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Zavras AG, Acosta JR, Holmberg KJ, Semenza NC, Jayamohan HR, Cheng BC, Altman DT, Sauber RD. Effect of device constraint: a comparative network meta-analysis of ACDF and cervical disc arthroplasty. Spine J 2024:S1529-9430(24)00267-5. [PMID: 38843960 DOI: 10.1016/j.spinee.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND CONTEXT Clinical trials have demonstrated that cervical disc arthroplasty (CDA) is an effective and safe alternative treatment to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease in the appropriately indicated patient population. Various devices for CDA exist, differing in the level of device constraint. PURPOSE To investigate outcomes following Anterior Cervical Discectomy and Fusion (ACDF) versus CDA stratified based on the level of device constraint: Constrained, Semiconstrained, and Unconstrained. STUDY DESIGN Systematic review and network meta-analysis. PATIENT SAMPLE 2,932 CDA patients (979 Constrained, 1,214 Semiconstrained, 739 Unconstrained) and 2,601 ACDF patients from 41 studies that compared outcomes of patients undergoing CDA or ACDF at a single level at a minimum of 2 years follow-up. OUTCOME MEASURES Outcomes of interest included the development of adjacent segment degeneration (ASD), index and adjacent segment reoperation rates, range of motion (ROM), high-grade heterotopic ossification (HO, McAfee Grades 3/4), and patient-reported outcomes (NDI/VAS). METHODS CDA devices were grouped based on the degrees of freedom (DoF) allowed by the device, as either Constrained (3 DoF), Semiconstrained (4 or 5 DoF), or Unconstrained (6 DoF). A random effects network meta-analysis was conducted using standardized mean differences (SMD) and log relative risk (RR) were used to analyze continuous and categorical data, respectively. RESULTS Semiconstrained (p=.03) and Unconstrained CDA (p=.01) demonstrated a significantly lower risk for ASD than ACDF. All levels of CDA constraint demonstrated a significantly lower risk for subsequent adjacent segment surgery than ACDF (p<.001). Semiconstrained CDA also demonstrated a significantly lower risk for index level reoperation than both ACDF and Constrained CDA (p<.001). Unconstrained devices retained significantly greater ROM than both Constrained and Semiconstrained CDA (p<.001). As expected, all levels of device constraint retained significantly greater ROM than ACDF (p<.001). Constrained and Unconstrained devices both demonstrated significantly lower levels of disability on NDI than ACDF (p=.02). All levels of device constraint demonstrated significantly less neck pain than ACDF (p<.05), while Unconstrained CDA had significantly less arm pain than ACDF (p=.02) at final follow-up greater than 2 years. CONCLUSION Cervical Disc Arthroplasty, particularly the unconstrained and semiconstrained designs, appears to be more effective than ACDF in reducing the risk of adjacent segment degeneration and the need for further surgeries, while also allowing for greater range of motion and better patient-reported outcomes. Less constrained CDA conferred a lower risk for index level reoperation, while also retaining more range of motion than more constrained devices.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Jonathan R Acosta
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kyle J Holmberg
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nicholas C Semenza
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Boyle C Cheng
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan D Sauber
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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Ortiz-Babilonia CD, Gupta A, Cartagena-Reyes MA, Xu AL, Raad M, Durand WM, Skolasky RL, Jain A. The Statistical Fragility of Trials Comparing Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion: A Meta Analysis. Spine (Phila Pa 1976) 2024; 49:708-714. [PMID: 37368958 DOI: 10.1097/brs.0000000000004756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To assess the robustness of randomized controlled trials (RCTs) that compared cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative cervical pathology by using fragility indices. SUMMARY OF BACKGROUND DATA RCTs comparing these surgical approaches have shown that CDA may be equivalent or even superior to ACDF due to better preservation of normal spinal kinematics. MATERIALS AND METHODS RCTs reporting clinical outcomes after CDA versus ACDF for degenerative cervical disc disease were evaluated. Data for outcome measures were classified as continuous or dichotomous. Continuous outcomes included: Neck Disability Index, overall pain, neck pain, radicular arm pain, and modified Japanese Orthopedic Association scores. Dichotomous outcomes included: any adjacent segment disease (ASD), superior-level ASD, and inferior-level ASD. The fragility index (FI) and continuous FI (CFI) were determined for dichotomous and continuous outcomes, respectively. The corresponding fragility quotient (FQ) and continuous FQ were calculated by dividing FI/CFI by sample size. RESULTS Twenty-five studies (78 outcome events) were included. Thirteen dichotomous events had a median FI of 7 [interquartile range (IQR): 3-10], and the median FQ was 0.043 (IQR: 0.035-0.066). Sixty-five continuous events had a median CFI of 14 (IQR: 9-22) and a median continuous FQ of 0.145 (IQR: 0.074-0.188). This indicates that, on average, altering the outcome of 4.3 patients out of 100 for the dichotomous outcomes and 14.5 out of 100 for continuous outcomes would reverse trial significance. Of the 13 dichotomous events that included a loss to follow-up data, 8 (61.5%) represented ≥7 patients lost. Of the 65 continuous events reporting the loss to follow-up data, 22 (33.8%) represented ≥14 patients lost. CONCLUSION RCTs comparing ACDF and CDA have fair to moderate statistical robustness and do not suffer from statistical fragility.
