1
|
Lazaro-Pacheco D, Mohseni M, Rudd S, Cooper-White J, Holsgrove TP. The role of biomechanical factors in models of intervertebral disc degeneration across multiple length scales. APL Bioeng 2023; 7:021501. [PMID: 37180733 PMCID: PMC10168717 DOI: 10.1063/5.0137698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
Low back pain is the leading cause of disability, producing a substantial socio-economic burden on healthcare systems worldwide. Intervertebral disc (IVD) degeneration is a primary cause of lower back pain, and while regenerative therapies aimed at full functional recovery of the disc have been developed in recent years, no commercially available, approved devices or therapies for the regeneration of the IVD currently exist. In the development of these new approaches, numerous models for mechanical stimulation and preclinical assessment, including in vitro cell studies using microfluidics, ex vivo organ studies coupled with bioreactors and mechanical testing rigs, and in vivo testing in a variety of large and small animals, have emerged. These approaches have provided different capabilities, certainly improving the preclinical evaluation of these regenerative therapies, but challenges within the research environment, and compromises relating to non-representative mechanical stimulation and unrealistic test conditions, remain to be resolved. In this review, insights into the ideal characteristics of a disc model for the testing of IVD regenerative approaches are first assessed. Key learnings from in vivo, ex vivo, and in vitro IVD models under mechanical loading stimulation to date are presented alongside the merits and limitations of each model based on the physiological resemblance to the human IVD environment (biological and mechanical) as well as the possible feedback and output measurements for each approach. When moving from simplified in vitro models to ex vivo and in vivo approaches, the complexity increases resulting in less controllable models but providing a better representation of the physiological environment. Although cost, time, and ethical constraints are dependent on each approach, they escalate with the model complexity. These constraints are discussed and weighted as part of the characteristics of each model.
Collapse
Affiliation(s)
- Daniela Lazaro-Pacheco
- Department of Engineering, University of Exeter, Harrison Building, Streatham Campus, North Park Road, Exeter EX4 4QF, United Kingdom
| | - Mina Mohseni
- School of Chemical Engineering, The University of Queensland, St. Lucia QLD 4072, Australia
| | - Samuel Rudd
- School of Chemical Engineering, The University of Queensland, St. Lucia QLD 4072, Australia
| | | | - Timothy Patrick Holsgrove
- Department of Engineering, University of Exeter, Harrison Building, Streatham Campus, North Park Road, Exeter EX4 4QF, United Kingdom
| |
Collapse
|
2
|
Astur N, Martins DE, Kanas M, Mendonça RGMD, Creek AT, Lenza M, Wajchenberg M. Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview. EINSTEIN-SAO PAULO 2022; 20:eAO6567. [PMID: 35476082 PMCID: PMC9000984 DOI: 10.31744/einstein_journal/2022ao6567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. Methods A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. Results A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. Conclusion Systematic reviews of surgical treatment of cervical degenerative diseases present “fair” to “good” quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.
Collapse
|
3
|
Gornet MF, Schranck FW, Sorensen KM, Copay AG. Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels. Int J Spine Surg 2020; 14:S41-S49. [PMID: 32994305 DOI: 10.14444/7090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1- and 2-level cervical pathology, with established long-term safety and effectiveness. Limited evidence exists for CDA at more than 2 levels. This study investigates the long-term outcomes of 3- and 4-level CDA out to 7 years. METHODS In a retrospective review of prospectively collected data, patient demographics and surgical characteristics were collected. Patient-reported outcomes (PROs) were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and annually thereafter, including: Neck Disability Index (NDI), numeric rating scales for neck pain and arm pain, the Veterans Rand 12-item Health Survey physical component summary (PCS) score and mental component summary (MCS) score, and patient satisfaction scores. Secondary surgery data were also collected. Predictive methods using mixed-effects regression models were used to analyze the data. RESULTS Data for 139 CDAs were available for evaluation (n = 116 three-level and n = 23 four-level). Statistical improvement was shown for all PRO scores at all postoperative intervals (P < .001). From preoperatively to 7 years postoperatively, mean NDI decreased from 57.9 to 31.3 (45.9% improvement), mean neck pain decreased from 15.6 to 7.9 (49.4% improvement), mean arm pain decreased from 12.2 to 5.6 (54.1% improvement), mean PCS increased from 29.2 to 41.4 (41.8% improvement), and mean MCS increased from 37.1 to 44.5 (19.9% improvement). Five (3.6%) 3-level patients underwent secondary surgery. Patient satisfaction exceeded 88% 7 years after surgery. CONCLUSION Statistical improvement in PROs, with a low rate of secondary surgeries out to 7 years, demonstrates that 3- and 4-level CDA may be performed safely and effectively in appropriately selected patients. LEVEL OF EVIDENCE 4.
Collapse
|
4
|
Abstract
BACKGROUND Although extensive reports of clinical outcome after cervical disc replacement (CDR) and anterior cervical discectomy and fusion exist, few reviews of the cost-effectiveness research in cervical spine surgery exist. The purpose of this study was to review the concepts of cost-effectiveness research, the various approaches to cost-effectiveness studies in the context of cervical spine surgery, and some of the literature results. METHODS Review article describing cost-effectiveness research concepts, methodology, and results. The article reviews the concept of value, cost, utility, incremental cost-effectiveness ratio, and recent research. RESULTS Mixed data on cost-effectiveness of CDR compared with fusion exist. Notably, several studies performed within the last 5 years that use prospectively collected utility scores, costs, and adverse event calculations demonstrate a significant cost savings associated with CDR compared with fusion. CONCLUSIONS The recent literature confirms that, in properly selected patients, CDR is more effective and less costly over a 7-year time horizon for patients with symptomatic degenerative disc disease. The primary driver of the differential in cost effectiveness is the difference in secondary surgery rates. LEVEL OF EVIDENCE Level 5 CLINICAL RELEVANCE: In properly selected patients, CDR is more effective and less costly over a 7-year time horizon for patients with symptomatic degenerative disc disease.
Collapse
Affiliation(s)
- Kris Radcliff
- Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Egg Harbor Township, New Jersey
| | - Richard D Guyer
- Texas Back Institute Research Foundation, Texas Back Institute, Plano, Texas
| |
Collapse
|
5
|
Singh V, Skipor AK, Selim AA, Jacobs JJ. Chromium and Nickel Concentrations in Subjects with a Stainless Steel Metal-on-Metal Cervical Disc Arthroplasty: Results from a Prospective Longitudinal Study with 7 Years Follow-Up. Int J Spine Surg 2018; 12:460-468. [PMID: 30276106 DOI: 10.14444/5055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion for degenerative cervical disc disease. The artificial discs provide intervertebral motion using multicomponent articulation and thus tend to generate particulate debris and soluble metal ions. Limited information is available on the long-term metal concentrations and associated systemic adverse events observed in metal-on-metal CDA. Serum chromium (Cr) and nickel (Ni) concentrations were assessed in patients implanted with ball-in-trough stainless steel-based cervical disc through 7 years. Methods A prospective, nonrandomized longitudinal study was conducted that included 25 patients following rigorous exclusion criteria that included no previous permanent metal implants and no professional exposure to metal particles. Blood serum Cr and Ni concentrations were assayed preoperatively and at 3, 6, 12, 24, 36, 60, and 84 months postoperatively using high-resolution inductively coupled plasma-mass spectrometry. Longitudinal statistical comparisons were made using the Friedman test with statistical significance at P < .05. Results Median serum concentrations determined preoperatively and at 3, 6, 12, 24, 36, 60, and 84 months postoperatively were 0.074, 0.106, 0.132, 0.170, 0.172, 0.274, 0.192, and 0.203 ng/mL for Cr and 0.085, 0.178, 0.222, 0.175, 0.205, 0.284, 0.181, and 0.194 ng/mL for Ni. The serum Cr concentrations were statistically higher for all postoperative time periods compared to preoperative concentration (Friedman P <.01), whereas serum Ni concentration was statistically higher at the 84-month postoperative time period than the preoperative concentration (Friedman P <.01) and then the concentration at 3, 12, 24, and 60 months postoperatively (Friedman P < .03). Conclusions The Cr concentrations detected at all postoperative times were statistically higher than preoperative concentrations, whereas Ni concentration was statistically higher than the preoperative concentration only at 84 months.
