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Singh R, Khan S, Ambade RE, Kanani K, Agrawal V, Patel SK. Revolutionizing Relief: Cervical Radiculopathy With Neurological Deficits Rescued by Cervical Disc Replacement. Cureus 2024; 16:e59923. [PMID: 38854171 PMCID: PMC11161573 DOI: 10.7759/cureus.59923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/05/2024] [Indexed: 06/11/2024] Open
Abstract
Cervical radiculopathy is a common condition characterized by neck pain radiating to the upper and lower limbs, often accompanied by tingling sensations, numbness, and weakness. We present the case of a 32-year-old male who presented with left-sided cervical radiculopathy and neurological deficits. Clinical examination revealed left C5/C6/C7 hypoesthesia, diminished grip strength, reduced power in the left upper and lower extremities, and a positive Spurling test. Magnetic resonance imaging (MRI) of the cervical spine revealed multilevel cervical disc herniations at C4-C5 and C5-C6 levels, resulting in stenosis. The patient underwent anterior cervical discectomies with artificial disc replacement (cervical disc arthroplasty (CDA)) at the C5-C6 level. The surgical procedure was uneventful, and the patient experienced prompt relief from neurological symptoms within two weeks postoperatively. Follow-up radiographs at one week post-surgery demonstrated a preserved range of motion at each operated level with the artificial disc in situ. This case highlights the successful management of cervical radiculopathy with neurological deficits using anterior cervical discectomy and artificial disc replacement. The timely intervention led to the resolution of symptoms and restoration of function, demonstrating the efficacy of this surgical approach in alleviating radicular symptoms and preserving cervical spine mobility. Further studies and long-term follow-up are warranted to validate the long-term outcomes and durability of artificial disc replacement in such cases.
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Affiliation(s)
- Rahul Singh
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sohael Khan
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ratnakar E Ambade
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kashyap Kanani
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vipul Agrawal
- Department of Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddharth K Patel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Shen YW, Yang Y, Hong Y, Ding C, Rong X, Meng Y, Wang BY, Wu TK, Liu H. Association of Craniocervical Sagittal Alignment With the Outcomes of Cervical Disc Replacement. Global Spine J 2024; 14:846-855. [PMID: 36044545 PMCID: PMC11192106 DOI: 10.1177/21925682221124531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To explore the association between craniocervical sagittal balance and clinical and radiological outcomes of cervical disc replacement (CDR). METHODS Patients who underwent 1-level and 2-level CDR were retrospectively analyzed. Clinical outcomes were evaluated using scores on the Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). The craniocervical sagittal alignment parameters, including the C0-C2 Cobb angle, C2-C7 Cobb angle, C2 slope, T1 slope, C2-C7 sagittal vertical axis (SVA), C1-C7 SVA, the center of gravity of the head (CGH)-C7 SVA, and range of motion (ROM) at the surgical segments were measured. RESULTS A total of 169 patients were involved. Significantly lower pre- and postoperative C2 slope and CGH-C7 SVA were found in arthroplasty levels with better ROMs. Patients with a higher preoperative C2 slope and CGH-C7 SVA had lower cervical lordosis and ROM after surgery. There were no significant differences in the clinical outcomes between patients with different sagittal balance statuses. C2-C7 SVA and CGH-C7 SVA were significantly associated with radiographic adjacent segment pathology (rASP). CONCLUSION Craniocervical sagittal balance is associated with cervical lordosis and ROM at the index level after CDR. A higher preoperative SVA is related to the presence and progression of rASP. A relationship between sagittal alignment and clinical outcomes was not observed.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Kui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Kuo CH, Tu TH, Chen KT. Editorial: Advanced technological applications in neurosurgery. Front Surg 2023; 10:1277997. [PMID: 37744725 PMCID: PMC10512053 DOI: 10.3389/fsurg.2023.1277997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ko-Ting Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Ko CC, Feng BK, Kuo YH, Kuo CH, Tu TH, Chang CC, Cheng H, Huang WC, Wu JC. Incidence and Risk Factor of Implant Dislocation After Cervical Disk Arthroplasty: A Retrospective Cohort Analysis of 756 Patients. Neurosurgery 2023; 93:330-338. [PMID: 36805569 DOI: 10.1227/neu.0000000000002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Implant dislocation after cervical disk arthroplasty (CDA) is obviously a critical complication, but no information about the incidence and associated risk factor has been reported. OBJECTIVE To investigate the incidence and risk factor of implant dislocation after CDA by a retrospective cohort analysis. METHODS A retrospective review of a consecutive series of CDA performed between January 2009 and March 2021 at a single institution was conducted. Analyses of chart records and radiological data established the incidence and associated risk factor of implant dislocation after CDA. A Kaplan-Meier survival estimation of implant survival was performed. RESULTS A total of 756 consecutive patients were included in this analysis. Five patients (0.7%) had a migration and even dropout of the artificial disk. The overall cumulative survival rate of the implant reached approximately 99.3% of the 756 patients. Preoperative kyphosis was significantly related to implant dislocation ( P = .016), with an odds ratio of 15.013. CONCLUSION The incidence of implant dislocation after CDA is as low as 0.7% or 5/756 patients. Preoperative kyphosis significantly increases the risk of postoperative implant dislocation by a factor of 15. The migrating implants could be revealed on radiographs as early as 0.9 to 1.4 months postoperatively and were revised to anterior cervical diskectomy and fusion within half a year. No new event of implant dislocation occurred half a year postoperatively. The overall cumulative survival rate of the implant reached 99.3% of the 756 patients. In conclusion, CDA remains a safe and reliable procedure.
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Affiliation(s)
- Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bo-Kai Feng
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tu TH, Wang CY, Chen YC, Wu JC. Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions. J Neurosurg Spine 2023; 38:372-381. [PMID: 36681966 DOI: 10.3171/2022.11.spine22880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.
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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Ching-Ying Wang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Yu-Chun Chen
- 2Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
- 4Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
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Wang L, Bai M, Li XB, Wang ZR, Wang B, Huang AB. Does the sizing of current cervical disc arthroplasty systems match Chinese cervical anatomic dimensions? Front Bioeng Biotechnol 2022; 10:1036223. [PMID: 36394034 PMCID: PMC9640970 DOI: 10.3389/fbioe.2022.1036223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2023] Open
Abstract
Objective: The objectives of this study were to analyze the computed tomography (CT) scan imaging data of the cervical spine from healthy volunteers and to correlate the measurements to the dimensions of current cervical disc arthroplasty systems. Methods: A total of 130 participants (78 males and 52 females) with a mean age of 41.0 years (range 18.0-66.0 years) who had undergone computed tomography scans of the cervical spine were included. The linear parameters of the C3 to C7 levels, including anterior-posterior diameter (AP), middle disc height (DH), anterior disc height (ADH), posterior disc height (PDH) and center mediolateral diameter (ML), were measured. The analysis was conducted comparing different cervical levels, sexes, and age groups. Known dimensions from eight cervical disc arthroplasty systems were compared with the morphologic data. Results: A total of 520 vertebral segments were measured. The mean values for the measured parameters were as follows: anterior-posterior diameter 16.08 ± 1.84 mm, mediolateral diameter 16.13 ± 1.99 mm, anterior disc height 3.88 ± 1.11 mm, disc height 5.73 ± 1.00 mm, posterior disc height 2.83 ± 0.94 mm, and mediolateral diameter/anterior-posterior diameter 1.01 ± 0.13. All parameters except for posterior disc height were significantly different across the different cervical levels (p < 0.05). There were also significant sex differences in terms of the linear parameters. No differences were found in the majority of parameters among the different age groups (p > 0.05), except for anterior-posterior diameter at the C6/7 level. A comparison of the bone dimensions from the study data and the dimensions of the implants indicated the presence of a size mismatch in the currently available cervical disc prostheses. Conclusion: There is a large discrepancy between the cervical anatomical data of Chinese patients and the sizes of currently available prostheses. The dimensions collected in this study could be used to design and develop appropriate disc prostheses for Chinese patients.