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Affiliation(s)
- Carlos D Ortiz-Babilonia
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
- Department of Orthopedic Surgery, University of Puerto Rico, PR
| | - Arjun Gupta
- Department of Orthopedic Surgery, Rutgers University, New Jersey, NJ
| | | | - Amy L Xu
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Richard L Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
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Abdelmalek G, Coban D, Patel N, Changoor S, Sahai N, Sinha K, Hwang K, Emami A. Are Patients With Segmental Cervical Kyphosis Appropriate Candidates for Cervical Disc Arthroplasty (CDA)? A Clinical and Radiographic Analysis Compared to Anterior Cervical Discectomy and Fusion (ACDF). Global Spine J 2024:21925682241232616. [PMID: 38359817 DOI: 10.1177/21925682241232616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare the clinical and radiographic outcomes of Anterior Cervical Discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in patients with preoperative segmental kyphosis. METHODS Patients with segmental cervical kyphosis at the operative levels undergoing 1- or 2-level ACDF or CDA from 2017 to 2020 with 2 years of follow were identified. Patient demographics, perioperative data, complication rates, radiographic findings and reported outcomes were analyzed. RESULTS A total of 48 patients met inclusion criteria and were included in our study (ACDF: n = 24, CDA: n = 24). Patient demographic data between the 2 cohorts was similar expect for proportion of males (ACDF: 62.5% vs CDA: 33.3%, P = .043). There was no statistical significance in the change of segmental lordosis (ACDF: +8.09° vs CDA: +5.88°, P = .075) between the preoperative and final postoperative period. Additionally, the change in cervical lordosis was similar between groups (ACDF:+ 9.86° vs CDA: +7.60°, P = .226). VAS scores were similar between the 2 groups at every follow-up interval. NDI scores were significantly different at the 6-month, 12 month and the final follow-up. Mean improvements between preoperative and final postoperative periods were statistically superior in the CDA cohort compared to the ACDF cohort (ACDF: 22.8 vs CDA: 24.1, P = .0375). CONCLUSION CDA was superior to ACDF in regards to NDI scores following index procedure in patients with preoperative segmental cervical kyphosis. Those in the CDA cohort had similar complication rates, revision rates and radiographic outcomes as those who underwent ACDF.
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Affiliation(s)
- George Abdelmalek
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Neil Patel
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Nikhil Sahai
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Ki Hwang
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
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Patel N, Abdelmalek G, Coban D, Changoor S, Sinha K, Hwang K, Emami A. Should patient eligibility criteria for cervical disc arthroplasty (CDA) be expanded? A retrospective cohort analysis of relatively contraindicated patients undergoing CDA. Spine J 2024; 24:210-218. [PMID: 37774985 DOI: 10.1016/j.spinee.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is a safe and effective alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of various degenerative pathologies with advantages of motion preservation and lower rates of adjacent segment degeneration (ASD). Absolute contraindications for CDA have been well outlined in order to prevent adverse outcomes in patients. However, in cases of patients with relative contraindications (kyphotic deformity, prior cervical surgery, etc.), there remains controversy. There is minimal literature evaluating long-term outcomes in this patient population. PURPOSE To compare long-term clinical and functional outcomes of CDA in typical patients versus those with relative contraindications. DESIGN Retrospective cohort review. PATIENT SAMPLE Eighty-nine patients were included in the study: 55 (no contraindications) in Group 1 and 34 (relatively contraindicated) in Group 2 and 26 (preoperative segmental kyphosis) in Group 3. OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS), and neck disability index (NDI) scores. METHODS Patients were placed in the relatively contraindicated cohort if they possessed at least one of the following: (1) segmental kyphosis of 5° to 10°, (2) significant loss of disc height (between 50% and 75% of initial measurements or 1.5-3mm), (3) bridging osteophytes, and (4) prior cervical spine surgery based on preoperative cervical radiographs. The other cohort included patients without any relative contraindication who underwent CDA over the same time frame. Additionally, a subgroup analysis was used to compare those without any contraindications to those with only preoperative segmental kyphosis. Patients were included in this study if they met the following criteria: over 18 years of age, minimum follow-up of 24 months, and availability of complete medical records. Patient demographics, levels operated on, and perioperative outcomes were assessed between the two groups. Revision and complication rates were recorded. Functional outcomes scores were compared using VAS and NDI scores at 6-months, 12-months and final follow-up. RESULTS Mean follow-up was 40.8 months in Group 1 and 38.3 months in Group 2 (p=.569). Complication rates were 21.8% in Group 1 and 26.4% in Group 2 (p=.615). Complication rates in a comparison between Groups 1 and 3 were statistically insignificant (p=.383). The most common complication was transient approach-related postoperative dysphagia (Group 1: 20% vs Group 2: 23.5%, p=.693). No significant differences were observed in the rates of transient dysphonia (Group 1: 0.0% vs Group 2: 2.9%, p=.201), adjacent segment degeneration (ASD) (Group 1: 1.8% vs Group 2: 0.0%, p=.429), infection (Group 1: 1.8% vs Group 2: 2.9%, p=.712), heterotopic ossification (Group 1: 49.1% vs Group 2: 50.0%, p=.934) or spontaneous fusion (Group 1: 1.8% vs Group 2: 2.9%, p=.728). No revision surgeries were observed in either cohort. All three groups demonstrated significant improvements in their VAS and NDI scores compared with preoperative measurements (p<.001), but no significant differences were found in the degree of improvement between groups at any point in time. CONCLUSIONS Our study found no significant differences in clinical and functional outcomes between patients undergoing 1- and 2-level CDA with relative contraindications versus typical patients. These findings suggest that patient eligibility criteria for CDA may warrant expansion. However, future prospective studies over a longer period of follow-up are necessary to corroborate our results.