Collapse
Affiliation(s)
| | - Anastasia K Skipor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Joshua J Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
6
|
Xu S, Liang Y, Zhu Z, Qian Y, Liu H. Adjacent segment degeneration or disease after cervical total disc replacement: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2018; 13:244. [PMID: 30285807 PMCID: PMC6169069 DOI: 10.1186/s13018-018-0940-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical total disc replacement (TDR) could reduce the stress of adjacent segments and retard ASD in theory, but the superiority has not been determined yet. This analysis aimed that whether TDR was superior to ACDF for decreasing adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). METHODS A meta-analysis was performed according to the guidelines of the Cochrane Collaboration with PubMed, EMBASE, Cochrane Library and CBM (China Biological Medicine) databases. It included randomized controlled trials (RCTs) that reported ASDeg, ASDis, and reoperation on adjacent segments after TDR and ACDF. Two investigators independently selected trials, assessed methodological quality, and evaluated the quality of this meta-analysis using the grades of recommendation, assessment, development, and evaluation (GRADE) approach. RESULTS Eleven studies with 2632 patients were included in the meta-analysis. The overall rate of ASD in TDR group was lower than ACDF group (OR = 0.6; 95% CI [0.38, 0.73]; P < 0.00001). Both the incidence of ASDeg and the reoperation rate were statistically lower in the TDR group than in the ACDF group (OR = 0.58, P < 0.00001; OR = 0.52, P = 0.01, respectively). Subgroup analysis was performed according to the follow-up time and trial site; the rate of ASDeg was lower in patients underwent TDR no matter the follow-up time, and TDR tended to increase the superiority across time. The rate of ASDeg was also lower with TDR both in the USA and China (P < 0.0001, P = 0.03, respectively). But the cost-effectiveness result might be prone to neither of the two surgery approaches. According to GRADE, the overall quality of this meta-analysis was moderate. CONCLUSIONS TDR decreased the rates of ASDeg and reoperation compared with that of ACDF, and the superiority may become more apparent over time. We cautiously and slightly suggest adopting TDR according to the GRADE but may not believe it excessively.
Collapse
Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, People's Republic of China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, People's Republic of China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, People's Republic of China
| | - Yalong Qian
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, People's Republic of China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, People's Republic of China.
| |
Collapse
|
7
|
Donk RD, Verbeek ALM, Verhagen WIM, Groenewoud H, Hosman AJF, Bartels RHMA. What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial. PLoS One 2017; 12:e0183603. [PMID: 28850600 PMCID: PMC5574537 DOI: 10.1371/journal.pone.0183603] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. Methods A randomized controlled trial is reported with 9 years follow up comparing anterior cervical anterior discectomy without fusion, with fusion by cage standalone, or with disc prosthesis. Patients suffering from symptomatic cervical disk degeneration at one level referred to spinal sections of department of neurosurgery or orthopedic surgery of a large general hospital with educational facilities were eligible. Neck Disability Index (NDI), McGill Pain Questionnaire Dutch language version (MPQ-DLV), physical-component summary (PCS), and mental-component summary (MCS) of the 36-item Short-Form Health Survey (SF-36), and re operation rate were evaluated. Findings 142 patients between 18 and 55 years were allocated. The median follow-up was 8.9±1.9 years (5.6 to 12.2 years). The response rate at last follow-up was 98.5%. NDI at the last follow-up did not differ between the three treatment groups, nor did the secondary outcomes as MPQ-DLV and PCS or MCS from SF-36. The major improvement occurred within the first 6 weeks after surgery. Afterward, it remained stable. Eleven patients underwent surgery for recurrent symptoms and signs due to nerve root compression at the index or adjacent level. Conclusions This randomized trial could not detect a difference between three surgical modalities for treating a single-level degenerative disk disease. Anterior cervical discectomy without implant seems to be similar to anterior cervical discectomy with fusion by cage stand-alone or with disk prosthesis. Due to the small study sample size, this statement should be considered as inconclusive so far. Trial registration ISRCTN41681847
Collapse
Affiliation(s)
- Roland D. Donk
- Via Sana Clinics, Department of Orthopedic Surgery, Mill, the Netherlands
| | - André L. M. Verbeek
- Radboud university medical center, Department for Health Evidence, Nijmegen, the Netherlands
| | - Wim I. M. Verhagen
- Canisius Wilhelmina Hospital, Department of Neurology, Nijmegen, the Netherlands
| | - Hans Groenewoud
- Radboud university medical center, Department for Health Evidence, Nijmegen, the Netherlands
| | - Allard J. F. Hosman
- Radboud university medical center, Department of Orthopedic Surgery, Nijmegen, the Netherlands
| | - Ronald H. M. A. Bartels
- Radboud university medical center, Department of Neurosurgery, Nijmegen, the Netherlands
- Canisius Wilhelmina Hospital, Department of Neurosurgery, Nijmegen, the Netherlands
- * E-mail:
| |
Collapse
|
8
|
Serum Metal Concentrations in Patients With Titanium Ceramic Composite Cervical Disc Replacements. Spine (Phila Pa 1976) 2017; 42:366-371. [PMID: 27323223 DOI: 10.1097/brs.0000000000001745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE The serum titanium (Ti) concentrations were examined in patients implanted with a PRESTIGE LP Cervical Disc System (Medtronic, Inc., Memphis, TN). The metal-on-metal disc with ball-in-trough articulation is made of titanium alloy/titanium carbide composite (Ti-6Al-4 V/TiC). SUMMARY OF BACKGROUND DATA Cervical disc arthroplasty provides a motion-preserving treatment alternative to anterior cervical discectomy and fusion for degenerative cervical disc disease. The articulating surfaces have a tendency to generate in vivo wear in the form of insoluble particulates (debris) and soluble metal ions. Not much information is available on the long-term metal concentrations observed in cervical disc arthroplasty and how these compare with the metal concentrations in Ti-based posterior fixation devices and other joint replacement implants. METHODS Thirty patients were enrolled after strict exclusion criteria that included no previous permanent metal implants and no professional exposure to metal particles. High-resolution inductively coupled plasma-mass spectrometry was used to assay blood serum titanium concentrations preoperatively and at 3, 6, 12, 24, 36, 60, and 84 months after surgery. The detection limit for Ti was 0.2 ng/mL. The Friedman test was used to make longitudinal statistical comparisons. RESULTS The median serum Ti concentrations determined preoperatively, and at 3, 6, 12, 24, 36, 60, and 84 months were 0.10, 1.22, 1.15, 1.27, 1.21, 1.46, 1.34, and 1.42 ng/mL, respectively. The serum Ti concentrations at all postoperative time points were significantly higher than that at the preoperative time point (Friedman P < 0.01). CONCLUSION The long-term postoperative serum Ti concentrations were significantly higher than the preoperative concentrations. The observed serum Ti concentrations in this study are lower than the reported concentrations in patients receiving posterior spinal instrumentation and metal or ceramic-on-polyethylene hip prostheses with Ti-alloy based stems and acetabular components. LEVEL OF EVIDENCE 3.