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Affiliation(s)
- Lu Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Meng Bai
- Department of Orthopedics, Xi’an People’s Hospital, Xi’an, Shaanxi, China
| | - Xing-Bin Li
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Zhao-Rui Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Bang Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
| | - Ai-Bing Huang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, China
- Department of Orthopedics, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, Jiangsu, China
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Single-level Cervical Arthroplasty with Prodisc-C Vivo Artificial Disc: Five-year Follow-up Results From One Center. Spine (Phila Pa 1976) 2022; 47:122-127. [PMID: 33988531 DOI: 10.1097/brs.0000000000004119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to evaluate the long-term clinical and radiographic outcomes of cervical arthroplasty using the ProDisc-C Vivo prosthesis. SUMMARY OF BACKGROUND DATA Previous reports have shown that cervical arthroplasty with ProDisc-C artificial disc has acceptable clinical outcomes at 5-year and 10-year follow-ups. METHODS Clinical and radiographic evaluations, including dynamic flexion-extension lateral images, were performed at baseline and at the 5-year follow-up. RESULTS Twenty-eight patients who underwent single-level ProDisc-C Vivo arthroplasty were followed-up for a mean period of 65 months. The range of motion at the operated level was 8.9° ± 2.3° at baseline and 8.3° ± 4.8° at the final follow-up (P = 0.494). Fourteen of 28 levels (50%) developed heterotopic ossification (HO). According to McAfee's classification, one level was classified as grade I, nine levels as grade II, two levels as grade III, and two levels as grade IV. Only four of 28 levels (14.3%) had severe HO. Among patients with cervical spondylotic myelopathy, mJOA score was 13.9 ± 2.5° at baseline and 15.9° ± 1.0° at the final follow-up (P = 0.001 < 0.05). Among patients with cervical spondylotic radiculopathy, Visual Analog Scale (VAS) neck and shoulder was 5.4 ± 1.4° at baseline and 0.7° ± 1.2° at the final follow-up (p = 0.000 < 0.05), VAS arm was 5.1 ± 2.8° at baseline and 0.5° ± 1.2° at the final follow-up (P = 0.000 < 0.05). A total of 49 adjacent segments were observed and 13 (26.5%) had adjacent segment degeneration. No patient developed recurrent cervical radiculopathy or myelopathy due to adjacent segment disease. No patient underwent re-operation. CONCLUSION ProDisc-C Vivo arthroplasty had satisfactory clinical and radiographic outcomes at 5-year follow-up.Level of Evidence: 4.
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Effects of endplate coverage and intervertebral height change on heterotopic ossification following cervical disc replacement. J Orthop Surg Res 2021; 16:693. [PMID: 34823557 PMCID: PMC8614029 DOI: 10.1186/s13018-021-02840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR). Biomechanical factors including endplate coverage and intervertebral disc height change may be related to HO formation. However, there is a dearth of quantitative analysis for endplate coverage, intervertebral height change and their combined effects on HO. Methods Patients who underwent single-level or two-level CDR with Prestige-LP were retrospectively reviewed. Clinical outcomes were evaluated through Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and visual analogue scale (VAS) score. Radiological data, including the prosthesis-endplate depth ratio, intervertebral height change, posterior heterotopic ossification (PHO) and angular parameters, were collected. Logistic regression analysis was used to identify the potential risk factors. Receiver operating characteristic curves were plotted and the cut-off values of each potential factors were calculated. Results A total of 138 patients with 174 surgical segments were evaluated. Both the prosthesis-endplate depth ratio (P < 0.001) and post-operative disc height change (P < 0.001) were predictive factors for PHO formation. The area under the curve (AUC) of the prosthesis-endplate depth ratio, disc height change and their combined effects represented by the combined parameter (CP) were 0.728, 0.712 and 0.793, respectively. The risk of PHO significantly increased when the prosthesis-endplate depth ratio < 93.77% (P < 0.001, OR = 6.909, 95% CI 3.521–13.557), the intervertebral height change ≥ 1.8 mm (P < 0.001, OR = 5.303, 95% CI 2.592–10.849), or the CP representing the combined effect < 84.88 (P < 0.001, OR = 10.879, 95% CI 5.142–23.019). Conclusions Inadequate endplate coverage and excessive change of intervertebral height are both potential risk factors for the PHO after CDR. Endplate coverage less than 93.8% or intervertebral height change more than 1.8 mm would increase the risk of PHO. The combination of these two factors may exacerbate the non-uniform distribution of stress in the bone-implant interface and promote HO development.
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Alves ÓL. Cervical Total Disc Replacement: Expanded Indications. Neurosurg Clin N Am 2021; 32:437-448. [PMID: 34538470 DOI: 10.1016/j.nec.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical total disc replacement (cTDR) is now a firm alternative to anterior cervical discectomy and fusion (ACDF) for degenerative disc disease (DDD). Robust level 1 data from Federal Drug Administration-approved clinical trials demonstrated that cTDR is in any case equally safe and effective compared with ACDF for 1- or 2-level DDD. Furthermore, from early postoperative to long-term follow-up of 10 to 15 years, cTDR rates superiorly in many primary clinical outcomes. According to the published literature, at least nine different cTDR devices share this consistent pattern. On the other hand, the surgical treatment of more than 2-level disc disease is haunted by an elusive paradox. It is easily understandable that 3- and 4-level ACDF, with the well-known associated limitations, is not the superlative intervention for a spine segment anatomically designed to provide motion, as cervical spine is. Furthermore, multilevel ACDF exacerbates many of the clinical and biomechanical complications related with single-level fusion. However, as cTDR is not immaculate of constraints and failures, its clinical safety and efficacy and cost-effectiveness in multilevel anterior compressive pathology need to be established. This article analyses the current available evidence supporting the expanded indication of cTDR to 3- and 4-level disc disease, either stand-alone or adjacent to fusion, from a less stringent European perspective.
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Affiliation(s)
- Óscar L Alves
- Hospital Lusíadas Porto; Centro Hospitalar de Gaia/Espinho, Rua Cónego Ferreira Pinto, 191, 4050-256 Porto, Portugal.
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Lee CY, Wu CL, Chang HK, Wu JC, Huang WC, Cheng H, Tu TH. Cervical disc arthroplasty for Klippel-Feil syndrome. Clin Neurol Neurosurg 2021; 209:106934. [PMID: 34543827 DOI: 10.1016/j.clineuro.2021.106934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Klippel-Feil syndrome (KFS) is a congenital musculoskeletal condition characterized by improper segmentation of the cervical spine. This study aimed to evaluate outcomes of KFS patients who underwent cervical disc arthroplasty (CDA). METHODS Consecutive patients who underwent anterior cervical surgery were retrospectively reviewed. Those patients with KFS who received discectomy adjacent to the congenitally fused vertebral segments were extracted and grouped into either the fusion or the CDA group. Clinical and radiological evaluations included visual analog scales, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, C2-7 range of motion (ROM), C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), and T1-slope. RESULTS Among 2320 patients, there were 41 with KFS (prevalence = 1.77%), who were younger than the entire cohort (53.3 vs 56.4 years). Thirty KFS patients had adjacent discs and were grouped into the CDA and fusion groups (14 vs 16). Type-I KFS with C3-4 involvement was the most common for both groups (92.8% vs 81.2% with 57% vs 50%, respectively). Post-operation, both groups demonstrated improvement of all the patient reported outcomes. The C2-7 ROM significantly decreased in the fusion group than that of pre-operation (12.8 ± 6° vs 28.1 ± 11.5°). In contrast, the CDA group successfully preserved C2-7 and segmental ROM without additional complications. CONCLUSIONS KFS is rare (prevalence = 1.77%) among cervical spine surgery patients, and it rarely affects the overall cervical spinal alignment, except that it decreases segmental mobility. CDA is a feasible option for KFS because it not only avoids long-segment fusion but also preserves segmental and global mobility.
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Affiliation(s)
- Chu-Yi Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ching-Lan Wu
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
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Hsu CH, Kuo YH, Kuo CH, Ko CC, Wu JC, Huang WC. Late complication of cervical disc arthroplasty: heterotopic ossification causing myelopathy after 10 years. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21351. [PMID: 35855090 PMCID: PMC9265189 DOI: 10.3171/case21351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) is a well-documented complication of cervical disc arthroplasty (CDA), although it rarely causes adverse clinical effects. Despite high-grade HO possibly limiting segmental mobility, it is reportedly seldom associated with symptoms. OBSERVATIONS The authors report a case of a 46-year-old male patient who underwent hybrid CDA and anterior cervical discectomy and fusion for 3-level cervical disc herniation that caused myeloradiculopathy. The surgery was successful; the patient experienced nearly complete recovery postoperatively. The follow-up images, including computed tomography and magnetic resonance imaging scans, showed satisfactory decompression at the indexed levels without residual osteophytes or ossification of the posterior longitudinal ligament. However, 10 years later, the patient presented with symptomatic compressive myelopathy caused by severe HO that prompted a secondary surgery. LESSONS Although it is generally reported in the literature that HO is clinically innocuous, in this patient, it gradually and progressively developed and caused myelopathy, requiring a secondary surgery. Symptomatic HO can be expected over time, and patients with a high risk of HO deserve long-term follow-up after CDA. Further investigations are warranted to corroborate these risk factors, including multilevel calcified disc herniation, severe spondylosis, and suboptimal placement of the device during primary CDA surgery.