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Affiliation(s)
- Neil Patel
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - George Abdelmalek
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Daniel Coban
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Stuart Changoor
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Kumar Sinha
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Ki Hwang
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Arash Emami
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA.
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Divi SN, Plantz MA, Tegethoff J, Su BW. Current and Expanded Indications for Cervical Disc Arthroplasty: Beyond the FDA IDE Studies. Clin Spine Surg 2023; 36:375-385. [PMID: 37691166 DOI: 10.1097/bsd.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Jason Tegethoff
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Brian W Su
- California Orthopedics & Spine, Novato, CA
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Wang Z, Luo G, Yu H, Zhao H, Li T, Yang H, Sun T. Comparison of discover cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical degenerative disc diseases: A meta-analysis of prospective, randomized controlled trials. Front Surg 2023; 10:1124423. [PMID: 36896262 PMCID: PMC9989026 DOI: 10.3389/fsurg.2023.1124423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Objective This study aims to evaluate the clinical efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) in Cervical degenerative disc diseases. Methods Two researchers independently conducted a search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails (CENTRAL) for randomized controlled trials (RCTs) following the Cochrane methodology guidelines. A fixed-effects or random-effects model was applied based on different heterogeneity. Review Manager (Version 5.4.1) software was used to perform data analysis. Results A total of 8 RCT studies were included in this meta-analysis. The results indicate that the DCDA group had a higher incidence of reoperation (P = 0.03) and a lower incidence of ASD (P = 0.04) than the CDA group. There was no significant difference between two groups regarding NDI score (P = 0.36), VAS ARM score (P = 0.73), VAS NECK score (P = 0.63), EQ-5D score (P = 0.61) and dysphagia incidence (0.18). Conclusion DCDA and ACDF have similar results in terms of NDI scores, VAS scores, EQ-5D scores, and dysphagia. In addition, DCDA can reduce the risk of ASD but increases the risk of reoperation.
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Affiliation(s)
- Ziqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Gan Luo
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Hongwei Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Hui Zhao
- School of Medicine, Nankai University, Tianjin, China
| | - Tianhao Li
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Houzhi Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Tianwei Sun
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
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Long-Term Clinical Results with Radiological Correlations After Posterior Foraminotomy for Unilateral Cervical Discopathy. World Neurosurg 2021; 158:e799-e809. [PMID: 34813935 DOI: 10.1016/j.wneu.2021.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In lateral cervical disc herniations, posterior foraminotomy (PF) provides direct nerve root decompression and maintains segmental mobility. However, partial facetectomy can cause instability. This study evaluated long-term clinical outcomes related to cervical sagittal alignment after PF. METHODS The study included 48 consecutive patients with lateral cervical disc herniations who underwent PF. Pain and mobility were evaluated using the Numeric Rating Scale and Neck Disability Index (NDI), respectively. Sagittal alignment was evaluated using the modified Toyama method. RESULTS Median Numeric Rating Scale arm, Numeric Rating Scale neck, and NDI scores improved by 7, 4.5, and 24 points, respectively. Corresponding mean minimal clinically important differences were achieved in 94%, 77%, and 98% of patients at a mean follow-up of 8.4 years. Of patients, 82% showed favorable radiological results (i.e., retained or developed lordosis or had straight spine), while 18% showed unfavorable radiological results (i.e., retained or changed toward kyphosis). The latter group had multilevel cervical degenerative disc disease (mcDDD) before PF. Nevertheless, the risk of developing kyphosis was only 2.6%, and the potential for improving sagittal balance was 43%. Follow-up median NDI scores, but not minimal clinically important differences, were significantly worse in patients with preoperative kyphosis (21 vs. 8; P = 0.03) or mcDDD (20 vs. 8; P = 0.024) compared with other patients. CONCLUSIONS Patients with preoperative kyphosis or mcDDD had worse NDI outcomes but also benefited from PF. Sagittal alignment improved in >40% of patients, but coexisting mcDDD was a main risk factor for kyphosis persistence.