Collapse
|
9
|
Boselie TFM, van Santbrink H. Arthroplasty in cervical degenerative disc disease: fulfilling its long-term promise? JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 2:359-361. [PMID: 28097260 PMCID: PMC5233857 DOI: 10.21037/jss.2016.12.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Toon F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center, the Netherlands
| | - Henk van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center, the Netherlands
| |
Collapse
|
10
|
Radcliff K, Coric D, Albert T. Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial. J Neurosurg Spine 2016; 25:213-24. [DOI: 10.3171/2015.12.spine15824] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The purpose of this study was to report the outcome of a study of 2-level cervical total disc replacement (Mobi-C) versus anterior cervical discectomy and fusion (ACDF). Although the long-term outcome of single-level disc replacement has been extensively described, there have not been previous reports of the 5-year outcome of 2-level cervical disc replacement.
METHODS
This study reports the 5-year results of a prospective, randomized US FDA investigational device exemption (IDE) study conducted at 24 centers in patients with 2-level, contiguous, cervical spondylosis. Clinical outcomes at up to 60 months were evaluated, including validated outcome measures, incidence of reoperation, and adverse events. The complete study data and methodology were critically reviewed by 3 independent surgeon authors without affiliation with the IDE study or financial or institutional bias toward the study sponsor.
RESULTS
A total of 225 patients received the Mobi-C cervical total disc replacement device and 105 patients received ACDF. The Mobi-C and ACDF follow-up rates were 90.7% and 86.7%, respectively (p = 0.39), at 60 months. There was significant improvement in all outcome scores relative to baseline at all time points. The Mobi-C patients had significantly more improvement than ACDF patients in terms of Neck Disability Index score, SF-12 Physical Component Summary, and overall satisfaction with treatment at 60 months. The reoperation rate was significantly lower with Mobi-C (4%) versus ACDF (16%). There were no significant differences in the adverse event rate between groups.
CONCLUSIONS
Both cervical total disc replacement and ACDF significantly improved general and disease-specific measures compared with baseline. However, there was significantly greater improvement in general and disease-specific outcome measures and a lower rate of reoperation in the 2-level disc replacement patients versus ACDF control patients.
Clinical trial registration no. NCT00389597 (clinicaltrials.gov)
Collapse
Affiliation(s)
- Kris Radcliff
- 1Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Egg Harbor, New Jersey
| | - Domagoj Coric
- 2Carolinas Medical Center, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; and
| | - Todd Albert
- 3Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| |
Collapse
|
11
|
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine the short-term clinical succesrate of the M6-C cervical disk prosthesis in primary and secondary surgery. SUMMARY OF BACKGROUND DATA Cervical disk arthroplasty (CDA) provides an alternative to anterior cervical decompression and fusion for the treatment of spondylotic radiculopathy or myelopathy. The prevention of adjacent segment disease (ASD), a possible complication of anterior cervical decompression and fusion, is its most cited--although unproven--benefit. Unlike older arthroplasty devices that rely on a ball-and-socket-type design, the M6-C cervical disk prosthesis represents a new generation of unconstrained implants, developed to achieve better restoration of natural segmental biomechanics. This device should therefore optimize clinical performance of CDA and reduce ASD. MATERIALS AND METHODS All patients had preoperative computed tomography or magnetic resonance imaging and postoperative x-rays. Clinical outcome was assessed using the Neck Disability Index, a Visual Analog Scale, and the SF-36 questionnaire. Patients were asked about overall satisfaction and whether they would have the surgery again. RESULTS Thirty-three patients were evaluated 17.1 months after surgery, on average. Nine patients had a history of cervical interventions. Results for Neck Disability Index, Visual Analog Scale, and SF-36 were significantly better among patients who had undergone primary surgery. In this group, 87.5% of patients reported a good or excellent result and 91.7% would have the procedure again. In contrast, all 4 device-related complications occurred in the small group of patients who had secondary surgery. CONCLUSIONS The M6-C prosthesis appears to be a valuable addition to the CDA armatorium. It generates very good results in patients undergoing primary surgery, although its use in secondary surgery should be avoided. Longer follow-up is needed to determine to what measure this device can prevent ASD.
Collapse
|
12
|
Radcliff K, Lerner J, Yang C, Bernard T, Zigler JE. Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies. J Neurosurg Spine 2016; 24:760-8. [PMID: 26824587 DOI: 10.3171/2015.10.spine15505] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the 7-year cost-effectiveness of cervical total disc replacement (CTDR) versus anterior cervical discectomy and fusion (ACDF) for the treatment of patients with single-level symptomatic degenerative disc disease. A change in the spending trajectory for spine care is to be achieved, in part, through the selection of interventions that have been proven effective yet cost less than other options. This analysis complements and builds upon findings from other cost-effectiveness evaluations of CTDR through the use of long-term, patient-level data from a randomized study. METHODS This was a 7-year health economic evaluation comparing CTDR versus ACDF from the US commercial payer perspective. Prospectively collected health care resource utilization and treatment effects (quality-adjusted life years [QALYs]) were obtained from individual patient-level adverse event reports and SF-36 data, respectively, from the randomized, multicenter ProDisc-C total disc replacement investigational device exemption (IDE) study and post-approval study. Statistical distributions for unit costs were derived from a commercial claims database and applied using Monte Carlo simulation. Patient-level costs and effects were modeled via multivariate probabilistic analysis. Confidence intervals for 7-year costs, effects, and net monetary benefit (NMB) were obtained using the nonparametric percentile method from results of 10,000 bootstrap simulations. The robustness of results was assessed through scenario analysis and within a parametric regression model controlling for baseline variables. RESULTS Seven-year follow-up data were available for more than 70% of the 209 randomized patients. In the base-case analysis, CTDR resulted in mean per-patient cost savings of $12,789 (95% CI $5362-$20,856) and per-patient QALY gains of 0.16 (95% CI -0.073 to 0.39) compared with ACDF over 7 years. CTDR was more effective and less costly in 90.8% of probabilistic simulations. CTDR was cost-effective in 99.8% of sensitivity analysis simulations and generated a mean incremental NMB of $20,679 (95% CI $6053-$35,377) per patient at a willingness-to-pay threshold of $50,000/QALY. CONCLUSIONS Based on this modeling evaluation, CTDR was found to be more effective and less costly over a 7-year time horizon for patients with single-level symptomatic degenerative disc disease. These results are robust across a range of scenarios and perspectives and are intended to support value-based decision making.
Collapse
Affiliation(s)
- Kris Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Egg Harbor Township, New Jersey
| | | | | | - Thierry Bernard
- Biostatistics and Data Management, DePuy Synthes Spine, West Chester, Pennsylvania; and
| | | |
Collapse
|
13
|
Lee SE, Jahng TA, Kim HJ. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26198705 DOI: 10.1007/s00586-015-4132-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. METHODS Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. RESULTS The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. CONCLUSION In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.