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Affiliation(s)
- Che-Han Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
- Institute of Biomedical Informatics, and
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
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Wang H, Wang X, Liu H, Meng Y, Guo Y, Hong Y. Risk Factors for High-Grade Heterotopic Ossification After Total Disc Replacement: A Single-Center Experience of 394 Cases. Neurosurgery 2021; 89:852-861. [PMID: 34382657 DOI: 10.1093/neuros/nyab298] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a common complication following total disc replacement (TDR). High-grade HO is a clinically relevant complication, however, only a few studies have evaluated risk factors for high-grade HO. OBJECTIVE To evaluate potential risk factors for HO and high-grade HO and their impact on clinical outcomes. METHODS We retrospectively reviewed patients who underwent TDR or hybrid surgery (HS) with Prestige-LP (Medtronic), Discover (Depuy), and Prodisc-C (Synthes). Clinical outcomes were assessed using Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores. Radiological variables, including preoperative ossification, global and segmental range of motion (ROM), HO, and adjacent segment degeneration (ASD) were reviewed. RESULTS A total of 394 patients were evaluated. HO and high-grade HO occurred in 67.77% and 11.17% patients, respectively. Preoperative ossification was significantly associated with the occurrence of HO (P < .001, OR: 3.507, 95%CI: 2.211-5.562) and high-grade HO (P = .019, OR: 2.176, 95%CI: 1.137-4.166). The ROM of replacement levels and C2-7 were significantly lower in the high-grade HO group compared to those without high-grade HO: (3.80° vs 10.18°, P < .001) and (42.81° vs 54.00°, P < .001), respectively. The incidence of ASD was significantly higher in patients with high-grade HO than those without high-grade HO (22.73% vs 11.14%, P = .048). CONCLUSION Preoperative ossification was identified as a potential risk factor for HO and high-grade HO. Patients with high-grade HO had limited ROM of replacement levels and the cervical spine and had a high incidence of ASD compared to those without high-grade HO.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yingjun Guo
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Ku J, Ku J, Chang HK, Wu JC. Cervical disc arthroplasty at C2–3: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21320. [PMID: 36131581 PMCID: PMC9563647 DOI: 10.3171/case21320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation.
OBSERVATIONS
In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level.
LESSONS
To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.
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Affiliation(s)
- Jason Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Johnson Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Department of Biomedical Imaging and Radiological Sciences, and
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sharma JK, Rustagi T, Marathe N, Mallepally AR, Mahajan R, Chhabra HS, Das K. Clinico-Radiological Outcome of Single-Level and Hybrid Total Disc Replacement with Spineart Baguera®-C for Cervical Myeloradiculopathy: Minimum 2-Year Follow-Up Study in Indian Population. Asian J Neurosurg 2021; 15:856-862. [PMID: 33708654 PMCID: PMC7869274 DOI: 10.4103/ajns.ajns_288_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022] Open
Abstract
Context Cervical radiculopathy and myelopathy is one of the most frequent ailments encountered by spine surgeon. Motion-preserving surgeries in cervical spine is a standard of care due to its certain advantages such as biomechanical anatomical conformity, reduced chances of adjacent segment degeneration, and revision surgeries. While there is abundant data from some centers, data from developing countries are still limited. Aims The aim was to study the clinico-radiological outcome of single-level and hybrid total disc replacement (TDR) with Spineart Baguera®-C cervical prosthesis for cervical myeloradiculopathy. Settings and Design Retrospective study. Materials and Methods Retrospective analysis of the 29 consecutive patient undergoing single level TDR and hybrid fixation (i.e., TDR with anterior cervical discectomy and fusion) with Spineart Baguera®-C cervical prosthesis for myeloradiculopathy from January 1, 2014 to December 31, 2017, was done. Radiological features and outcome were studied from data collected on Insta-picture archiving and communication system. Statistical Analysis Used SAS 9.4 was used for all computations. Results on continuous measurements were presented as mean and standard deviation (min-max) and results on categorical measurements were presented as numbers (n) and percentages. Results Twenty-nine patients were included in the study. The mean age was 43.31 ± 9.04 years with 14 males and 15 females. The most common level of TDR was C5-C6 (72.41%). The mean follow-up duration was 3.14 years ± 1.13 years (2-5 years). The mean hospital stay was 4.93 ± 2.12 days. The mean neck disability index (NDI) at admission was 27.24 ± 7.66 which decreased to 6.41 ± 4.29 at final follow-up. Conclusions Two-year data on treatment with Spineart Baguera®-C cervical prosthesis shows significantly improved NDI, visual analog scale (arm) with maintenance of movement of the prosthesis.
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Kuo YH, Kuo CH, Chang HK, Fay LY, Tu TH, Chang CC, Cheng H, Wu CL, Lirng JF, Wu JC, Huang WC. The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty. Neurosurgery 2020; 87:1231-1239. [PMID: 32649746 DOI: 10.1093/neuros/nyaa271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck. OBJECTIVE To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA. METHODS The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (<28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed. RESULTS The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG. CONCLUSION In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.
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Affiliation(s)
- Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Fay
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Lan Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Xu H, Liu H, Hong Y, Rong X, Huang K, Dan P, Wang B. Clinical and radiological outcomes of single-level cervical disc arthroplasty in the patients with preoperative reversible kyphosis: A matched cohort study. Clin Neurol Neurosurg 2020; 198:106247. [DOI: 10.1016/j.clineuro.2020.106247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022]
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17
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Wang X, Liu H, Meng Y, Hong Y, Wang B, Ding C, Yang Y. Effect of Disc Height and Degree of Distraction on Heterotopic Ossification After Cervical Disc Replacement. World Neurosurg 2020; 145:e100-e107. [PMID: 33010509 DOI: 10.1016/j.wneu.2020.09.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a potential and severe complication of cervical disc replacement (CDR). However, the underlying mechanism of CDR and its association with preoperative disc height loss (DHL) and postoperative degree of distraction remain unclear. We hypothesized that DHL and postoperative degree of distraction could predict HO after CDR. METHODS Data were obtained from 127 patients who underwent single-level CDR with a minimum follow-up of 2 years. DHL and adjusted degree of distraction (ADD) were obtained from lateral radiographs, and HO was evaluated at the last follow-up appointment. Receiver operating characteristic curves were calculated to verify the diagnostic value of DHL and ADD in predicting HO. RESULTS Both DHL and ADD were significantly larger in the HO group than in the non-HO group (P < 0.05). DHL ≥24.97% increased the risk of HO by 5 times (P = 0.003, 95% confidence interval 1.62-15.49), and ADD ≥36.67% increased the risk of HO by 3.87 times (P < 0.001, 95% confidence interval 1.81-8.27). A combined DHL and ADD (combined parameter) cutoff of 60.36 had a sensitivity of 87.18%, specificity of 67.35%, and area under the curve of 0.77 for predicting HO. CONCLUSIONS DHL and ADD are associated with the development of HO after CDR. The cutoff value of DHL may narrow the criteria for CDR with the aim of reducing HO formation. The combined parameter may help surgeons to select the most suitable implant height to reduce the prevalence of HO.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Nursing, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to analyze risk factors of heterotopic ossification (HO) after cervical disk replacement (CDR) and evaluate the effect of footprint mismatch on HO. SUMMARY OF BACKGROUND DATA Incidence of HO after CDR is high, but the exact related factors have not been fully elucidated. MATERIALS AND METHODS Radiographic data of patients who had undergone CDR with Prestige LP or Discover prosthesis in Tongji Hospital from July 2012 to December 2015 were reviewed. HO was graded according to McAfee classification and classified according to Jin morphologic classification. Footprint matching degree was evaluated using 3-dimensional computed tomographic images. Cervical sagittal alignment, functional spinal unit height, and range of motion were measured on radiographs. Preexisting degeneration was scored using Walraevens scoring system. Postulated risk factors including general factors, cervical sagittal alignment, functional spinal unit height, range of motion, postoperative biomechanical changes, preexisting degeneration, number of surgical levels, prosthesis type, use of nonsteroid anti-inflammatory drugs, and footprint matching degree were analyzed by first univariate tests, and then multivariate logistic regression was done to examine the relation with HO occurrence. Effect of footprint mismatch on type 1 HO of morphologic classification was evaluated. RESULTS Data of 46 patients were collected; 43 were finally evaluated with a total 57 prostheses implanted, with a mean follow-up duration of 41.16±12.49 months. No significant differences in basic characteristics existed between 2 prosthesis groups, except follow-up time. Incidence of HO was 66.7%. Mean footprint matching degree in sagittal plane was 0.877±0.068 and in coronal plane was 0.852±0.092. Mean overall footprint matching degree was 0.699±0.102 (range: 0.388-0.993). Prosthesis type and footprint matching degree were significantly related with HO among all postulated risk factors in both univariate and multivariate analyses (P<0.05); the latter had larger Exp(B). Type 1 HO occurrence significantly related with footprint mismatch. CONCLUSIONS Incidence of HO after CDR was high, and serious footprint mismatch existed. HO occurrence was significantly related with prosthesis type and footprint matching degree; the latter played a more important role.