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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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Mok JK, Vaishnav AS, Chaudhary C, Alluri RK, Lee R, Urakawa H, Sato K, Chen DA, Gang CH, Huang R, Albert TJ, Qureshi SA. Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement. Neurospine 2020; 17:588-602. [PMID: 33022164 PMCID: PMC7538348 DOI: 10.14245/ns.2040398.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate outcomes of cervical disc replacement (CDR) in patients with nonlordotic alignment.
Methods Patients who underwent CDR were retrospectively reviewed and divided into 3 cohorts: (1) neutral/lordotic segmental and C2–7 Cobb angle (L), (2) nonlordotic segmental Cobb angle, lordotic C2–7 Cobb angle (NL-S), and (3) nonlordotic segmental and C2–7 Cobb angle (NL-SC). Radiographic and patient-reported outcomes (PROMs) were compared.
Results One-hundred five patients were included (L: 37, NL-S: 30, NL-SC: 38). A significant gain in segmental lordosis was seen in all cohorts at < 6 months (L: -1.90° [p = 0.007]; NL-S: -5.16° [p < 0.0001]; NL-SC: -6.00° [p < 0.0001]) and ≥ 6 months (L: -2.07° [p = 0.031; NL-S: -6.04° [p < 0.0001]; NL-SC: -6.74° [p < 0.0001]), with greater lordosis generated in preoperatively nonlordotic cohorts (p < 0.0001). C2–7 lordosis improved in the preoperatively nonlordotic cohort (NL-SC: 8.04°) at follow-up of < 6 months (-4.15°, p=0.003) and ≥ 6 months (-6.40°, p=0.003), but not enough to create lordotic alignment (< 6 months: 3.89°; ≥ 6 months: 4.06°). All cohorts showed improvement in Neck Disability Index, visual analogue scale (VAS) neck, and VAS arm, without significant difference among groups in the amount of improvement (≥ 6-month PROMs follow-up=69%).
Conclusion In patients without major kyphotic deformity, CDR has the potential to generate and maintain lordosis and improve PROMs in the short-term, and can be an effective treatment option for patients with nonlordotic alignment.
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Affiliation(s)
- Jung Kee Mok
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Ryan Lee
- Hospital for Special Surgery, New York, NY, USA
| | | | - Kosuke Sato
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Russel Huang
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Todd J Albert
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
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Oitment C, Watson T, Lam V, Aref M, Koziarz A, Kachur E, Badhiwala JH, Almenawer SA, Cenic A. The Role of Anterior Cervical Discectomy and Fusion on Relieving Axial Neck Pain in Patients With Single-Level Disease: A Systematic Review and Meta-Analysis. Global Spine J 2020; 10:312-323. [PMID: 32313797 PMCID: PMC7160803 DOI: 10.1177/2192568219837923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES This study aims to evaluate the effects of anterior cervical decompression and fusion (ACDF) on axial neck pain in adult patients receiving surgery for myelopathy, radiculopathy, or a combination of both. METHODS Two independent reviewers completed a librarian-assisted search of 4 databases. Visual Analogue Scale (VAS) and Neck Disability Index (NDI) scores were extracted preoperatively and at 3, 6, 12, 24, 36, 48, and 48+ months postoperatively for ACDF groups and pooled using a random-effects model. RESULTS Of 17 850 eligible studies, 37 were included for analysis, totaling 2138 patients analyzed with VAS and 2477 with NDI score. Individual VAS mean differences were reduced at 6 weeks (-2.5 [95% confidence interval (CI): -3.5 to -1.6]), 3 months (-2.9 [-3.7 to -2.2]), 6 months (-3.2 [-3.9 to -2.6]), 12 months (-3.7 [-4.3 to -3.1]), 24 months (-4.0 [-4.4 to -3.5]), 48 months (-4.6 [-5.5 to -3.8]), and >48 months (-4.7 [-5.8 to -3.6]) follow-up (P < .0001 for all endpoints). Individual NDI mean differences were reduced at 6 weeks (-26.7 [-30.9 to -22.6]), 3 months (-29.8 [-32.7 to -26.8]), 6 months (-31.2 [-35.5 to -26.8)], 12 months (-29.3 [-33.2 to -25.4]), 24 months (-28.9 [-32.6 to -25.2]), 48 months (-33.1 [-37.4 to -28.7]), and >48 months (-37.6 [-45.9 to -29.3]) follow-up (P < .0001 for all endpoints). CONCLUSIONS ACDF is associated with a significant reduction in axial neck pain compared with preoperative values in patients being treated specifically for myelopathy or radiculopathy. This influences the preoperative discussions surgeons may have with patients regarding their expectations for surgery. The effects seen are stable over time and represent a clinically significant reduction in axial neck pain.