Collapse
Affiliation(s)
- Soo Eon Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, 463-707, Republic of Korea.
| | - Hyun Jib Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, 463-707, Republic of Korea
| |
Collapse
|
14
|
Boselie TFM, Willems PC, van Mameren H, de Bie R, Benzel EC, van Santbrink H. WITHDRAWN: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev 2015; 2015:CD009173. [PMID: 25994307 PMCID: PMC6457693 DOI: 10.1002/14651858.cd009173.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty over fusion, that is, the prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long‐term results become available, it is important to know whether results of one of the two treatments are superior to the other in the first one to two years. Objectives To assess the effects of arthroplasty versus fusion for radiculopathy or myelopathy, or both due to single level cervical degenerative disc disease. Search methods We searched the following databases for randomised controlled trials (RCTs): CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, and EBMR. Additionally, we searched the System for Information on Grey Literature (SIGLE), subheading Biological and Medical Sciences, the US Food and Drug Administration (FDA) database on medical devices, and Clinicaltrials.gov to identify trials in progress. We also screened the reference list of all selected papers. Date of search: 25 May 2011. Selection criteria We included RCTs that directly compared any type of cervical fusion with any type of arthroplasty, with at least one year of follow‐up. Primary outcomes were arm pain, neck pain, neck‐related functional status, patient satisfaction, neurological outcome, and global health status. Secondary outcomes were the presence of (radiological) fusion, revision surgery at the treated level, secondary surgery on adjacent levels, segmental mobility of treated and adjacent levels, and work status. Data collection and analysis Study selection was performed independently by three review authors, and 'Risk of bias' assessment and data extraction were performed by two review authors. In case of missing data or insufficient information for a judgement about risk of bias, we tried to contact the study authors or the study sponsor. The data were entered into RevMan by one review author and subsequently checked by a second review author. We assessed the quality of evidence using GRADE. We analysed heterogeneity and performed sensitivity analyses for the pooled analyses. Main results We included nine studies (2400 participants), five of which had a low risk of bias. Eight of these studies were industry sponsored. The most important results showed low‐quality evidence for a small but significant difference in alleviation of arm pain at one to two years in favour of arthroplasty (mean difference (MD) ‐1.54; 95% confidence interval (CI) ‐2.86 to ‐0.22; 100‐point scale). A small study effect could not be ruled out for this outcome in the sensitivity analyses. This means that smaller studies (or small published subsets of larger studies) showed larger differences for this outcome, which may indicate publication bias. Also, moderate‐quality evidence showed a small difference in neck‐related functional status at one to two years in favour of arthroplasty (MD ‐2.79; 95% CI ‐4.73 to ‐0.85; 100‐point scale) and a small difference in neurological outcome in favour of arthroplasty (risk ratio (RR) 1.05; 95% CI 1.01 to 1.09). These two outcomes were robust to sensitivity analyses. For none of the primary outcomes, was a clinically relevant difference shown. Additionally, there was high‐quality evidence for a large, statistically significant difference in segmental mobility at one to two years (measured as degrees segmental range of motion) at the treated level (MD 6.90; 95% CI 5.45 to 8.35). There was low‐quality evidence that there was no statistically significant difference in secondary surgery at the adjacent levels at one to two years (RR 0.60; 95% CI 0.35 to 1.02). The latter was not robust to sensitivity analyses. Authors' conclusions There was a tendency for clinical results to be in favour of arthroplasty; often these were statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. Significance was often gained or lost in the varying sensitivity analyses, probably owing to the relatively small number of studies, in combination with the small differences that were found. Given the fact that all of the included studies were not blinded, this could be due to patient or carer expectations. However, at this time both treatments can be seen as valid options with respect to results at a maximum of one to two years. Given the current absence of truly long‐term results, use of these mobile disc prostheses should still be limited to clinical trials. There was high‐quality evidence that the goal of preservation of segmental mobility in arthroplasty was met. A statistically significant effect on the incidence of secondary symptoms at adjacent levels, the primary goal of arthroplasty over fusion, was not found at one to two years. If there was a protective effect, this should become clearer over time. A future update, when studies with 'truly long‐term' results (five years or more) become available, should focus on this issue. A herniated disc in the neck often causes radiating pain, numbness, and weakness in muscles of the neck, shoulders, arms, and hands. It may also lead to symptoms in the trunk and legs. When there is no or insufficient relief of symptoms with non‐surgical treatment, surgery can be an option. Traditional 'fusion' surgery involves fusion of the two bones of the spine (the vertebrae) that form the disc space. Motion between these two vertebrae is then no longer possible. It has been suggested that this may cause the adjacent parts of the spine to become more mobile, as compensation. This in turn might accelerate normal wear and tear in these parts of the spine, which could lead to new symptoms. At present this is not confirmed. Mobile disc prostheses have been introduced in an effort to reduce the amount of new symptoms at the longer term after surgery by preserving motion between the vertebrae involved. Long‐term results are not available yet. However, it is important to know whether disc arthroplasty is at least as effective as fusion in relieving symptoms, the primary aim of surgery. In this review we have searched for all studies in which the patient receives one of these two possible treatments at random. We identified nine studies (2400 participants), and considered five of these to have high methodological quality. This review shows that patients who were treated with a mobile disc prosthesis had less pain radiating to the arm one to two years after surgery, and less disability owing to these complaints. However, the actual differences were very small, only between 1 and 5 points on a 100‐point scale. The overall quality of the evidence was low to moderate, which means that including new studies in future years could change these conclusions. The conclusion that mobility is in fact preserved after placement of a mobile disc prosthesis, compared to traditional 'fusion' surgery, is unlikely to change. Whether this preserved mobility will lead to fewer new symptoms in the future is uncertain based on results for the first one to two years after surgery. Therefore, a comparison of results in the long term (five years or more) will be made when more studies with long‐term results have become available.
Collapse
Affiliation(s)
- Toon FM Boselie
- Maastricht University Medical CentreDepartment of NeurosurgeryP. Debeyelaan 25MaastrichtNetherlands6229 HX
| | - Paul C Willems
- Maastricht University Medical CentreDepartment of OrthopaedicsPO Box 5800MaastrichtNetherlands6202 AZ
| | - Henk van Mameren
- Maastricht UniversityDepartment of EpidemiologyPO Box 616MaastrichtNetherlands200 MD
| | - Rob de Bie
- Maastricht UniversityDepartment of EpidemiologyPO Box 616MaastrichtNetherlands200 MD
| | - Edward C Benzel
- Cleveland Clinic FoundationDepartment of NeurosurgeryS‐80, 9500 Euclid AvenueClevelandUSA44195
| | - Henk van Santbrink
- Maastricht University Medical CentreDepartment of NeurosurgeryP. Debeyelaan 25MaastrichtNetherlands6229 HX
| |
Collapse
|
15
|
Costs of cervical disc replacement versus anterior cervical discectomy and fusion for treatment of single-level cervical disc disease: an analysis of the Blue Health Intelligence database for acute and long-term costs and complications. Spine (Phila Pa 1976) 2015; 40:521-9. [PMID: 25868092 DOI: 10.1097/brs.0000000000000822] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collective administrative data. OBJECTIVE The purpose of this study was to determine the reoperation rates, adverse event rate, as well as the direct and follow-on costs of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF) in a "real-world" population of patients with single-level symptomatic cervical disc disease. SUMMARY OF BACKGROUND DATA Until very recently, there was a paucity of human clinical data to demonstrate that CDA lowers the rate of adjacent segment disease over ACDF. METHODS This was a retrospective, matched cohort analysis of a prospectively collected database of costs and outcomes for patients aged 18 to 60 years, who were continuously enrolled in a Blue Cross Plan contributing data to a claims database. Inclusion criteria were as follows: all patients who were treated surgically with either CDA or ACDF between January 2008 and December 2009, with single-level cervical pathology and claims reflecting at least 6 weeks of nonsurgical preoperative care without claims history of prior surgery. RESULTS There were 6635 ACDF patients and 327 CDA patients. There were no significant differences in the incidence of comorbidities or mean follow-up time (ACDF 25.7 mo vs. CDA 26.1 mo) between groups. By 36 months postoperatively, the reoperation rate was significantly increased in the ACDF group (10.5%) versus the CDA group (5.7%) (hazard ratio, P = 0.0214). The index surgery and 90-day global window costs were significantly lower in the CDA groups. At final follow-up, there was a statistically significant reduction in total costs paid by insurer in CDA patients (CDA $34,979 vs. ACDF $39,820). CONCLUSION Patients who underwent CDA for single-level degenerative disease had lower readmission rates, lower reoperation rates, and reduced index and total costs than those treated with ACDF. CDA was effective in reducing the monthly cost of care compared with ACDF. LEVEL OF EVIDENCE 2.
