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Yan C, Wang H, Abudouaini H, Wu T, Wang B, Liu H. Predictive Value of Cervical Degenerative Quantitative Scoring System on Postoperative Disc Height Loss After Cervical Disc Replacement. Clin Spine Surg 2024; 37:E201-E207. [PMID: 38491846 PMCID: PMC11142648 DOI: 10.1097/bsd.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/29/2023] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE In this study, a cervical degenerative quantitative scoring system was used to identify the risk factors for disc height loss after cervical disc replacement (CDR) and to verify their accuracy. BACKGROUND Disc height loss after CDR is drawing much attention. Preoperative cervical degeneration has been proven related to postoperative disc height loss but lacked quantitative verification. PATIENTS AND METHODS A total of 160 patients who underwent CDR with the Prestige-LP disc at our hospital between January 2011 and December 2016 were retrospectively reviewed. Disc height loss was defined as a reduction of more than 2 mm from postoperative to the final follow-up. A quantitative scoring system was used to evaluate preoperative degeneration on radiographs. Multivariate logistic regression was applied to determine predictive factors and calculate the logistic regression formula. Moreover, receiver operating characteristic curve analysis was conducted to obtain the optimal cutoff value and the area under the receiver operating characteristic curve [areas under the curve (AUC)]. RESULTS Study subjects had a mean age of 43.51 ± 8.51 years, with a mean follow-up time of 60.14 ± 12.75 months. The overall incidence rate of disc height loss was 65.62%. Multivariate logistic regression analysis showed that endplate sclerosis ( P = 0.000) and low preoperative disc height ( P = 0.000) were independent risk factors for postoperative disc height loss. In addition, the calculated optimal cutoff point was 1 point of endplate sclerosis (AUC = 0.768) and 4.5 mm of preoperative disc height (AUC = 0.795). The regression formula established by multivariate logistic regression analysis was composed of preoperative disc height (odds ratio: 2.995, P = 0.000) and endplate sclerosis (odds ratio: 18.131, P = 0.000), with an AUC of 0.879. CONCLUSIONS Our findings suggest that a comprehensive preoperative assessment is essential when patients with apparent endplate sclerosis and low preoperative disc height are being considered for CDR.
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Zavras AG, Federico VP, Butler AJ, Nolte MT, Dandu N, Phillips FM, Colman MW. Relative Efficacy of Cervical Total Disc Arthroplasty Devices and Anterior Cervical Discectomy and Fusion for Cervical Pathology: A Network Meta-Analysis. Global Spine J 2024; 14:322-346. [PMID: 37099726 PMCID: PMC10676167 DOI: 10.1177/21925682231172982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta Analysis. OBJECTIVE This study sought to compare patient-reported outcomes, success, complications, and radiographic outcomes directly and indirectly between different cervical total disc arthroplasty (TDA) devices and anterior cervical discectomy and fusion (ACDF). METHODS Patients of prospective randomized controlled trials of 1-level cervical TDA with a minimum of 2 years follow up were identified in the literature. A frequentist network meta-analysis model was used to compare each outcome across the different TDA devices included and ACDF using the mixed effect sizes. RESULTS 15 studies were included for quantitative analysis, reporting the outcomes of 2643 patients with an average follow-up was 67.3 months (range: 24-120 months), 1417 of whom underwent TDA and 1226 of whom underwent ACDF. Nine TDA devices were compared to ACDF, including the Bryan, Discover, Kineflex, M6, Mobi-C, PCM, Prestige ST, ProDisc-C, and Secure-C cervical prostheses. Several devices outperformed ACDF for certain outcomes, including Visual Analog Scale (VAS) Arm, Physical Component Score of the Short-Form Health Survey (SF PCS), neurological success, satisfaction, index-level secondary surgical interventions (SSI), and adjacent level surgeries. Cumulative ranking of each intervention assessed demonstrated the highest performance with the M6 prosthesis (P = .70), followed by Secure-C (P = .67), PCM (P = .57), Prestige ST (P = .57), ProDisc-C (P = .54), Mobi-C (P = .53), Bryan (P = .49), Kineflex (P = .49), Discover (P = .39), and ACDF (P = .14). CONCLUSION Cervical TDA was found to be superior on most outcomes assessed in the literature of high-quality clinical trials. While most devices demonstrated similar outcomes, certain prostheses such as the M6 were found to outperform others across several outcomes assessed. These findings suggest that the restoration of near-normal cervical kinematics may lead to improved outcomes.