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Affiliation(s)
| | | | - Victor Lam
- University of Western Ontario, London, Ontario, Canada
| | | | - Alex Koziarz
- McMaster University, Hamilton, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Aleksa Cenic
- McMaster University, Hamilton, Ontario, Canada,Aleksa Cenic, Division of Neurosurgery, Hamilton
Health Sciences, 237 Barton St E, Hamilton, Ontario L8L 2X2, Canada.
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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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Sagittal Reconstruction and Clinical Outcome Using Traditional ACDF, Versus Stand-alone ACDF Versus TDR: A Systematic Review and Quantitative Analysis. Spine (Phila Pa 1976) 2019; 44:E1151-E1158. [PMID: 31261280 DOI: 10.1097/brs.0000000000003077] [Citation(s) in RCA: 10] [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 Systematic review. OBJECTIVE To determine the difference in postoperative sagittal alignment when single level cervical radiculopathy or myelopathy is treated with an anterior cervical discectomy and fusion (ACDF) using a structural graft and plate, a stand-alone ACDF, or a total disc arthroplasty (TDR). We also wanted to determine if postoperative sagittal alignment impacted clinical outcomes in this patient population. SUMMARY OF BACKGROUND DATA Although there are several accepted techniques for interbody reconstruction during single level anterior cervical surgery, little is known on the impact of any of them on segmental and regional sagittal alignment. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines of the PubMed, Embase, and Cochrane databases. Only studies which contained pre and postoperative C2-7 Cobb angles as well as Neck Disability Index (NDI) scores following single level traditional ACDF with plate and cage, stand-alone ACDF, or TDR with at least 1 year follow up were included. RESULTS There were 12 publications that fulfilled the inclusion criteria with a total of 658 patients. Cluster regression analysis showed no difference between treatment arms at each respective time-point or in the overall change in NDI from preoperative to postoperative (P = 0.88). Cluster regression analysis showed no difference between treatment arms at each respective time point or in the overall change in lordosis from pre-op to post-op (P = 0.93). CONCLUSION This review provides evidence that while NDI scores improved across all devices, there was no significant difference in NDI improvement or C2-7 Cobb angle change between single level traditional ACDF, stand-alone ACDF, or TDR. Although TDR has not been considered a lordosis producing operation, our investigation shows it does not differ significantly in sagittal profile from other cervical fusion techniques. Moreover, we show that the NDI score improved, regardless of device implanted. LEVEL OF EVIDENCE 1.
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Tederko P, Krasuski M, Tarnacka B. Effectiveness of rehabilitation after cervical disk surgery: a systematic review of controlled studies. Clin Rehabil 2018; 33:370-380. [PMID: 30458634 DOI: 10.1177/0269215518810777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To present a synopsis of evidence on the efficacy of rehabilitation after cervical disk surgery performed for neck pain and radiculopathy. Data sources: The databases of Medline, EMBASE, and Cochrane Central were searched for studies reporting effects of rehabilitation interventions in patients undergoing surgery due to cervical disk disease with pain and radicular syndrome, published before 31 August 2018. Review methods: Project was registered with PROSPERO database (number CRD42018085937). Randomized controlled trials that evaluated the efficacy of rehabilitation interventions versus other, sham, or no treatment were selected. The primary outcomes were disability and pain. Secondary outcomes were other measures assessing biological, psychological or social effect of rehabilitation. Two reviewers independently screened studies for eligibility, assessed risk of bias and extracted data. Evaluation of evidence was performed with the GRADE system. Results: Five papers were included in the review. The eligible studies were heterogeneous in intervention and outcome reporting. There are low- to very-low-quality evidence that some interventions (use of cervical collars after non-plated anterior cervical diskectomy an fusion, structured physiotherapy, and interactive patients’ education) provide some benefit within functioning, pain, and selected psychological variables in patients undergoing cervical disk surgery. Controlled trials addressing comprehensive interdisciplinary rehabilitation, multidisciplinary pain management, occupational therapy, psychotherapy, social and vocational interventions were not identified. Conclusion: There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness, harms, and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy.