Collapse
|
16
|
Current concepts of anterior cervical discectomy and fusion: a review of literature. Asian Spine J 2014; 8:531-9. [PMID: 25187874 PMCID: PMC4150000 DOI: 10.4184/asj.2014.8.4.531] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/08/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.
Collapse
|
17
|
Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24 Suppl 1:S245-53. [DOI: 10.1007/s00590-014-1445-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/21/2014] [Indexed: 01/15/2023]
|
18
|
Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials. 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 2014; 23:1115-23. [PMID: 24515337 DOI: 10.1007/s00586-014-3220-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the mid- to long-term clinical outcomes after cervical disc arthroplasty (CDA) as compared with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. METHODS A systematic review and a meta-analysis were performed for articles published up to March 2013. Randomized controlled trials that reported mid- to long-term outcomes (≥48 months) after CDA as compared with ACDF were included. Two authors independently extracted the articles and the predefined data. RESULTS Five US Food and Drug Administration randomized controlled trials that reported 4-6 years of follow-up data were retrieved. Patients who underwent CDA had a lower mid- to long-term rate of reoperation and had greater mid- to long-term improvements in the Neck Disability Index, neck and arm pain scores, and Short Form 36 Health Survey physical component score than did those who underwent ACDF. Segmental motion was maintained in patients who underwent CDA. The mid- to long-term rates of adjacent segment disease and neurological success were not significantly different between the two groups. CONCLUSIONS CDA may result in better mid- to long-term functional recovery and a lower rate of subsequent surgical procedures than ACDF would. A review of the literature showed that only an insufficient number of studies had investigated adjacent segment disease; therefore, it is mandatory that adequate future research should focus in this direction.
Collapse
|
19
|
Adjacent segment disease after anterior cervical discectomy and fusion: clinical outcomes after first repeat surgery versus second repeat surgery. Spine (Phila Pa 1976) 2014; 39:120-6. [PMID: 24150434 DOI: 10.1097/brs.0000000000000074] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE To study the long-term effects of repeat cervical fusion after development of adjacent segment disease (ASD). SUMMARY OF BACKGROUND DATA ASD is a well-recognized development after anterior cervical discectomy and fusion (ACDF). Although there are data on the development of ASD after ACDF, the incidence of ASD after repeat ACDF has not been well established. METHODS We collected 888 consecutive patients who underwent ACDF for cervical degenerative disease during a 20-year period at a single institution. Patients were followed for an average of 94.0 ± 78.1 months after the first ACDF. RESULTS Of the 888 patients who underwent ACDF, 108 patients developed ASD, necessitating a second cervical fusion. Among these 108 patients, 27 patients later developed recurrent ASD, requiring a third cervical fusion. Thus, in this series, the incidence of ASD after ACDF is 12.2%, statistically increasing to 25% after a second cervical fusion (P = 0.0002). Notably, ASD occurred 47.0 ± 44.9 months after the first ACDF and statistically decreased to 30.3 ± 24.9 months after a second cervical fusion (P = 0.01). Of the 77 patients who underwent a second cervical fusion via an anterior approach, 23 developed recurrent ASD requiring a third cervical fusion. In contrast, of the 31 patients who had a posteriorly approached second cervical fusion, only 4 developed recurrent ASD requiring a third cervical fusion. CONCLUSION We present a cohort of patients undergoing multiple sequential operations due to ASD during a 20-year period. In this series of 888 patients, the incidence of ASD development is lowest after the first ACDF. Patients who undergo a second cervical fusion develop ASD at both higher and faster rates. Moreover, patients who had a second cervical fusion via an anterior approach had a higher chance of developing recurrent ASD versus patients who had a posterior approach. LEVEL OF EVIDENCE 3.
Collapse
|
20
|
Demetriades AK, Ringel F, Meyer B. Cervical disc arthroplasty: a critical review and appraisal of the latest available evidence. Adv Tech Stand Neurosurg 2014; 41:107-129. [PMID: 24309922 DOI: 10.1007/978-3-319-01830-0_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anterior cervical discectomy and fusion (ACDF) has been a very successful procedure in the management of cervical radiculopathy and myelopathy. Concerns with adjacent segment disease and the desire to preserve physiological motion have led to technological and clinical efforts for cervical disc arthroplasty. The suggested move to cervical disc replacement has led to this latter procedure being one of the most scrutinised surgical treatments in the twenty-first century. Short- and medium-term prospective randomised clinical trials and systematic reviews show cervical disc replacement to be at least as good as ACDF as regards the clinical outcomes in the management of degenerative cervical spondylosis. This is logical since the neural decompression procedure is essentially the same. However, the rationale for arthroplasty over arthrodesis has been built on two main proposed roles: the preservation of segmental motion and the prevention of adjacent segment disease. Whilst results thus far show that this first role seems to be achieved, its clinical significance is as yet unproven; the second is so far not proven. In addition, the long-term fate of the implants is also unknown. Long-term safety and efficacy, therefore, still await further clinical studies.
Collapse
Affiliation(s)
- Andreas K Demetriades
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany,
| | | | | |
Collapse
|
21
|
Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine (Phila Pa 1976) 2013; 38:2253-7. [PMID: 24335631 DOI: 10.1097/brs.0000000000000052] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis of randomized controlled trials. OBJECTIVE To compare the reported incidence of adjacent segment disease (ASD) requiring surgical intervention between anterior cervical decompression and fusion (ACDF) and total disc arthroplasty (TDA). SUMMARY OF BACKGROUND DATA The concern for ASD has led to the development of motion-preserving technologies such as TDA. To date, however, no known study has sought to compare the incidence of ASD between ACDF and TDA in major prospective studies. METHODS A systematic review of IDE and non-IDE trials was performed using PubMed and Cochrane libraries. These databases were thoroughly searched for prospective randomized studies comparing ACDF and TDR. Six studies met the inclusion criteria for a meta-analysis and were used to report an overall rate of ASD for both ACDF and TDA. RESULTS Pooling data from 6 prospective studies, the overall sample size at baseline was 1586 (ACDF = 777, TDA = 809) and at the final follow-up was 1110 giving an overall follow-up of 70%. Patients after an ACDF had a lower rate of follow-up overall than those after TDR (ACDF: 67.3% vs. TDR: 72.6%, P= 0.01). Thirty-six patients required adjacent-level surgery after an ACDF at 2 to 5 years of follow-up (6.9%) compared with 30 patients after a TDA (5.1%). The corresponding reoperation rate for ASD was 2.4 ± 1.7% per year for ACDF versus 1.1 ± 1.5% per year for TDR. These differences were not statistically significant (P= 0.44). Using a Kaplan-Meier analysis and historical data, we expect 48 patients in the ACDF group and 55 patients in the TDR group to have symptomatic disease at an adjacent level. CONCLUSION From a meta-analysis of prospective studies, there is no difference in the rate of ASD for ACDF versus TDA. We also report an overall lower rate of follow-up for patients with ACDF than for those with TDR. Future prospective studies should continue to focus on excellent patient follow-up and accurate assessment of patient symptoms that are attributable to an adjacent level as this has been an under-reported finding in prospective studies. LEVEL OF EVIDENCE 1.