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Affiliation(s)
- Athan G. Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander J. Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Frank M. Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W. Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Liang Y, Qian Y, Xia W, Guo C, Zhu Z, Liu H, Xu S. Adjacent segment degeneration after single- and double-level cervical total disc replacement: a cohort with an over 12-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:232-242. [PMID: 37947890 DOI: 10.1007/s00586-023-08018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To characterize the change of adjacent segment degeneration (ASD) after cervical total disc replacement (CTDR) with more than 12-year follow-up, and identify the risk factors for ASD. METHOD This process included 75 patients underwent CTDR from February 2004 to December 2012, with the follow-up of 151.9 ± 36.0 (m). The artificial disc included ProDisc-C, Prestige-LP and Mobi-C. ASD was followed up at 1 week, 6 months, 1 year, 2 years, 5 years, 10 years after CTDR and at the endpoint of June 2022. The radiographic measurements were cervical mobility, intervertebral disc height (IDH), cervical lordosis and balance status. The complications were implant migration, subsidence and heterotopic ossification (HO). RESULTS Cervical mobility in adjacent segments, IDH and lordosis showed no statistical differences between ASD and NASD group. Balance status, subsidence and migration showed no relationship with ASD. Postoperative ASD increased at 6 m and especially between 6 m to 2y. There was no difference between the incidence of upper ASD and lower ASD all the time and few ASD-related reoperation. The majority of adjacent segments were C4/5 (33.6%) and C6/7 (34.2%), and ASD of C5/6 had the highest incidence (61.5%). Cox regression showed ASD was not related to the types of prosthesis or operated numbers. Generalized estimating equations (GEE) analysis showed severe HO had a higher (2.68 times) probability to suffer from ASD. CONCLUSIONS After over 12-year follow-up of CTDR, the occurrence of ASD and HO had temporal synchronization. ASD was not merely a natural progression but with the pathological process such as HO.
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Affiliation(s)
- Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yalong Qian
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Weiwei Xia
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
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Anterior Bone Loss after Cervical Baguera C Disc versus Bryan Disc Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8010223. [PMID: 36794256 PMCID: PMC9925247 DOI: 10.1155/2023/8010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/07/2022] [Accepted: 01/15/2023] [Indexed: 02/08/2023]
Abstract
Objectives The objectives of this study were to identify the risk factors and incidence of anterior bone loss (ABL) after Baguera C cervical disc arthroplasty (CDA) and identify whether design differences in artificial discs affect ABL. Methods In this retrospective radiological review of patients who underwent single-level Baguera C CDA in a medical center, the extent of ABL and the following radiological parameters were recorded: global and segmental alignment angle, lordotic angle (or functional spinal unit angle), shell angle, global range of motion (ROM), and ROM of the index level. ABL at the index level was grade 0-2. Grade 0 was defined as no remodeling, grade 1 as spur disappearance or mild change in body contour, and grade 2 as obvious bone regression with Baguera C Disc exposure. Results Combining grade 1 and grade 2, ABL was found in 56 upper adjacent vertebrae and 52 lower adjacent vertebrae of the 77 patients. Only 18 patients (23.4%) had no ABL. Shell angle differed significantly between ABL grades of both the upper and lower adjacent level: 0.0° in grade 0 and 1 ABL vs. 2.0° in grade 2 ABL of the upper adjacent level (p < 0.05); and 0.0° in grade 0 and 1 ABL vs. 3.5° in grade 2 ABL of the lower adjacent level (p < 0.05). A female predominance of ABL was found. Hybrid surgery and artificial disc size were also related to ABL. Conclusions ABL is more common in Baguera C Disc arthroplasty than Bryan Disc arthroplasty. Larger shell angle was related to ABL after CDA with Baguera C Discs, which may indicate that shell angle is pivotal in determining the incidence of ABL after CDA. Females had more ABL with Baguera C Disc arthroplasty; this might be related to shorter endplate lengths as well as a smaller endplate-implant mismatch.