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Affiliation(s)
- Piotr Tederko
- Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marek Krasuski
- Private Medical Practice, Konstancin-Jeziorna, Poland
- Comprehensive Rehabilitation Centre, Konstancin-Jeziorna, Poland
| | - Beata Tarnacka
- Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Chen WM, Jin J, Park T, Ryu KS, Lee SJ. Strain behavior of malaligned cervical spine implanted with metal-on-polyethylene, metal-on-metal, and elastomeric artificial disc prostheses - A finite element analysis. Clin Biomech (Bristol, Avon) 2018; 59:19-26. [PMID: 30119037 DOI: 10.1016/j.clinbiomech.2018.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative alterations in cervical spine curvature (i.e. loss of lordotic angle) are frequently observed following total disc replacement surgery. However, it remains unclear whether such changes in lordotic angle are due to preoperative spinal deformities and/or prostheses design limitations. The objective of the study is to investigate strain and segmental biomechanics of the malaligned cervical spine following total disc replacement. METHODS Three disc prostheses were chosen, namely a metal-on-polyethylene, a metal-on-metal, and an elastomeric prosthesis, which feature different geometrical and material design characteristics. All discs were modelled and implanted into multi-segmental cervical spine finite element model (C3-C7) with normal, straight and kyphotic alignments. Comparative analyses were performed by using a hybrid protocol. FINDINGS The results indicated that as the spine loses lordotic alignment, the prosthesis with elastomeric core tends to produce significantly larger flexion range of motion (difference up to 6.1°) than metal-on-polyethylene and metal-on-metal prostheses. In contrast, when the treated spine had normal lordotic alignment, the range of motion behaviors of different prostheses are rather similar (difference within 1.9°). Large localized strains up to 84.8% were found with the elastomeric prosthesis, causing a collapsed anterior disc space under flexion loads. INTERPRETATION Changes in cervical spinal alignments could significantly affect the surgical-level range of motion behaviors following disc arthroplasty; the in situ performance was largely dependent on the designs of the artificial disc devices in particular to the material properties.
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Affiliation(s)
- Wen-Ming Chen
- Department of Biomedical Engineering, University of Shanghai for Science and Technology, 516 JunGong Road, Shanghai, China.
| | - Jie Jin
- Department of Orthopedic Surgery, YanBian University Hospital, China
| | - Taehyung Park
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, 607 O-bang, Gyongnam, Republic of Korea
| | - Kyeong-Sik Ryu
- Department of Neurosurgery, College of medicine, The Catholic University of Korea, 222 Banpo-Daero, Seoul, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, 607 O-bang, Gyongnam, Republic of Korea.
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Kim SW, Kim TH, Bok DH, Jang C, Yang MH, Lee S, Yoo JH, Kwak YH, Oh JK. Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters. Spine J 2018; 18:797-810. [PMID: 28962913 DOI: 10.1016/j.spinee.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many studies tend to characterize cervical kyphosis as a significant clinical condition that needs to be treated. Moreover, opinions vary on whether cervical kyphosis should be considered a pathologic status or a natural occurrence in asymptomatic people. PURPOSE This study aimed to determine the frequency of kyphotic posture of the cervical spine in currently asymptomatic individuals and to ascertain its relation with other spinopelvic parameters. STUDY DESIGN A cross-sectional radiographic study was carried out. PATIENT SAMPLE This study targeted 1,026 currently asymptomatic adult volunteers who agreed to participate in this study from January 2010 to March 2016. Only 958 were eligible for the study. OUTCOME MEASURES Radiographic images, including the C-spine dynamic view and whole-spine lateral view, were measured. The sagittal parameters of the cervical spine and other parts of the spine and pelvis, such as the C2-C7 angle, C0-C2 range of motion (ROM), C2-C7 ROM, and C0-C7 ROM, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence, were measured. METHODS Based on the C-spine neutral lateral X-ray, a C2-C7 Cobb angle greater than 0 degree was defined as lordosis and an angle less than 0 degree was defined as kyphosis. Patients who showed kyphosis were further classified into the reducible or non-reducible group, depending on the ability of recovering neck motions (lordosis) in extension. The cervical and other global spine parameters between the two groups were analyzed, and the relation between the cervical alignment and other parts of the spine and pelvis were also examined. This study was not supported by any funding and had no conflicts of interest. RESULTS Nearly one-fourth of the asymptomatic participants (26.3%) have kyphotic cervical posture, and almost one-sixth of the kyphotic individuals (16.7%) have non-reducible kyphosis. The prevalence increases with advanced age; non-reducible cases are mostly kyphotic, kyphosis stems from the C2-C7 region, and kyphosis is not correlated with any of the radiological parameters of the other parts of the spine except lumbar lordosis. CONCLUSIONS Cervical kyphosis can be observed in normal healthy adults.