Collapse
|
22
|
Bydon M, Xu R, Macki M, De la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion in a Large Series. Neurosurgery 2013; 74:139-46 discussion 146. [DOI: 10.1227/neu.0000000000000204] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Adjacent segment disease (ASD) development is known to occur after anterior cervical discectomy and fusion (ACDF).
OBJECTIVE:
To study the relationship between index ACDF levels and the location of ASD development (above/below), as well as the effect of fusion length on ASD development.
METHODS:
We report 888 patients who underwent ACDF for cervical spondylosis over a twenty-year period at a single institution. Of these patients, 108 had re-do surgery due to symptomatic ASD. Patients were followed for an average of 92.4 ± 52.6 months after the index ACDF.
RESULTS:
In agreement with previous ACDF case series, we found the highest rates of cervical spinal degenerative disease requiring surgery at C5/C6, followed by C6/C7. Interestingly, neither the inherent location of index ACDF nor the length of instrumented arthrodesis appeared to correlate with the propensity to develop ASD. However, patients were more likely to develop ASD above the index level of fusion. This was true even for patients undergoing a second revision surgery due to recurrent ASD. Importantly, our data are consistent with existing in vitro biomechanical data in cadaveric spines.
CONCLUSION:
We describe in detail the location and length of arthrodesis for index ACDFs, as well as first and second revision fusion surgeries in one of the largest Western cohorts in the literature. Our findings support the theory that iatrogenically introduced stress and instability at adjacent spinal segments contribute to the pathogenesis of ASD.
Collapse
Affiliation(s)
- Mohamad Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamed Macki
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Rafael De la Garza-Ramos
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Timothy F. Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| |
Collapse
|
23
|
Eubanks JD, Belding J, Schnaser E, Rowan A, Moffitt G, Weaver J, Reich MS, Bechtel C, Xie K, Gande A, Hohl J, Braly B, Hilibrand A, Kang JD. Congenital stenosis and adjacent segment disease in the cervical spine. Orthopedics 2013; 36:e1251-5. [PMID: 24093699 DOI: 10.3928/01477447-20130920-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Symptomatic adjacent segment disease (ASD) after anterior cervical fusion (ACF) is reported in 25% of patients at 10 years postoperatively. Debate continues as to whether this degeneration is due to the natural history of the disk or the changed biomechanics after ACF. This study explored whether congenital stenosis predisposes patients to an increased incidence of ASD after ACF. A retrospective review of 635 patients with myelopathy or radiculopathy was performed; 364 patients had complete records for review. Patients underwent 1- to 5-level ACF (94 one-level, 145 two-level, 79 three-level, 45 four-level, and 1 five-level). Radiographs were evaluated for bony congenital stenosis using validated parameters, and ASD was measured according to Hilibrand's criteria and correlated with symptomatic ASD. Congenital stenosis was found in 21.7% of patients and radiographic ASD in 33.5%, with a significant association between these parameters. However, symptomatic ASD occurred in 11.8% of patients; no association between congenital stenosis and symptomatic ASD or myelopathy and ASD was found. Clinical results demonstrated excellent or good Robinson scores in 86.2% of patients and Odom scores in 87% of patients. Despite mostly excellent to good outcomes, symptomatic ASD is common after ACF. Although congenital stenosis appears to increase the incidence of radiographic ASD, it does not appear to predict symptomatic ASD.
Collapse
|
24
|
Radcliff KE, Kepler CK, Jakoi A, Sidhu GS, Rihn J, Vaccaro AR, Albert TJ, Hilibrand AS. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J 2013; 13:1339-49. [PMID: 23773433 DOI: 10.1016/j.spinee.2013.03.020] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 11/26/2012] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adjacent segment disease (ASD) is symptomatic deterioration of spinal levels adjacent to the site of a previous fusion. A critical issue related to ASD is whether deterioration of spinal segments adjacent to a fusion is due to the spinal intervention or due to the natural history of spinal degenerative disease. PURPOSE The purpose of this review is to summarize the recent clinical literature on adjacent segment disease in light of the natural history, patient-modifiable risk factors, surgical risk factors, sagittal balance, and new technology. STUDY DESIGN This review will evaluate the recent literature on genetic and hereditary components of spinal degenerative disease and potential links to the development of ASD. METHODS After a meticulous search of Medline for relevant articles pertaining to our review, we summarized the recent literature on the rate of ASD and the effect of various interventions, including motion preservation, sagittal imbalance, arthroplasty, and minimally invasive surgery. RESULTS The reported rate of ASD after decompression and stabilization procedures is approximately 2% to 3% per year. The factors that are consistently associated with adjacent segment disease include laminectomy adjacent to a fusion and a sagittal imbalance. CONCLUSIONS Spinal surgical interventions have been associated with ASD. However, whether such interventions may lead to an acceleration of the natural history of the disease remains questionable.
Collapse
Affiliation(s)
- Kristen E Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976) 2013; 38:E1096-107. [PMID: 23656959 DOI: 10.1097/brs.0b013e3182994a32] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review of randomized controlled trials (RCTs). OBJECTIVE To assess the effects of arthroplasty versus fusion in the treatment of radiculopathy or myelopathy, or both, due to single-level cervical degenerative disc disease. SUMMARY OF BACKGROUND DATA There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single-level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty compared with fusion, prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long-term results become available, it is important to know whether results of 1 of the 2 treatments are superior to the other in the first 1 to 2 years. METHODS We searched electronic databases for randomized controlled trials. We included randomized controlled trials that directly compared any type of cervical fusion with any type of cervical arthroplasty, with at least 1 year of follow-up. Study selection was performed independently by 3 review authors, and "risk of bias" assessment and data extraction were independently performed by 2 review authors. In case of missing data, we contacted the study authors or the study sponsor. We assessed the quality of evidence. RESULTS Nine studies (2400 participants) were included in this review; 5 of these studies had a low risk of bias. Results for the arthroplasty group were better than the fusion group for all primary comparisons, often statistically significant. For none of the primary outcomes was a clinically relevant difference in effect size shown. Quality of the evidence was low to moderate. CONCLUSION There is low to moderate quality evidence that results are consistently in favor of arthroplasty, often statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. LEVEL OF EVIDENCE 1.