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Zavras AG, Dandu N, Nolte MT, Butler AJ, Federico VP, Sayari AJ, Sullivan TB, Colman MW. Segmental range of motion after cervical total disc arthroplasty at long-term follow-up: a systematic review and meta-analysis. J Neurosurg Spine 2022; 37:579-587. [PMID: 35453108 DOI: 10.3171/2022.2.spine2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As an alternative procedure to anterior cervical discectomy and fusion, total disc arthroplasty (TDA) facilitates direct neural decompression and disc height restoration while also preserving cervical spine kinematics. To date, few studies have reported long-term functional outcomes after TDA. This paper reports the results of a systematic review and meta-analysis that investigated how segmental range of motion (ROM) at the operative level is maintained with long-term follow-up. METHODS PubMed and MEDLINE were queried for all published studies pertaining to cervical TDA. The methodology for screening adhered strictly to the PRISMA guidelines. All English-language prospective studies that reported ROM preoperatively, 1 year postoperatively, and/or at long-term follow-up of 5 years or more were included. A meta-analysis was performed using Cochran's Q and I2 to test data for statistical heterogeneity, in which case a random-effects model was used. The mean differences (MDs) and associated 95% confidence intervals (CIs) were reported. RESULTS Of the 12 studies that met the inclusion criteria, 8 reported the long-term outcomes of 944 patients with an average (range) follow-up of 99.86 (60-142) months and were included in the meta-analysis. There was no difference between preoperative segmental ROM and segmental ROM at 1-year follow-up (MD 0.91°, 95% CI -1.25° to 3.07°, p = 0.410). After the exclusion of 1 study from the comparison between preoperative and 1-year ROM owing to significant statistical heterogeneity according to the sensitivity analysis, ROM significantly improved at 1 year postoperatively (MD 1.92°, 95% CI 1.04°-2.79°, p < 0.001). However, at longer-term follow-up, the authors again found no difference with preoperative segmental ROM, and no study was excluded on the basis of the results of further sensitivity analysis (MD -0.22°, 95% CI -1.69° to -1.23°, p = 0.760). In contrast, there was a significant decrease in ROM from 1 year postoperatively to final long-term follow-up (MD -0.77°, 95% CI -1.29° to -0.24°, p = 0.004). CONCLUSIONS Segmental ROM was found to initially improve beyond preoperative values for as long as 1 year postoperatively, but then ROM deteriorated back to values consistent with preoperative motion at long-term follow-up. Although additional studies with further longitudinal follow-up are needed, these findings further support the notion that cervical TDA may successfully maintain physiological spinal kinematics over the long term.
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Vasquez-Alvarez M, Zapata U, Casado FL. Development of an Intervertebral Disc for Cervical Spondylosis Composed of Seeded Biomaterials. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3931-3934. [PMID: 36086263 DOI: 10.1109/embc48229.2022.9871418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Most of the current artificial disc prosthesis presented a restricted range of motion. Here we propose the design of a novel intervertebral disc composed of carbon fiber, hyaluronic methylcellulose hydrogel loaded with mesenchymal stem cells and polycaprolactone. The prosthesis was biomechanically evaluated under two static physiological conditions to study the mechanical influence of the material on the device. The results obtained in the simulations showed a not only a congruent behavior with preclinical condition, but also that the proposed materials met the desired biomechanical properties Clinical Relevance- Cervical spondylosis is a degenerative disease of the human spine that causes wear and tear of the cervical intervertebral discs. Nowadays, the proposed surgical solutions do not allow fully recovery of normal movement because the surgical intervention do not emulate the natural range of motion, may lack shock absorption mechanisms, show signs of fatigue over time affecting its durability, and do not have good bone adhesion. Therefore, hypermobility and problems of heterotopic ossification may restrict the range of motion.
