of Mechanical Engineering, Vellore Institute of Technology, Chennai Campus, Chennai, Tamil Nadu 600127, India
| | - Narayan Yoganandan
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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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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TO THE EDITOR. Spine (Phila Pa 1976) 2021; 46:E354-E355. [PMID: 33315780 DOI: 10.1097/brs.0000000000003878] [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: 02/05/2023]
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Schroeder GD, Vaccaro AR, Divi SN, Reyes AA, Goyal DKC, Phillips FM, Zigler J. 2021 Position Statement From the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement. Int J Spine Surg 2021; 15:37-46. [PMID: 33900955 DOI: 10.14444/8004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ariana A Reyes
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dhruv K C Goyal
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Frank M Phillips
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Are Industry-funded Studies of Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion Biased? Clin Spine Surg 2021; 34:1-3. [PMID: 32049677 DOI: 10.1097/bsd.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
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49
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Virk S, Phillips F, Khan S, Qureshi S. A cross-sectional analysis of 1347 complications for cervical disc replacements from medical device reports maintained by the United States Food and Drug Administration. Spine J 2021; 21:265-272. [PMID: 32966907 DOI: 10.1016/j.spinee.2020.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc replacement (CDR) has increased in popularity over the past decade based on published outcomes from FDA IDE studies with narrowly defined inclusion and exclusion criteria. A low rate of complications was noted in these studies. The broader complication profile for CDR in widespread clinical practice has yet to be described. PURPOSE To outline the complications reported to the FDA regarding commonly used CDR products STUDY DESIGN/SETTING: Retrospective database review PATIENT SAMPLE: Nationwide database of reported complications related to CDR products from patients across the country OUTCOME MEASURES: Complications related to CDR METHODS: We queried the MAUDE database and Alternative Summary Reporting (ASR) data files submitted between January 2005 to March 2020. The complications listed for seven FDA-approved CDR implants were analyzed. The entries in the databases were cataloged for complication type, date of entry, source of report, and whether the investigation was "complete". Reports that had too little information to extract relevant data were excluded. RESULTS There were 1,517 entries identified in the MAUDE database. After removal of duplicate entries and entries without sufficient information, there were 1,347 entries analyzed. The top five complications were (1) migration of implant (338 entries, 25.2%) (2) insertion problem/failure (312 entries, 23.3%) (3) neck pain (203 entries, 15.2%) (4) heterotopic ossification (108 entries, 8.1%) and (5) radiculopathy (90 entries, 8.1%). The number of analyzed implant-related MAUDE entries and most common implant-related complication for each implant was 209 entries for insertion problem/failure for Mobi-C; 158 entries for migration of implant for ProDisc-C; 154 entries for insertion problem/failure for Bryan cervical disc; 130 entries for migration of implant for Prestige cervical disc; 49 entries for migration of implant for PCM cervical disc; 12 entries for migration of implant for M6 and 10 entries for migration of implant for Secure-C. Only 263 entries (19.5%) were deemed "complete". Most entries were from the manufacturer/company representative/distributor (923 entries, 70%). There were no entries related to cervical disc replacement devices within the ASR data. CONCLUSIONS The MAUDE database highlights complications related to CDR implants that may not be emphasized in currently published studies. It is important to understand this broad complication profile for CDR to ensure safe utilization of this new technology.
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Affiliation(s)
- Sohrab Virk
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY, USA; Northwell Health, Department of Orthopedic Surgery, Great Neck, NY.
| | - Frank Phillips
- Department of Orthopedic Surgery, Rush University, Chicago, IL, USA
| | - Safdar Khan
- Department of Orthopedic Surgery, Ohio State University, Columbus, OH, USA
| | - Sheeraz Qureshi
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY, USA
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Efficacy and Safety of Total Disc Replacement compared with Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Disease: A Meta-analysis. Spine (Phila Pa 1976) 2020; 45:1419-1425. [PMID: 32453243 DOI: 10.1097/brs.0000000000003569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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