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19
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Huang WC, Chen YC, Tu TH, Chang HK, Kuo CH. Letter to the Editor. Indolent clinical and radiological effects of cervical disc arthroplasty. J Neurosurg Spine 2020; 32:984-985. [PMID: 32005009 DOI: 10.3171/2019.11.spine191369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wen-Cheng Huang
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Chen
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3Taipei Veterans General Hospital, Taipei, Taiwan
- 4Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 5School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
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Reinas R, Kitumba D, Pereira L, Baptista AM, Alves ÓL. Multilevel cervical arthroplasty-clinical and radiological outcomes. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:233-242. [PMID: 32309661 PMCID: PMC7154349 DOI: 10.21037/jss.2020.01.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is a valid option for single-level cervical disc disease (CDD) as an alternative to fusion. However, the use in 3- and 4-level disc disease is under scrutiny with scarce data published so far. Our aim was to study clinical and radiological outcomes of arthroplasty in patients with multilevel CDD. METHODS Retrospective analysis of clinical records, pre- and post-operative neutral/dynamic X-rays of patients who underwent CDA in multilevel CDD (2-4 levels). We evaluated sagittal balance parameters (C2-7 and index angle, SVA), global and segmental range of motion (ROM)), neck and arm VAS, Odom's criteria, re-operation rate, adjacent segment disease (ASD), willingness to undertake the same procedure again. Rate of heterotopic ossification (HO) was studied for follow-up >2 years. A subgroup analysis was performed regarding 2-level versus 3- or 4-level arthroplasty. RESULTS Thirty-two patients were included, 6 males and 26 females, mean age of 46 years (range, 30-63). Seventy-seven cervical disc levels were treated with the same artificial disc. Twenty-one patients were operated on 2 levels, nine in 3 levels, and 2 patients in 4 levels. Post-operatively, there was a decrease in SVA (-2.2±8.36 mm, P=0.098) and an increase in global (3.7±9.6º, P=0.042) and index (1.3±6.1º, P=0.071) ROM. Mean nVAS and aVAS decreased (7.5±1.1 to 2.5±1.5; 6.3±1.9 to 2.2±1.7, P<0.05). Two-level versus 3-4 level patient subgroups showed a lower SVA (-1.3±8.1 mm P=0.47; -3.4±6.3 mm P=0.107), a slight increase in global (1.6±9.4º P=0.44; 7.2±11.7º P=0.07) and index (1.1±4.7º P=0.12; 1.3±8.1º P=0.35) ROM. HO was present in 9.9% (7/71) of disc levels operated, none of them with grade 3 or 4. CONCLUSIONS Multilevel CDA provides good clinical and radiological outcomes, preserving global and segmental cervical mobility, while having a beneficial effect on sagittal balance. These results hold for 2 to 4 levels, making this technique a valuable option in selected patients with cervical multilevel CDD.
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Affiliation(s)
- Rui Reinas
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Djamel Kitumba
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
- Department of Neurosurgery, Hospital Américo Boavida, Luanda, Angola
| | - Leopoldina Pereira
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - António M. Baptista
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Óscar L. Alves
- Department of Neurosurgery, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
- Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal
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Hui N, Phan K, Kerferd J, Lee M, Mobbs RJ. Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics. Asian Spine J 2020; 15:127-137. [PMID: 32050310 PMCID: PMC7904491 DOI: 10.31616/asj.2019.0234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meiyi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ralph Jasper Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Sydney, Australia
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Chang HK, Huang WC, Tu TH, Fay LY, Kuo CH, Chang CC, Wu CL, Lirng JF, Wu JC, Cheng H, Hsu SM. Radiological and clinical outcomes of 3-level cervical disc arthroplasty. J Neurosurg Spine 2020; 32:174-181. [PMID: 31675702 DOI: 10.3171/2019.8.spine19545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One- and two-level cervical disc arthroplasty (CDA) has been compared to anterior cervical discectomy and fusion (ACDF) in several large-scale, prospective, randomized trials that have demonstrated similar clinical outcomes. However, whether these results would be similar when treating 3-level disc herniation and/or spondylosis has remained unanswered. This study aimed to investigate the differences between 3-level CDA and ACDF. METHODS A series of 50 patients who underwent 3-level CDA at C3-7 was retrospectively reviewed and compared with another series of 50 patients (age- and sex-matched controls) who underwent ACDF at C3-7. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain, the modified Japanese Orthopaedic Association (mJOA) scale, and the Neck Disability Index (NDI). Radiological outcomes included range of motion (ROM) at the index levels. Every patient was evaluated by CT for the presence of fusion in the ACDF group. Also, complication profiles were investigated. RESULTS The demographics and levels of distribution in both groups were very similar. During the follow-up period of 24 months, clinical outcomes improved (overall and respectively in each group) for both the CDA and ACDF patients when compared with the patients' preoperative condition. There were essentially few differences between the two groups in terms of neck and arm pain VAS scores, mJOA scores, and NDI scores preoperatively and at 3, 6, 12, and 24 months postoperatively. After the 3-level surgery, the CDA group had an increased mean ROM of approximately 3.4°, at 25.2° ± 8.84°, compared to their preoperative ROM (21.8° ± 7.20°) (p = 0.001), whereas the ACDF group had little mobility (22.8° ± 5.90° before and 1.0° ± 1.28° after surgery; p < 0.001). The mean operative time, estimated blood loss, and complication profiles were similar for both groups. CONCLUSIONS In this selectively matched retrospective study, clinical outcomes after 3-level CDA and ACDF were similar during the 2-year follow-up period. CDA not only successfully preserved but slightly increased the mobility at the 3 index levels. However, the safety and efficacy of 3-level CDA requires more long-term data for validatation.
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Affiliation(s)
- Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
- 3Department of Biomedical Imaging and Radiological Sciences, and
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
| | - Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
| | - Ching-Lan Wu
- 2School of Medicine
- 5Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- 2School of Medicine
- 5Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
- 4Institute of Pharmacology, National Yang-Ming University; and
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine
- 4Institute of Pharmacology, National Yang-Ming University; and
| | - Shih-Ming Hsu
- 3Department of Biomedical Imaging and Radiological Sciences, and
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Wang X, Meng Y, Liu H, Hong Y, Wang B. Is Anterior Bone Loss the Opposite of Anterior Heterotopic Ossification in Prestige-LP Cervical Disc Replacement? World Neurosurg 2020; 136:e407-e418. [PMID: 31931240 DOI: 10.1016/j.wneu.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) and anterior bone loss (ABL) are 2 complications in cervical disc replacement (CDR), which have impacts on the clinical outcomes. Physiologically, bone formation (HO) and bone loss are 2 sides of bone remodeling. However, clinically, some patients experienced anterior HO (AHO) after CDR, whereas other patients experienced ABL. Is there any factor in determining the fate of the vertebral bone in the anterior region? Is ABL the opposite of AHO? This study aims to answer these questions. METHODS Seventy patients with 1-level Prestige-LP CDR were retrospectively reviewed and were divided into an AHO group or ABL group. Radiologic outcomes, including cervical lordosis, sagittal vertical axis, functional spine unit angle, disc angle, range of motion, implant migration, subsidence, and adjacent segment degeneration were evaluated. Patient-reported clinical outcomes were also evaluated. RESULTS AHO group showed significantly lower disc angle after surgery (0.9° ± 4.2°), compared with ABL group (6.7° ± 4.7°) (P < 0.001). The preoperative segmental range of motion was significantly higher in the AHO group (10.2° ± 3.3°) than in the ABL group (8.2° ± 3.7°) (P = 0.042). No correlation was observed between clinical outcomes and the presence of anterior bone remodeling. Both groups maintained cervical alignment and functional spine unit angle during long-term follow-up. No significant difference was found in the end plate preparation, implant subsidence, migration, or adjacent segment degeneration rate between the 2 groups. CONCLUSIONS The differences in the disc angle showed the role of mechanical load in the anterior bone remodeling. Combined the results with the basic concepts of bone remodeling, ABL may be the opposite of AHO.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Abstract
Anterior cervical disc replacement (arthroplasty) has gained momentum over the past 2 decades. The ball-and-socket prosthesis design of arthroplasty has been shown to simulate normal motion in all 3 rotation planes at the level of surgery and replicates physiologic motion. Anterior cervical discectomy and fusion has been shown to be a safe and effective surgery over decades; cervical disc replacement counters some secondary effects owing to its preservation of segmental mobility, the potential to reduce adjacent segment degeneration, and the lack of plating or harvesting bone graft. The literature is growing in support of the success and longevity of arthroplasty.