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Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1273-1282. [PMID: 35020078 DOI: 10.1007/s00586-021-07094-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND According to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses. METHODS This prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated. RESULTS Fifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events. CONCLUSIONS There is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.
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Pérez-Bovet J, Buxó M, Rimbau Muñoz J. Clinical Practice in Spine Surgery: An International Survey. J Neurol Surg A Cent Eur Neurosurg 2021; 83:451-460. [PMID: 34897620 DOI: 10.1055/s-0041-1739223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. METHODS An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. RESULTS The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. CONCLUSION We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.
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Affiliation(s)
- Jordi Pérez-Bovet
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Maria Buxó
- Department of Statistics, Girona Biomedical Research Institute, Salt, Girona, Spain
| | - Jordi Rimbau Muñoz
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain.,Department of Neurosurgery, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Jain M, Doki SK, Gaikwad M, Khutia S. Acute Migration Following Dissociation of Components of Cervical Disc Arthroplasty. Neurol India 2021; 69:1037-1039. [PMID: 34507439 DOI: 10.4103/0028-3886.323895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cervical disc arthroplasty (CDA) is a newer alternative to the traditional fusion, in patients with prolapsed cervical disc in the younger eligible patient aiming to provide mobility similar to the native disc and by some ways preventing the adjacent segment disease. The rising popularity of its early success has seen emergence of a number of products in the market. In a country where cost remains an important constraint for the patients, local design products are available to cater to these lesser privileged patients. The present complication is an acute dissociation of components from such a product wherein the implant was retrieved and fusion was done. The patient was subsequently discharged uneventfully.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | | | - Susanta Khutia
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
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Kim KR, Chin DK, Kim KS, Cho YE, Shin DA, Kim KN, Kuh SU. Revision Surgery for a Failed Artificial Disc. Yonsei Med J 2021; 62:240-248. [PMID: 33635014 PMCID: PMC7934106 DOI: 10.3349/ymj.2021.62.3.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This study aimed to present our experience with failures in C-TDR and revision surgery outcomes. MATERIALS AND METHODS We retrospectively examined patients who underwent revision surgery due to the failure of C-TDR between May 2005 to March 2019. Thirteen patients (8 males and 5 females) were included in this study. The mean age was 46.1 years (range: 22-61 years), and the average follow-up period was 19.5 months (range: 12-64 months). The outcome measures of pre- and post-operative neck and arm pain using a visual analogue scale (VAS) and functional impairment were assessed using a modified Japanese Orthopedic Association (JOA) scale and the Neck Disability Index (NDI). RESULTS The main complaints of patients were posterior neck pain (77%), radiculopathy (62%), and/or myelopathy (62%). The causes of failure of C-TDR were improper indications for the procedure, osteolysis and mobile implant use, inappropriate techniques, and postoperative infection. The most common surgical level was C5-6, followed by C4-5. After revision surgery, the neck and arm pain VAS (preoperative vs. postoperative: 5.46 vs. 1.31; 4.86 vs. 1.08), a modified JOA scale (14.46 vs. 16.69), and the NDI (29.77 vs. 9.31) scores were much improved. CONCLUSION C-TDR is good surgical option. However, it is very important to adhere to strict surgical indications and contraindications to avoid failure of C-TDR. The results of reoperations were good regardless of the approach. Therefore, various reoperation options could be considered in patients with failed C-TDR.