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Affiliation(s)
- Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea; Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea.
| | - Tae-Hwan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea; Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Do Hee Bok
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Chulyoung Jang
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Myung Ho Yang
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Seonjong Lee
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Je Hyun Yoo
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Yoon Hae Kwak
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
| | - Jae Keun Oh
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea; Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea
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Lei T, Tong T, Miao D, Gao X, Xu J, Zhang D, Shen Y. Anterior Migration After Bryan Cervical Disc Arthroplasty: The Relationship Between Hyperlordosis and its Impact on Clinical Outcomes. World Neurosurg 2017; 101:534-539. [DOI: 10.1016/j.wneu.2017.02.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 12/14/2022]
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Shangguan L, Ning GZ, Tang Y, Wang Z, Luo ZJ, Zhou Y. Discover cervical disc arthroplasty versus anterior cervical discectomy and fusion in symptomatic cervical disc diseases: A meta-analysis. PLoS One 2017; 12:e0174822. [PMID: 28358860 PMCID: PMC5373642 DOI: 10.1371/journal.pone.0174822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/15/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Symptomatic cervical disc disease (SCDD) is a common degenerative disease, and Discover artificial cervical disc, a new-generation nonconstrained artificial disk, has been developed and performed gradually to treat it. We performed this meta-analysis to compare the efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) for SCDD. METHODS An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials that compared DCDA with ACDF for patients suffering SCDD. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval. RESULTS Of 33 articles identified, six studies were included. Compared with ACDF, DCDA demonstrated shorter operation time (P < 0.0001), and better range of motion (ROM) at the operative level (P < 0.00001). But no significant differences were observed in blood loss, neck disability index (NDI) scores, neck and arm pain scores, Japanese orthopaedic association (JOA) scores, secondary surgery procedures and adverse events (P > 0.05). Subgroup analyses did not demonstrated significant differences. CONCLUSION In conclusion, DCDA presented shorter operation time, and better ROM at the operative level. However, no significant differences were observed in blood loss, NDI scores, neck and arm pain scores, JOA scores, secondary surgery procedures and adverse events between the two groups. Additionally, more studies of high quality with mid- to long-term follow-up are required in future.
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Affiliation(s)
- Lei Shangguan
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Shapingba District, Chongqing, China
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Guang-Zhi Ning
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Shapingba District, Chongqing, China
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Yu Tang
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Shapingba District, Chongqing, China
| | - Zhe Wang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhuo-Jing Luo
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- * E-mail: (YZ); (ZJL)
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Shapingba District, Chongqing, China
- * E-mail: (YZ); (ZJL)
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Tan W, Zhou C, Guo D, Sun J, Cao W, Yang LZ, Wu M. Treatment of Single-Level Cervical Spondylosis: Cervical Disk Arthroplasty Versus Anterior Cervical Decompression and Fusion. Orthopedics 2017; 40:e23-e34. [PMID: 27992641 DOI: 10.3928/01477447-20161213-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/23/2016] [Indexed: 02/03/2023]
Abstract
A meta-analysis was performed to compare cervical arthroplasty with anterior cervical diskectomy and fusion for single-level cervical spondylosis. A comprehensive search was conducted with PubMed, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 2000, to April 30, 2015. Random-effects models were used for heterogeneous data. Fixed-effects models were used for pooled nonheterogeneous data. Mean difference or standard mean difference was used for continuous outcomes, and odds ratio, risk ratio, or risk difference was used for dichotomous outcomes. [Orthopedics. 2017; 40(1):e23-e34.].
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Hou Y, Nie L, Pan X, Si M, Han Y, Li J, Zhang H. Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis. Bone Joint J 2016; 98-B:829-33. [PMID: 27235528 DOI: 10.1302/0301-620x.98b6.36381] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 01/15/2016] [Indexed: 12/11/2022]
Abstract
Aims In order to evaluate the effectiveness of the Mobi-C implant in cervical disc degeneration, a randomised study was conducted, comparing the Mobi-C prosthesis arthroplasty with anterior cervical disc fusion (ACDF) in patients with single level cervical spondylosis. Patients and Methods From January 2008 to July 2009, 99 patients were enrolled and randomly divided into two groups, those having a Mobi-C implant (n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28 men, 20 women).The patients were followed up for five years, with the primary outcomes being the Japanese Orthopaedic Association score, visual analogue scale for pain and the incidence of further surgery. The secondary outcomes were the Neck Disability Index and range of movement (ROM) of the treated segment. Results The incidence of further surgery was found to be statistically significant between the two groups (p = 0.49), with seven ACDF patients requiring further surgery and only one Mobi-C patient requiring re-operation. There were significant differences (p < 0.001) between the two groups in the ROM of the treated segment. However, both Mobi-C surgery and ACDF surgery were effective in improving the patient’s clinical symptoms. Take home message: Mobi-C implant surgery is a safe alternative to ACDF surgery in cervical disc degeneration. Cite this article: Bone Joint J 2016;98-B:829–3.