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Implant Design and the Anchoring Mechanism Influence the Incidence of Heterotopic Ossification in Cervical Total Disc Replacement at 2-year Follow-up. Spine (Phila Pa 1976) 2019; 44:1471-1480. [PMID: 31568185 DOI: 10.1097/brs.0000000000003098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time. SUMMARY OF BACKGROUND DATA The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication. METHODS Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO. RESULTS The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%. CONCLUSION These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time. LEVEL OF EVIDENCE 3.
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Wahood W, Yolcu YU, Kerezoudis P, Goyal A, Alvi MA, Freedman BA, Bydon M. Artificial Discs in Cervical Disc Replacement: A Meta-Analysis for Comparison of Long-Term Outcomes. World Neurosurg 2019; 134:598-613.e5. [PMID: 31627001 DOI: 10.1016/j.wneu.2019.10.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cervical disc replacement (CDR) has emerged as an alternative to anterior cervical discectomy and fusion for the surgical treatment of degenerative cervical disc disease. Although comparison of the 2 techniques has been studied in the literature, a thorough assessment of all artificial discs between each has not been performed. The objective of the present study was to examine the long-term outcomes of 5 artificial discs. METHODS An electronic literature search was conducted for studies of CDR devices for all years available. Only articles in English were included. Heterotopic ossification, adjacent segment disease, and reoperation comprised the primary outcomes of interest. Pooled descriptive statistics with effect size (ES) and 95% confidence interval were used to synthesize the outcomes for each device. RESULTS Sixty-five studies (n = 5785) were included in the analysis. Comparison of the incidence of grade III/IV heterotopic ossification showed a significant variability between the 5 devices (P < 0.001) with ProDisc-C (ES, 38%; 95% confidence interval [CI], 24%-54%) having the highest incidence rate. Overall rate of adjacent segment disease was 14% (95% CI, 7%-23%) with significant associated heterogeneity (P < 0.001). Regarding 2-year reoperation risk, the overall incidence rate was 2% (95% CI, 1%-3%), with nonsignificant variability between devices (P = 0.63). The highest rate was observed in the Discover group (ES, 4%; 95% CI, 0%-13%). CONCLUSIONS The results of the present meta-analysis indicate that surgical and clinical outcomes may differ among different CDR devices. These findings may assist surgeons in tailoring their decision making to specific patient profiles. Future multicenter efforts are needed to validate associations found in this study.
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Affiliation(s)
- Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Turner I, Choi D. NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up. Neurosurgery 2019; 83:422-428. [PMID: 28973309 DOI: 10.1093/neuros/nyx424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 07/11/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anterior cervical disc replacement is an alternative to fusion for the treatment of selected cases of radiculopathy and myelopathy. We report clinical and radiological outcomes after disc replacement with the NuNec™ artificial cervical disc (Pioneer® Surgical Technology, Marquette, Michigan) with subgroup analysis. OBJECTIVE To review clinical and radiological outcomes after anterior cervical disc replacement with the NuNec™ artificial cervical disc. METHODS A consecutive case series of patients undergoing cervical disc replacement with the NuNec™ artificial disc was conducted. Clinical outcomes were assessed by questionnaires preoperatively and up to 2 yr postoperatively including neck and arm pain, Neck Disability Index, Euroqol 5-dimensions, and Short Form-36; x-rays from the same period were analyzed for range of movement and presence of heterotopic ossification. RESULTS A total of 44 NuNec™ discs were implanted in 33 patients. Clinical improvements were seen in all outcomes; significant improvements on the Neck Disability Index, Euroqol 5-dimensions, and physical domain of the Short Form-36 were maintained at 2 yr. There was a mean of 4° range of movement at the replacement disc level at 2 yr, a significant reduction from baseline; there was also progression in levels of heterotopic ossification. Complications included temporary dysphagia (10%) and progression of disease requiring foraminotomy (6%); no surgery for adjacent level disease was required. There was no significant difference in the outcomes of the radiculopathy and myelopathy groups. CONCLUSION Clinical outcomes using the NuNec™ disc replacement are comparable with other disc replacements. Although the range of movement is reduced, the reoperation rate is very low.
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Affiliation(s)
- Isobel Turner
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, England
| | - David Choi
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, England
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Tu TH, Lee CY, Kuo CH, Wu JC, Chang HK, Fay LY, Huang WC, Cheng H. Cervical disc arthroplasty for less-mobile discs. J Neurosurg Spine 2019; 31:310-316. [PMID: 31075765 DOI: 10.3171/2019.2.spine181472] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°-9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM. METHODS A series of consecutive patients who underwent CDA at the level of C5-6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5-6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5-6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed. RESULTS A total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups. CONCLUSIONS Preoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.
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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica; and
| | - Chu-Yi Lee
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Wu JC, Chang HK, Huang WC, Chen YC. Risk factors of second surgery for adjacent segment disease following anterior cervical discectomy and fusion: A 16-year cohort study. Int J Surg 2019; 68:48-55. [DOI: 10.1016/j.ijsu.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 12/31/2022]
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Heterotopic ossification is related to change in disc space angle after Prestige-LP cervical disc arthroplasty. 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 2019; 28:2359-2370. [DOI: 10.1007/s00586-019-06053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
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Radiological exploration on adjacent segments after total cervical disc replacement with Prodisc-C prosthesis. J Orthop Surg Res 2019; 14:160. [PMID: 31138246 PMCID: PMC6540473 DOI: 10.1186/s13018-019-1194-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/14/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose The relationship between upper or lower adjacent segments (UAS/LAS) and the cervical spine parameters was not clear yet. So, the purpose was to analyze range of motion (ROM), lordosis (LOR), and intervertebral disc height (IDH) of UAS and LAS before and after total cervical disc replacement (TDR) and to explore the influencing factors of cervical spine radiological parameters on adjacent segments. Methods A single-center retrospective study was performed on patients completing 10-year follow-up undergone TDR. As the primary outcomes, radiological parameters included UAS-ROM/LAS-ROM, UAS-LOR/LAS-LOR, and UAS-IDH/LAS-IDH. The secondary outcomes were ROM and LOR of C2–C7 and surgical levels, IDH of surgical segments, prosthesis migration, subsidence, heterotopic ossification (HO), and adjacent segment degeneration (ASD), which were measured on X-ray. Results UAS-ROM and LAS-ROM remained stable in follow-up periods. There was no significance on UAS-LOR or LAS-LOR between pre- and post- operation, so was UAS-IDH or LAS-IDH. UAS-ROM was larger in the segments with ASD (P < 0.001), the same to LAS-ROM (P < 0.001), and UAS-LOR was larger in segments with ASD (P = 0.02). UAS-ROM was positively correlated with C2–C7 ROM and LOR (both P < 0.001). UAS-LOR was correlated with operated-segmental LOR while LAS-LOR were in correlation with surgical segment ROM. The influencing factors of UAS-ROM were the surgical segment ROM and C2–C7 LOR. The influencing factors of UAS-LOR and LAS-LOR were LAS-ROM and UAS-ROM, respectively. The influencing factors of UAS-IDH were LAS-IDH, surgical segment IDH, and HO while that of LAS-IDH were UAS-IDH and surgical segment IDH. Conclusions TDR has only a little effect on the adjacent segments. There is an interaction between UAS and LAS. The maintenance on surgical segments ROM and reconstruction of IDH will benefit to adjacent segments.
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Effect of Prosthesis Width and Depth on Heterotopic Ossification After Cervical Disc Arthroplasty. Spine (Phila Pa 1976) 2019; 44:624-628. [PMID: 30395084 DOI: 10.1097/brs.0000000000002915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To investigate the effect of width and depth of the inserted cervical disc prosthesis on heterotopic ossification (HO) after cervical disc arthroplasty, and to explore the relationship between clinical outcome and HO. SUMMARY OF BACKGROUND DATA The mechanism of HO formation still remains unknown. Footprint mismatch of cervical disc prosthesis was common in cervical arthroplasty. Compared with endplate, some inserted prostheses were smaller in width and length. METHODS Retrospectively analyze the patients who underwent cervical disc arthroplasty with Prestige-LP Disc in our institute. Patients were divided into HO group or non-HO group according to the McAfee classification. The ratios of the width (Rw) and depth (Rd) of prosthesis to endplate were calculated. Radiographic and clinical assessments included: C2-7 angle, segmental angle, range of motion (ROM) of the index level, visual analogue scale, neck disability index, and Japanese orthopaedic association scores. RESULTS The mean follow-up time was 47.7 months. At the last follow-up, the overall incidence of HO was 34.3% (35/102). There were 35 patients in the HO-group, and 67 patients in the non-HO group. The overall Rw and Rd were 0.887 ± 0.057 and 0.927 ± 0.048, respectively. Both the Rw and Rd of HO-group were smaller than those of non-HO group (0.869 vs. 0.897, P = 0.033; 0.888 vs. 0.948, P < 0.001). There were no significant differences in visual analogue scale, neck disability index, or Japanese orthopaedic association scores, C2-7 angle, or segmental angle between the two groups. But the HO group had less ROM of the index level than the non-HO group (5.3° vs. 9.0°). CONCLUSION Some of prosthesis had insufficient coverage to the endplate in width and depth. Insufficient coverage of endplate in width and depth may induce the formation of HO. HO could reduce the ROM of the index level, but did not influence the clinical outcome. LEVEL OF EVIDENCE 3.