Collapse
|
26
|
Mehrkens A, Müller AM, Valderrabano V, Schären S, Vavken P. Tissue engineering approaches to degenerative disc disease--a meta-analysis of controlled animal trials. Osteoarthritis Cartilage 2012; 20:1316-25. [PMID: 22789805 DOI: 10.1016/j.joca.2012.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/06/2012] [Accepted: 06/15/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this systematic review was to assess cell/biomaterial treatments of degenerative disc disease in controlled animal trails. The primary endpoints were restoration of disc height and T2 signal intensity. METHOD PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) were searched for studies reporting on the use of tissue engineering treatments (cells/biomaterials/cells and biomaterials) for degenerative disc disease treatments in a controlled trial. Publication bias was assessed graphically using funnel plots and Egger's regression. Data were grouped by follow-up duration - early (<4 weeks), intermediate (4-12 weeks) and late (>12 weeks), and weighted mean differences (WMD) were calculated using DerSimonian-Laird Random Effect models. RESULTS Thirteen papers, published between 2004 and 2011, were included in this study. In comparison with the injured disc, all three treatments showed a positive effect in disc height, but none of the treatments restored disc height compared to the healthy disc. Overall, there seemed to be a better effect on disc height restoration for the treatment with cells and biomaterials. None of the treatments could achieve the same T2 signal intensity as the healthy disc, and compared to the injured disc, only the treatment with cells and biomaterials showed consistently better results. CONCLUSION Treatment of an injured/degenerating disc with cells, cells plus biomaterial or biomaterial alone has a potential for at least a partial regeneration of the disc. However, so far, none of the treatments is able to effectively restore the properties of a healthy disc.
Collapse
Affiliation(s)
- A Mehrkens
- Toronto Western Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
27
|
Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine (Phila Pa 1976) 2012; 37:S96-S112. [PMID: 22872222 DOI: 10.1097/brs.0b013e31826cb2d6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE To critically review and summarize the literature comparing motion preservation devices to fusion in the cervical spine to determine whether the use of these devices decreases the development of radiographical (RASP) or clinical adjacent segment pathology (CASP) compared with fusion. SUMMARY OF BACKGROUND DATA Historically, surgical treatment of symptomatic cervical disc disease presenting as radiculopathy and/or myelopathy with anterior cervical decompression and fusion has yielded excellent results. Controversy remains whether RASP and CASP requiring treatment is due to fusion-altered biomechanics and kinematics versus natural history. METHODS We conducted a systematic search in MEDLINE and the Cochrane Collaboration Library for literature published through February 2012 on human randomized control trials or cohort studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that total disc replacement (TDR) is associated with a lower risk of RASP or CASP compared with fusion? (2) Is there evidence that other procedures that do not involve arthrodesis or other motion-sparing devices are associated with a lower risk of RASP or CASP compared with fusion? (3)Is one type of motion preservation device or procedure associated with a lower risk of RASP or CASP compared with others? RESULTS The initial literature search yielded 276 citations, of which 73 unique, potentially relevant citations that were evaluated against the inclusion/exclusion criteria set a priori. A total of 14 studies were selected for inclusion. For question 1, RASP was variably reported in studies that compared total disc replacement (TDR) to anterior cervical decompression and fusion (ACDF), and risk differences for reoperation due to CASP ranged from 1.0% to 4.8%, with no statistically significant differences between groups. For question 2, no studies comparing motion preservation devices to ACDF met our inclusion criteria. For question 3, one study comparing motion-sparing devices found the risk of RASP to be similar between groups. CONCLUSION A paucity of high-quality literature comparing motion-preserving devices or treatment methods to fusion or other motion-preserving techniques or devices (with RASP and/or CASP as an outcome using consistent definitions) exists. Independently funded, blinded long-term follow-up prospective studies would be able to delineate the true effects regarding incidence of RASP and CASP and treatment of CASP. CONSENSUS STATEMENT 1. There is no significant difference in development of RASP and CASP after C-TDR versus ACDF at short- to mid-term follow-up. LEVEL OF EVIDENCE Moderate. Strength of Statement: Strong. Recommendation 1: No recommendation can be made from comparative literature of nonarthroplasty motion preservation device or techniques compared with fusion regarding the risk of RASP or CASP. LEVEL OF EVIDENCE Insufficient. Strength of Statement: Strong. Recommendation 2: No recommendation can be made from direct comparative literature of various motion preservation devices or techniques regarding the risk of RASP or CASP. LEVEL OF EVIDENCE Insufficient. Strength of Statement: Strong.
Collapse
|
28
|
Boselie TFM, Willems PC, van Mameren H, de Bie R, Benzel EC, van Santbrink H. Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev 2012:CD009173. [PMID: 22972137 DOI: 10.1002/14651858.cd009173.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty over fusion, that is, the prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long-term results become available, it is important to know whether results of one of the two treatments are superior to the other in the first one to two years. OBJECTIVES To assess the effects of arthroplasty versus fusion for radiculopathy or myelopathy, or both due to single level cervical degenerative disc disease. SEARCH METHODS We searched the following databases for randomised controlled trials (RCTs): CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, and EBMR. Additionally, we searched the System for Information on Grey Literature (SIGLE), subheading Biological and Medical Sciences, the US Food and Drug Administration (FDA) database on medical devices, and Clinicaltrials.gov to identify trials in progress. We also screened the reference list of all selected papers. Date of search: 25 May 2011. SELECTION CRITERIA We included RCTs that directly compared any type of cervical fusion with any type of arthroplasty, with at least one year of follow-up. Primary outcomes were arm pain, neck pain, neck-related functional status, patient satisfaction, neurological outcome, and global health status. Secondary outcomes were the presence of (radiological) fusion, revision surgery at the treated level, secondary surgery on adjacent levels, segmental mobility of treated and adjacent levels, and work status. DATA COLLECTION AND ANALYSIS Study selection was performed independently by three review authors, and 'Risk of bias' assessment and data extraction were performed by two review authors. In case of missing data or insufficient information for a judgement about risk of bias, we tried to contact the study authors or the study sponsor. The data were entered into RevMan by one review author and subsequently checked by a second review author. We assessed the quality of evidence using GRADE. We analysed heterogeneity and performed sensitivity analyses for the pooled analyses. MAIN RESULTS We included nine studies (2400 participants), five of which had a low risk of bias. Eight of these studies were industry sponsored. The most important results showed low-quality evidence for a small but significant difference in alleviation of arm pain at one to two years in favour of arthroplasty (mean difference (MD) -1.54; 95% confidence interval (CI) -2.86 to -0.22; 100-point scale). A small study effect could not be ruled out for this outcome in the sensitivity analyses. This means that smaller studies (or small published subsets of larger studies) showed larger differences for this outcome, which may indicate publication bias. Also, moderate-quality evidence showed a small difference in neck-related functional status at one to two years in favour of arthroplasty (MD -2.79; 95% CI -4.73 to -0.85; 100-point scale) and a small difference in neurological outcome in favour of arthroplasty (risk ratio (RR) 1.05; 95% CI 1.01 to 1.09). These two outcomes were robust to sensitivity analyses. For none of the primary outcomes, was a clinically relevant difference shown. Additionally, there was high-quality evidence for a large, statistically significant difference in segmental mobility at one to two years (measured as degrees segmental range of motion) at the treated level (MD 6.90; 95% CI 5.45 to 8.35). There was low-quality evidence that there was no statistically significant difference in secondary surgery at the adjacent levels at one to two years (RR 0.60; 95% CI 0.35 to 1.02). The latter was not robust to sensitivity analyses. AUTHORS' CONCLUSIONS There was a tendency for clinical results to be in favour of arthroplasty; often these were statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. Significance was often gained or lost in the varying sensitivity analyses, probably owing to the relatively small number of studies, in combination with the small differences that were found. Given the fact that all of the included studies were not blinded, this could be due to patient or carer expectations. However, at this time both treatments can be seen as valid options with respect to results at a maximum of one to two years. Given the current absence of truly long-term results, use of these mobile disc prostheses should still be limited to clinical trials. There was high-quality evidence that the goal of preservation of segmental mobility in arthroplasty was met. A statistically significant effect on the incidence of secondary symptoms at adjacent levels, the primary goal of arthroplasty over fusion, was not found at one to two years. If there was a protective effect, this should become clearer over time. A future update, when studies with 'truly long-term' results (five years or more) become available, should focus on this issue.