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Affiliation(s)
- Y. Hou
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - L. Nie
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - X. Pan
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - M. Si
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - Y. Han
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - J. Li
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
| | - H. Zhang
- Qilu Hospital of Shandong University, 107
Wenhua W Road, Jinan, Shandong
250012, China
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Cervical spine alignment in disc arthroplasty: should we change our perspective? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 7:810-25. [PMID: 26441258 DOI: 10.1007/s00586-015-4258-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE The alignment at the cervical spine has been considered a determinant of degeneration at the adjacent disc, but this issue in cervical disc replacement surgery is poorly explored and discussed in this patient population. The aim of this systematic review is to compare anterior cervical fusion and total disc replacement (TDR) in terms of preservation of the overall cervical alignment and complications. METHODS A systematic review of the current literature was performed, together with the evaluation of the methodological quality of all the retrieved studies. RESULTS In most of the retrieved studies, a tendency towards a more postoperative kyphotic alignment in TDR was reported. The reported mean complication rate was of 12.5 % (0-66.2 %). Complications associated with cervical prosthesis included heterotopic ossification, device migration, mechanical instability, failure, implant removal, reoperations and revision. CONCLUSIONS Even though cervical disc arthroplasty leads to similar outcomes compared to arthrodesis in the middle term follow-up, no evidence of superiority of cervical TDR is available up to date. We understand that the overall cervical alignment after TDR tends towards the loss of lordosis, but only longer follow-up can determine its influence on the clinical results.
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Lee SE, Jahng TA, Kim HJ. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26198705 DOI: 10.1007/s00586-015-4132-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. METHODS Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. RESULTS The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. CONCLUSION In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.
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Affiliation(s)
- Soo Eon Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, 463-707, Republic of Korea.
| | - Hyun Jib Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-Ro, Bundang-Gu, Seongnam, Gyeonggi-Do, 463-707, Republic of Korea
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Kim CH, Shin KH, Chung CK, Park SB, Kim JH. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy. Global Spine J 2015; 5:31-8. [PMID: 25648214 PMCID: PMC4303481 DOI: 10.1055/s-0034-1395423] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/29/2014] [Indexed: 01/08/2023] Open
Abstract
Study Design Case series. Objective Posterior percutaneous endoscopic cervical diskectomy (PECD) can preserve the disk in patients with a foraminal disk herniation. However, progressive angulation at the operated segment is a concern, especially for patients with cervical lordosis < 10 degrees. The change in cervical lordosis after posterior PECD was analyzed. Methods Medical records were reviewed of 32 consecutive patients (22 men, 10 women; mean age, 49 ± 12 years) who had single-level foraminal soft disk herniation. The operation levels were as follows: C4-5 in 1 patient, C5-6 in 12, C6-7 in 18, and C7-T1 in 1. All patients were discharged the day after the operation, and neck motion was encouraged. All patients were followed for 30 ± 7 months (range, 24 to 46 months), and 21/32 patients (66%) had radiographs taken at 25 ± 11 months (range, 12 to 45 months). Radiologic parameters were assessed, including cervical curvature (C2-7), segmental Cobb's angle (SA), and anterior and posterior disk height (AH and PH, respectively) at the operative level. Results At the last follow-up, 29/32 patients (91%) had no or minimal pain, and 3/32 patients had occasional pain. SA, AH, and PH were not significantly changed. Cervical lordosis < 10 degrees was present in 10/21 patients preoperatively and in 3/21 patients at the last follow-up. For patients with cervical lordosis < 10 degrees, cervical curvature changed from -2.5 ± 8.0 to -11.3 ± 9.3 degrees (p = 0.01). For patients with cervical lordosis ≥ 10 degrees, cervical curvature changed from -17.5 ± 5.8 to -19.9 ± 5.7 degrees (p = 0.24). Conclusions Cervical curvature does not worsen after posterior PECD.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea,Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea,Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Hyun Shin
- Department of Orthopedic Surgery, Shin Hospital, Kyung-Gi, Seoul, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea,Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea,Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea,Address for correspondence Chun Kee Chung, MD, PhD Department of Neurosurgery, Seoul National University College of Medicine101 Daehak-Ro, Jongno-gu, Seoul, 110-744South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea,Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Jung Hee Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea,Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea,Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Oh CH, Kim DY, Ji GY, Kim YJ, Yoon SH, Hyun D, Kim EY, Park H, Park HC. Cervical arthroplasty for moderate to severe disc degeneration: clinical and radiological assessments after a minimum follow-up of 18 months--Pfirrmann grade and cervical arthroplasty. Yonsei Med J 2014; 55:1072-9. [PMID: 24954339 PMCID: PMC4075369 DOI: 10.3349/ymj.2014.55.4.1072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. MATERIALS AND METHODS Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. RESULTS VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. CONCLUSION Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.
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Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Do Yeon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yeo Ju Kim
- Department of Radiology, Inha University Hospital, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea.
| | - Dongkeun Hyun
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Hyeonseon Park
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Hyeong-Chun Park
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
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