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Wu JC, Chang HK, Huang WC, Tu TH, Fay LY, Kuo CH, Chang CC, Wu CL, Chang HC, Cheng H. Radiological and clinical outcomes of cervical disc arthroplasty for the elderly: a comparison with young patients. BMC Musculoskelet Disord 2019; 20:115. [PMID: 30885198 PMCID: PMC6421705 DOI: 10.1186/s12891-019-2509-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to investigate whether cervical disc arthroplasty (CDA) would be equally effective in elderly patients as in the young. The inclusion criteria of published clinical trials for CDA-enrolled patients covered the ages from 18 to 78 years. However, there was a paucity of data addressing the differences of outcomes between older and the younger patients. Methods A series of consecutive patients who underwent one- or two-level CDA were retrospectively reviewed. Patients at the two extreme ends of the age distribution (≥65 and ≤ 40 years) were selected for comparison. Clinical outcome parameters included visual analog scale (VAS) of neck and arm pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiographic outcomes included range of motion (ROM) at the indexed level and evaluation of heterotopic ossification (HO) by computed tomography (CT). Complication profiles were also investigated. Results There were 24 patients in the elderly group (≥65 years old) and 47 patients in the young group (≤40 years old) with an overall mean follow-up of 28.0 ± 21.97 months. The elderly group had more two-level CDA, and thus the mean operative time was longer (239 vs. 179 min, p < 0.05) than the young group. Both groups had similarly significant improvement in clinical outcomes at the final follow-up. All the replaced disc segments remained mobile on post-operative lateral flexion and extension radiographs. However, the elderly group had a slight decrease in mean ROM (− 0.32° ± 3.93°) at the index level after CDA when compared to that of pre-operation. In contrast, the young group had an increase in mean ROM (+ 0.68° ± 3.60°). The complication profiles were not different, though a trend toward dysphagia was noted in the elderly group (p = 0.073). The incidence or severity (grading) of HO was similar between the two groups. Conclusions During the follow-up of two years, CDA was equally effective for patients over 65 years old and those under 40 years in clinical improvement. Although the elderly group demonstrated a small reduction of mean ROM after CDA, in contrast to the young group which had a small increase, the segmental mobility was well preserved at every indexed level for each group.
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Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Fay
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huang-Chou Chang
- Department of Surgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Abstract
STUDY DESIGN A nonrandomized, prospective, and single-center clinical trial of the ProDisc Vivo prosthesis. OBJECTIVE The aim of this study was to investigate the clinical and radiological results of a refined total cervical disc replacement (cTDR), the ProDisc Vivo, with two years of follow-up (FU). The incidence of implant-related complications was recorded as a secondary outcome variable. SUMMARY OF BACKGROUND DATA Previous generations of the ProDisc artificial cervical disc replacement generate high primary stability due to keel-based designs with opening of the anterior cortex during the implantation and subsequent high rates of heterotopic ossifications. METHODS Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires. The radiological outcome included the range of motion (ROM) and the occurrence of heterotopic ossifications. The incidence of implant-related complications with new implant design was recorded as a secondary outcome variable. RESULTS A total of 55 patients received a single-level treatment with the ProDisc Vivo cTDR between C3/4 and C6/7, with a follow-up rate of 78%. The clinical outcome scores improved in all parameters significantly (P = 0.0001) (NDI: 68.3 → 17.4; VAS arm: 6.3 → 1.4; VAS neck: 4.9 → 1.6). The ROM of the index-segment did not show a significant change (P = 0.26) (7.9° → 9.2°). Heterotopic ossifications at the index segment was found as grade 0 in 58%, grade 1 in 22%, grade 2 in 10%, grade 3 (with functional impairment of the prosthesis) in 7%, and grade 4 in 3% of the cases. We observed three implant-related complications (5.5%), with two implant dislocations anteriorly and one low-grade infect. CONCLUSION cTDR with ProDisc Vivo demonstrated a significant and sustained improvement of all clinical outcome parameters. A less invasive implantation mechanism with lower primary stability of the cTDR might be a reason for a higher dislocation rate than the keel-based previous generation ProDisc C. LEVEL OF EVIDENCE 4.
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Tu TH, Kuo CH, Huang WC, Fay LY, Cheng H, Wu JC. Effects of smoking on cervical disc arthroplasty. J Neurosurg Spine 2019; 30:168-174. [PMID: 31066538 DOI: 10.3171/2018.7.spine18634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective Cigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA. Methods The authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO). Results A total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43). Conclusions During an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked. Abbreviations ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment degeneration; CDA = cervical disc arthroplasty; FDA = Food and Drug Administration; HO = heterotopic ossification; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; ROM = range of motion; VAS = visual analog scale.
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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Institute of Biomedical Sciences, Academia Sinica, and National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; and
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
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Chang CC, Huang WC, Wu JC, Mummaneni PV. The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update. Neurospine 2018; 15:296-305. [PMID: 30545210 PMCID: PMC6347355 DOI: 10.14245/ns.1836186.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 12/22/2022] Open
Abstract
Cervical disc arthroplasty (CDA), or total disc replacement, has emerged as an option in the past two decades for the management of 1- and 2-level cervical disc herniation and spondylosis causing radiculopathy, myelopathy, or both. Multiple prospective randomized controlled trials have demonstrated CDA to be as safe and effective as anterior cervical discectomy and fusion, which has been the standard of care for decades. Moreover, CDA successfully preserved segmental mobility in the majority of surgical levels for 5–10 years. Although CDA has been suggested to have long-term efficacy for the reduction of adjacent segment disease in some studies, more data are needed on this topic. Surgery for CDA is more demanding for decompression, because indirect decompression by placement of a tall bone graft is not possible in CDA. The artificial discs should be properly sized, centered, and installed to allow movement of the vertebrae, and are commonly 6 mm high or less in most patients. The key to successful CDA surgery includes strict patient selection, generous decompression of the neural elements, accurate sizing of the device, and appropriately centered implant placement.
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Affiliation(s)
- Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
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Song Q, Tian W, He D, Han X, Zhang N, Wang J, Li Z. [Long-term clinical efficacy of cervical artificial disc replacement for cervical spondylotic radiculopathy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:668-672. [PMID: 29905042 DOI: 10.7507/1002-1892.201712045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR). Methods The data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C 3, 4 in 2 cases, C 4, 5 in 6 cases, C 5, 6 in 18 cases, C 6, 7 in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups ( P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification (PO) grading. The clinical evaluation indexes included neck disability index (NDI) and overall efficacy (Odom's score). Results All patients were followed up 121-153 months (mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased ( P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up ( P>0.05). Except that the loss of ROM (ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A ( P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups ( P>0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups ( P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom's score between 2 groups ( P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups. Conclusion CADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.
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Affiliation(s)
- Qingpeng Song
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035,
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Ning Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Zuchang Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
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Song Q, Tian W, He D, Han X, Zhang N, Wang J, Li Z, Feng X. [Analysis of influence of shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:526-530. [PMID: 29806337 DOI: 10.7507/1002-1892.201710083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the influence of the shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement (CADR). Methods The clinical data of 71 patients who were treated with single-level CADR with Bryan prosthesis between December 2003 and December 2007 and followed up more than 10 years, were retrospectively analyzed. There were 44 males and 27 females with an age of 26-69 years (mean, 45.9 years). According to the shell angle of the cervical artificial disc which was measured on the postoperative lateral X-ray film, the patients were divided into kyphotic group (shell angle was negative) and non-kyphotic group. The following evaluation indexes before operation and at last follow-up were compared between 2 groups. Radiographic indexes included the range of motion (ROM) of cervical spine, the ROM of operated level, Cobb angle of operated level (the negative value indicated that the segmental kyphosis occurred at operated level), paravertebral ossification (PO) grades (grades 3 and 4 were high grade PO). Clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and overall effectiveness evaluation (Odom criteria). Results There were 24 patients in kyphotic group and 47 patients in non-kyphotic group. There was no significant difference in baseline data including gender, age, and operated level between 2 groups ( P>0.05). All the patients in 2 groups were followed up 121-165 months (mean, 128 months). There was no significant difference in preoperative ROM of cervical spine and ROM of operated level between 2 groups ( P>0.05); but the preoperative Cobb angle of operated level in kyphosis group was significantly lower than that in non-kyphotic group ( t=2.636, P=0.013). There was no significant difference in ROM of cervical spine at last follow-up between 2 groups ( t=1.393, P=0.168), however, the ROM and the Cobb angle of operated level in kyphotic group were significantly lower than those in non-kyphotic group ( P<0.05). According to the Cobb angle of operated level at last follow-up, there were 9 patients (37.5%) with segmental kyphosis in kyphotic group and 7 patients (14.9%) in non-kyphotic group, showing significant difference ( χ2=4.651, P=0.031). There was a significant difference in PO grades between 2 groups ( Z=2.894, P=0.004) at last follow-up. In kyphotic group, there were 10 patients (41.7%) with low grade PO and 14 patients (58.3%) with high grade PO; and in non-kyphosis group, there were 36 patients (76.6%) with low grade PO and 11 patients (23.4%) with high grade PO. There was no significant difference in JOA scores and NDI before operation and at last follow-up, and the JOA improvement rate, NDI decline, and Odom criteria score at last follow-up between 2 groups ( P>0.05). Conclusion The shell angle of cervical artificial disc may lead to a decrease in the postoperative segmental ROM, and an increased occurrence of segmental kyphosis and high incidence of PO.