Collapse
Affiliation(s)
- Toon F M Boselie
- Department of Neurosurgery, Maastricht University Medical Centre,Maastricht, Netherlands.
| | | | | | | | | | | |
Collapse
|
29
|
Fallah A, Akl EA, Ebrahim S, Ibrahim GM, Mansouri A, Foote CJ, Zhang Y, Fehlings MG. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis. PLoS One 2012; 7:e43407. [PMID: 22912869 PMCID: PMC3422251 DOI: 10.1371/journal.pone.0043407] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/24/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis. DATA SOURCES Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles. STUDY SELECTION We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. DATA SYNTHESIS We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. RESULTS Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. CONCLUSIONS There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.
Collapse
Affiliation(s)
- Aria Fallah
- Division of Neurosurgery, University of Toronto, Toronto, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Botelho RV, Dos Santos Buscariolli Y, de Barros Vasconcelos Fernandes Serra MVF, Bellini MNP, Bernardo WM. The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review. Open Orthop J 2012; 6:121-8. [PMID: 22523524 PMCID: PMC3314868 DOI: 10.2174/1874325001206010121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 11/25/2022] Open
Abstract
Background: The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height. Objective: The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI). Methods: randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE. Results: Seven studies were selected for analysis. Conclusion: Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD. There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.
Collapse
Affiliation(s)
- Ricardo Vieira Botelho
- Spine surgery Service-Hospital do Servidor Público do Estado de São Paulo-São Paulo, Brazil
| | | | | | | | | |
Collapse
|
31
|
Nishizawa K, Mori K, Saruhashi Y, Matsusue Y. Operative outcomes for cervical degenerative disease: a review of the literature. ISRN ORTHOPEDICS 2012; 2012:165050. [PMID: 24977072 PMCID: PMC4063127 DOI: 10.5402/2012/165050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 11/29/2011] [Indexed: 11/23/2022]
Abstract
To date, several studies were conducted to find which procedure is superior to the others for the treatment of cervical myelopathy. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone, or a combination of both. Posterior approaches have historically been considered safe and direct methods for cervical multisegment stenosis and lordotic cervical alignment. On the other hand, anterior approaches are indicated to the patients with cervical compression with anterior factors, relatively short-segment stenosis, and kyphotic cervical alignment. Recently, posterior approach is widely applied to several cervical degenerative diseases due to the development of various instruments. Even if it were posterior approach or anterior approach, each would have its complication. There is no Class I or II evidence to suggest that laminoplasty is superior to other techniques for decompression. However, Class III evidence has shown equivalency in functional improvement between laminoplasty, anterior cervical fusion, and laminectomy with arthrodesis. Nowadays, each surgeon tends to choose each method by evaluating patients' clinical conditions.
Collapse
Affiliation(s)
- Kazuya Nishizawa
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yasuo Saruhashi
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yoshitaka Matsusue
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| |
Collapse
|
32
|
Uschold TD, Fusco D, Germain R, Tumialan LM, Chang SW. Cervical and lumbar spinal arthroplasty: clinical review. AJNR Am J Neuroradiol 2011; 33:1631-41. [PMID: 22033716 DOI: 10.3174/ajnr.a2758] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In contrast to cervical and lumbar fusion procedures, the principal aim of disk arthroplasty is to recapitulate the normal kinematics and biomechanics of the spinal segment affected. Following decompression of the neural elements, disk arthroplasty allows restoration of disk height and maintenance of spinal alignment. Based on clinical observations and biomechanical testing, the anticipated advantage of arthroplasty over standard arthrodesis techniques has been a proposed reduction in the development of symptomatic ALD. In this review of cervical and lumbar disk arthroplasty, we highlight the clinical results and experience with standard fusion techniques, incidence of ALD in the population of patients with surgical fusion, and indications for arthroplasty, as well as the biomechanical and clinical outcomes following arthroplasty. In addition, we introduce the devices currently available and provide a critical appraisal of the clinical evidence regarding arthroplasty procedures.
Collapse
Affiliation(s)
- T D Uschold
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
| | | | | | | | | |
Collapse
|
33
|
Tissue-engineered intervertebral discs produce new matrix, maintain disc height, and restore biomechanical function to the rodent spine. Proc Natl Acad Sci U S A 2011; 108:13106-11. [PMID: 21808048 DOI: 10.1073/pnas.1107094108] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lower back and neck pain are leading physical conditions for which patients see their doctors in the United States. The organ commonly implicated in this condition is the intervertebral disc (IVD), which frequently herniates, ruptures, or tears, often causing pain and limiting spinal mobility. To date, approaches for replacement of diseased IVD have been confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Here we present the evaluation of a living, tissue-engineered IVD composed of a gelatinous nucleus pulposus surrounded by an aligned collagenous annulus fibrosus in the caudal spine of athymic rats for up to 6 mo. When implanted into the rat caudal spine, tissue-engineered IVD maintained disc space height, produced de novo extracellular matrix, and integrated into the spine, yielding an intact motion segment with dynamic mechanical properties similar to that of native IVD. These studies demonstrate the feasibility of engineering a functional spinal motion segment and represent a critical step in developing biological therapies for degenerative disc disease.
Collapse
|
34
|
Le Huec JC. Artificial disks: Modest medium- and long-term benefits and a need for better patient selection. Joint Bone Spine 2011; 78:441-4. [PMID: 21803630 DOI: 10.1016/j.jbspin.2011.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2011] [Indexed: 11/29/2022]
|
35
|
Adjacent-level degeneration after cervical disc arthroplasty versus fusion. 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 2011; 20 Suppl 3:403-7. [PMID: 21796395 DOI: 10.1007/s00586-011-1916-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/29/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The principal objective of this study was to evaluate the incidence of adjacent-segment degeneration (ASD) in patients who underwent cervical disc arthroplasty (CDA) as compared with anterior cervical discectomy and fusion (ACDF). METHODS It is a prospective cohort study of patients with a single-level cervical degenerative disc disease from C3 to C7 who underwent CDA or ACDF between January 2004 and December 2006, with a minimum follow-up of 3 years. The patients were evaluated pre- and postoperatively with the visual analog scale (VAS), the neck disability index (NDI), and a complete neurological examination. Plain radiographic assessments included sagittal-plane angulation, range of motion (ROM), and radiological signs of ASD. RESULTS One hundred and five patients underwent ACDF and 85 were treated with CDA. The postoperative VAS and NDI were equivalent in both groups. The ROM was preserved in the CDA group but with a small decreased tendency within the time. Radiographic evidence of ASD was found in 11 (10.5%) patients in the ACDF group and in 7 (8.8%) subjects in the CDA group. The Kaplan-Meier survival analysis for the ASD occurrence did not reach statistically significant differences (log rank, P = 0.72). CONCLUSIONS Preservation of motion in the CDA patients was not associated with a reduction of the incidence of symptomatic adjacent-segment disease and there may be other factors that influence ASD.
Collapse
|
36
|
Die Bedeutung des sagittalen Profils bei der zervikalen Endoprothetik. DER ORTHOPADE 2011; 40:719-25. [DOI: 10.1007/s00132-011-1801-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
37
|
Boselie AFM, van Santbrink H, van Mameren H, de Bie R, Benzel EC, Willems PC. Fusion versus arthroplasty in single level cervical degenerative disc disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|