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Affiliation(s)
- Qingpeng Song
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035,
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Ning Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Zuchang Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Xiao Feng
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
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Wang LN, Hu BW, Wang L, Song YM, Yang X, Liu LM, Liu H. Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up. BMC Musculoskelet Disord 2018; 19:101. [PMID: 29615017 PMCID: PMC5883531 DOI: 10.1186/s12891-018-2017-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 02/05/2023] Open
Abstract
Background To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. Methods From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. Results The mean follow-up period was 72.3 months (range 68–78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. Conclusions The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.
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Affiliation(s)
- Lin-Nan Wang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Bo-Wen Hu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Lei Wang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China.
| | - Yue-Ming Song
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China.
| | - Xi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Li-Min Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China
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Clinical and radiographic comparison of cervical disc arthroplasty with Prestige-LP Disc and anterior cervical fusion: A minimum 6-year follow-up study. Clin Neurol Neurosurg 2018; 164:97-102. [DOI: 10.1016/j.clineuro.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/20/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022]
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Zeng J, Liu H, Yang Y. Letter to the Editor. Segmental mobility and heterotopic ossification after cervical arthroplasty. Neurosurg Focus 2017; 43:E15. [PMID: 28965449 DOI: 10.3171/2017.5.focus17276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Junfeng Zeng
- West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hao Liu
- West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Yang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Yang P, Li Y, Li J, Shen Y. Impact of T1 slope on surgical and adjacent segment degeneration after Bryan cervical disc arthroplasty. Ther Clin Risk Manag 2017; 13:1119-1125. [PMID: 28894375 PMCID: PMC5584913 DOI: 10.2147/tcrm.s138990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This retrospective study investigated an association between preoperative T1 slope and surgical and adjacent segment degeneration (SASD) after Bryan cervical disc arthroplasty (BCDA) in patients with cervical degenerative disc disease. METHODS Based on preoperative standing lateral radiographs, 90 patients were classified according to T1 slope that was higher or lower than the 50th percentile (high T1 or low T1, 28 and 62 patients, respectively). Patients were also classified as SASD or non-SASD (38 and 52 patients, respectively) determined by radiographs at final follow-up. Visual analog scale (VAS) and Neck Disability Index (NDI) scores for neck and arm pain were noted, and changes in the sagittal alignment of the cervical spine (SACS), functional spinal unit (FSU) angle, and FSU range of motion (ROM) were also noted. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for SASD. RESULTS The overall rate of SASD was 42.2% (38/90). The SACS, FSU angle, FSU ROM, and SASD rates of the high T1 and low T1 slope groups were significantly different at the last follow-up. The NDI and VAS scores of the high T1 slope group were significantly greater than those of the low T1 slope. The multivariate logistic regression analysis showed that high T1 slope and endplate coverage discrepancy (ie, residual space behind the prosthesis) were significant risk factors for SASD after BCDA. CONCLUSION High T1 slope and endplate coverage discrepancy were associated with SASD after BCDA. Patients with a high preoperative T1 slope have a smaller FSU angle and more neck pain after BCDA.
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Affiliation(s)
- Peng Yang
- Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan
| | - Yongqian Li
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Jia Li
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yong Shen
- Department of Orthopedic Surgery
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
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Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement. 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 2017; 26:2441-2449. [PMID: 28676980 DOI: 10.1007/s00586-017-5204-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/09/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Previous studies have demonstrated that total cervical disc replacement (cTDR) represents a viable treatment alternative to the 'gold standard' anterior cervical discectomy and fusion for the treatment of well-defined cervical pathologies at short- and mid-term follow-up (FU). However, the implementation and acceptance of a non-fusion philosophy is closely associated with its avoidance of adjacent segment degeneration. Proof of the functional sustainability and clinical improvement of symptoms at long-term FU is still pending. The aim of this ongoing prospective study was to investigate the clinical and radiological results of cTDR at long-term FU. METHODS 50 patients were treated surgically within a non-randomised prospective study framework with cTDR (ProDisc C™, Synthes, Paoli, PA, USA). Patients were examined preoperatively followed by routine clinical and radiological examinations at 1, 5 and 10 years after surgery, respectively. In addition to the clinical scores, conventional X-ray images of the cervical spine were taken in anteroposterior and lateral view as well as flexion/extension images. Clinical outcome scores included parameters such as the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires as well as subjective patient satisfaction rates. The radiological outcome variables included the range of motion (ROM) of the implanted prosthesis between maximum flexion and extension images, the occurrence of heterotopic ossifications and radiographic signs of adjacent segment degenerative changes. The reoperation rate following cTDR was recorded as a secondary outcome variable. RESULTS A significant and maintained clinical improvement of all clinical outcome scores was observed after a mean FU of 10.2 years (VASarm 6.3-2.1; VASneck 6.4-1.9; NDI 21-6; p < 0.05). An increase in the incidence and the extent of heterotopic ossifications was noted during the post-operative course with a significant influence on the function of the prosthesis, which, however, did not reveal any detrimental effect on the patients' clinical symptomatology. Prosthesis mobility declined from 9.0° preoperatively and 9.1° at 1 year FU to 7.7° and 7.6° at the five- and ten-year FU examinations, respectively. Radiological signs of adjacent segment degeneration were detected in 13/38 (35.7%), however, in only 3/38 (7.9%) patients this radiological changes were associated with clinical symptoms requiring conservative treatment. Intraoperative technical failure in two cases required interbody fusion with a cage (2/50). One patient (1/48, 2.1%) treated this motion device had revision surgery at the index level. CONCLUSION Cervical total disc replacement with ProDisc C demonstrated a significant and maintained improvement of all clinical outcome parameters at a follow-up of ≥10 years. The present long-term data reveal that with an exceptionally low implant-related reoperation rate and low symptomatic adjacent segment degeneration rate, cTDR may be regarded as a safe and viable treatment option.
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Analysis of the Factors That Could Predict Segmental Range of Motion After Cervical Artificial Disk Replacement: A 7-Year Follow-up Study. Clin Spine Surg 2017; 30:E603-E608. [PMID: 28525485 DOI: 10.1097/bsd.0000000000000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify the potential preoperative factors and surgical technique factors that are associated with long-term range of motion (ROM) after surgery. Further, this article aimed to guide selection of patients with cervical artificial disk replacement and a fine surgical technique. SUMMARY OF BACKGROUND DATA Segmental ROM is the most important parameter concerning cervical kinematics after a cervical artificial disk replacement. There are few researches regarding the influencing factors on postoperative ROM, and consistent results have not yet been reported. METHODS The cohort comprised a total of 68 disks implanted into 57 patients who were retrospectively analyzed. The mean follow-up period was 84.1 months. Segmental ROM and other useful parameters were measured using lateral neutral, extension, and flexion radiographs, which were obtained preoperatively, 3 months after surgery, and at last follow-up. Preoperative CT and clinical assessment were also used. To find out associated factors, the patients were divided into 2 groups according to the segmental ROM at last follow-up. RESULTS After surgery, the clinical outcomes were satisfactory. The segmental ROM at last follow-up (7.8±4.3 degrees) was preserved without significant change from preoperative ROM (8.8±3.8 degrees). The patients who had a better segmental ROM after surgery were found to have a higher preoperative segmental ROM, a younger age, a better disk insertion angle, and disk insertion depth. These 4 factors were identified as independent risk factors (P=0.027, 0.017, 0.036, and 0.046, respectively) for long-term ROM. CONCLUSIONS The postoperative long-term, segmental ROM was well preserved and found to be affected by the preoperative segmental ROM, patient's age, disk insertion angle, and disk insertion depth.
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Tian W, Han X, Liu B, He D, Lv Y, Yue J. Generation and Development of Paravertebral Ossification in Cervical Artificial Disk Replacement: A Detailed Analytic Report Using Coronal Reconstruction CT. Clin Spine Surg 2017; 30:E179-E188. [PMID: 28323697 DOI: 10.1097/bsd.0000000000000044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective follow-up study and review of images in published papers. OBJECTIVE To determine whether true heterotopic ossification (HO) occurs in artificial disk replacement (ADR); to evaluate the incidence of paravertebral ossification (PO) and its influence on ADR. SUMMARY OF BACKGROUND DATA HO is typically defined as the abnormal formation of true bone within extraskeletal soft tissues. However, HO in ADR does not fit this definition precisely, as it originates from vertebral body, making it hard to distinguish radiologically from preexisting osteophytes. In this study, the term used for bone formation around ADR is PO. METHODS First, all images in the published papers were evaluated as to whether the presented PO in ADR fit the classic definition of HO or osteophytes. Second, we studied 37 consecutive patients who underwent ADR and follow-up for minimum 24 months. The preoperative and follow-up incidence of PO and its influence on range of motion were evaluated using x-ray and computed tomography. RESULTS All 52 images of PO were found adjacent to the disk in 1 segment rather than entire cervical spine. Fifty (96.2%) of the POs were found to originate from the vertebral body rather than in the soft tissue. A total of 31 patients were included in the follow-up study. No significant difference was found in the incidence of PO between the follow-up and preoperation (61.29% vs. 48.39%, P>0.05). The range of motion of the ADR segment in patients with progressed PO (7.44±4.64 degrees) was significantly lower than that of patients with stable PO grade (12.13±4.42 degrees, P<0.01) at last follow-up. CONCLUSIONS A proportion of HO might in fact be the natural development of preoperative osteophytes, which is unrelated to ADR; the remaining HO might be due to changes in biomechanical environment after surgery, which promotes the grade of osteophytes and affects the segment motion.
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Affiliation(s)
- Wei Tian
- *Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China †Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT
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Chang HK, Chang CC, Tu TH, Wu JC, Huang WC, Fay LY, Chang PY, Wu CL, Cheng H. Can segmental mobility be increased by cervical arthroplasty? Neurosurg Focus 2017; 42:E3. [DOI: 10.3171/2016.10.focus16411] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Many reports have successfully demonstrated that cervical disc arthroplasty (CDA) can preserve range of motion after 1- or 2-level discectomy. However, few studies have addressed the extent of changes in segmental mobility after CDA or their clinical correlations.
METHODS
Data from consecutive patients who underwent 1-level CDA were retrospectively reviewed. Indications for surgery were medically intractable degenerative disc disease and spondylosis. Clinical outcomes, including visual analog scale (VAS)–measured neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores, were analyzed. Radiographic outcomes, including C2–7 Cobb angle, the difference between pre- and postoperative C2–7 Cobb angle (ΔC2–7 Cobb angle), sagittal vertical axis (SVA), the difference between pre- and postoperative SVA (ΔSVA), segmental range of motion (ROM), and the difference between pre- and postoperative ROM (ΔROM), were assessed for their association with clinical outcomes. All patients underwent CT scanning, by which the presence and severity of heterotopic ossification (HO) were determined during the follow-up.
RESULTS
A total of 50 patients (mean age 45.6 ± 9.33 years) underwent a 1-level CDA (Prestige LP disc) and were followed up for a mean duration of 27.7 ± 8.76 months. All clinical outcomes, including VAS, NDI, and JOA scores, improved significantly after surgery. Preoperative and postoperative ROM values were similar (mean 9.5° vs 9.0°, p > 0.05) at each indexed level. The mean changes in segmental mobility (ΔROM) were −0.5° ± 6.13°. Patients with increased segmental mobility after surgery (ΔROM > 0°) had a lower incidence of HO and HO that was less severe (p = 0.048) than those whose ΔROM was < 0°. Segmental mobility (ROM) was significantly lower in patients with higher HO grade (p = 0.012), but it did not affect the clinical outcomes. The preoperative and postoperative C2–7 Cobb angles and SVA remained similar. The postoperative C2–7 Cobb angles, SVA, ΔC2–7 Cobb angles, and ΔSVA were not correlated to clinical outcomes after CDA.
CONCLUSIONS
Segmental mobility (as reflected by the mean ROM) and overall cervical alignment (i.e., mean SVA and C2–7 Cobb angle) had no significant impact on clinical outcomes after 1-level CDA. Patients with increased segmental mobility (ΔROM > 0°) had significantly less HO and similarly improved clinical outcomes than those with decreased segmental mobility (ΔROM < 0°).
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Affiliation(s)
- Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
- 3Institute of Pharmacology, National Yang-Ming University; and
| | - Peng-Yuan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
| | - Ching-Lan Wu
- 2School of Medicine and
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine and
- 3Institute of Pharmacology, National Yang-Ming University; and
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Byval'tsev VA, Kalinin AA, Stepanov IA, Pestryakov YY, Shepelev VV. [Analysis of the results of total cervical disc arthroplasty using a M6-C prosthesis: a multicenter study]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:46-55. [PMID: 29076467 DOI: 10.17116/neiro201781546-55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Cervical spondylosis and intervertebral disc (IVD) degeneration are the most common cause for compression of the spinal cord and/or its roots. Total IVD arthroplasty, as a modern alternative to surgical treatment of IVD degeneration, is gaining popularity in many neurosurgical clinics around the world. Aim - the study aim was to conduct a multicenter analysis of cervical spine arthroplasty with an IVD prosthesis M6-C ('Spinal Kinetics', USA). MATERIAL AND METHODS The study included 112 patients (77 males and 35 females). All patients underwent single-level discectomy with implantation of the artificial IVD prosthesis M6-C. The follow-up period was up to 36 months. Dynamic assessment of the prosthesis was based on clinical parameters (pain intensity in the cervical spine and upper extremities (visual analog scale - VAS); quality of life (Neck Disability Index - NDI)); and subjective satisfaction with the results of surgical treatment (Macnab scale) and instrumental data (range of motion in the operated spinal motion segment, degree of heterotopic ossification (McAfee-Suchomel classification), and time course of degenerative changes in the adjacent segments).
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Affiliation(s)
- V A Byval'tsev
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education', Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - V V Shepelev
- 1477th Naval Clinical Hospital of the Ministry of Defense of the Russian Federation, Vladivostok, Russia
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Chang HC, Tu TH, Chang HK, Wu JC, Fay LY, Chang PY, Wu CL, Huang WC, Cheng H. Hybrid Corpectomy and Disc Arthroplasty for Cervical Spondylotic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament and Disc Herniation. World Neurosurg 2016; 95:22-30. [PMID: 27474455 DOI: 10.1016/j.wneu.2016.07.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/16/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Ozbek Z, Ozkara E, Arslantaş A. Implant Migration in Cervical Disk Arthroplasty. World Neurosurg 2016; 97:390-397. [PMID: 27756667 DOI: 10.1016/j.wneu.2016.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this study is to discuss the causes of implant migration after cervical arthroplasty with clinical cases. METHODS The patients who underwent cervical arthroplasty operations in our department between 2006 and 2015 because of cervical disk disease were retrospectively analyzed. The patients who were determined to be symptomatic of implant migration were evaluated. RESULTS Symptomatic implant migration was detected in 5 of 163 (0.3%) patients who underwent cervical disk arthroplasty, and these patients also underwent reoperation. In 4 patients who underwent reoperation, the prosthesis was removed, and an anterior fusion was made. The prosthesis was only removed in 1 patient. CONCLUSIONS The following situations should be considered in the prevention of dislocation and migration of the implant in cervical arthroplasty: protection of the structure of the end plate, selection of the appropriate implant size, and proper surgical construction. In the preoperative period, computed tomography scan may be useful for determining the implant size and details of the bone structure. Foreign body reactions or postoperative trauma may be a rare and unpreventable reason for prosthesis dislocation despite all of the preoperative and perioperative measures and well-made prosthesis designs.
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Affiliation(s)
- Zuhtu Ozbek
- Department of Neurosurgery, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Emre Ozkara
- Department of Neurosurgery, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ali Arslantaş
- Department of Neurosurgery, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Chang HK, Huang WC, Wu JC, Chang PY, Tu TH, Fay LY, Wu CL, Chang HC, Cheng H. Should Cervical Disc Arthroplasty Be Done on Patients with Increased Intramedullary Signal Intensity on Magnetic Resonance Imaging? World Neurosurg 2016; 89:489-96. [DOI: 10.1016/j.wneu.2016.02.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
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