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Affiliation(s)
- Kwang Ryeol Kim
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Kang KC, Lee HS, Lee JH. Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian Spine J 2020; 14:921-930. [PMID: 33373515 PMCID: PMC7788378 DOI: 10.31616/asj.2020.0647] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It mainly presents with neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis. It is important to find the exact symptomatic segment and distinguish between conditions that may mimic certain cervical radicular compression syndromes through meticulous physical examinations and precise reading of radiographs. Non-surgical treatments are recommended as an initial management. Surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits. Cervical radiculopathy is treated surgically by anterior and/or posterior approaches. The appropriate choice of surgical treatment should be individualized, considering the patient’s main pathophysiology, specific clinical symptoms and radiographic findings thoroughly.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Sung Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Hee Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Chen TY, Chen WH, Tzeng CY, Huang CW, Yang CC, Chen HT, Chang CC, Lee CY, Tsou HK. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J 2020; 20:1211-1218. [PMID: 32360762 DOI: 10.1016/j.spinee.2020.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is an innovative procedure launched in the early 2000s. Compared with anterior cervical discectomy and fusion, many studies show that CDA offers equivalent clinical outcomes while reducing secondary procedures and total cost. PURPOSE We sought to determine the incidence of anterior bone loss after CDA and the related biomechanical effects. STUDY DESIGN/ SETTING Retrospective chart review. PATIENT SAMPLE Patients who underwent CDA with one level Bryan Disc (Medtronic SofamorDanek, Memphis, TN, USA) at one institution. OUTCOME MEASURES Radiological measurements, including the extent of anterior bone loss, global alignment angle, shell angle, lordotic angle, mean degree of angle of the endplate with the horizontal line, global range of motion (ROM) and ROM of the index level were recorded. The grading of anterior bone loss of the index level was defined as Grade 0, no remodeling; Grade 1, spur disappearance or mild change in body contour; Grade 2, obvious bone regression with Bryan Disc exposure. METHODS Anatomical measures and ROM were compared by grade of bone loss. RESULTS Of the 121 patients included in the study, anterior bone loss was found in 53 (43.8%) on the upper adjacent level and 54 (44.6%) on the lower adjacent level. Twenty-nine patients (23.9%) had anterior bone loss in both levels. The majority of cases had Grade 1 anterior bone loss. Grade 2 bone loss was noted in the upper adjacent vertebra in only 5 patients and in 4 patients in the lower adjacent vertebra. Age, sex, operative level, and hybrid surgery had no effect on anterior bone loss. Most radiological assessments, including global alignment angle, lordotic angle, mean degree of angle of the endplate with the horizontal line, global ROM, and ROM of the index level, showed no correlation to anterior bone loss. Shell angle was found to be different in groups with or without remodeling in the upper adjacent level: 5.0 degreesin the Grade 0 group and 7.0 degrees in the Grade 1-2 group, p<.05. CONCLUSIONS Many more patients than predicted had anterior bone loss. Increasing the shell angle of the artificial disc may increase the incidence of anterior bone loss after CDA. Further study of the biomechanics following CDA should help clarify the mechanisms at work.
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Affiliation(s)
- Tse-Yu Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Wen-Hsien Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, Republic of China.
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan, Republic of China.
| | - Chi-Wei Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Chih-Chang Yang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, Republic of China; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China; Spine Center, China Medical University Hospital, Taichung, Taiwan, Republic of China.
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China; Spine Center, China Medical University Hospital, Taichung, Taiwan, Republic of China; Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung, University, Hsinchu, Taiwan, Republic of China.
| | - Cheng-Ying Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung, Taiwan 40705 Republic of China; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, Republic of China; College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, Republic of China.
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Zhou F, Li S, Zhao Y, Zhang Y, Ju KL, Zhang F, Pan S, Sun Y. Quantitative analysis of the correlation between preoperative cervical degeneration and postoperative heterotopic ossification after cervical disc replacement: minimum 10-year follow-up data. J Neurosurg Spine 2020; 33:674-679. [PMID: 32679563 DOI: 10.3171/2020.4.spine191303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to identify factors that may be useful for quantifying the amount of degenerative change in preoperative patients to identify ideal candidates for cervical disc replacement (CDR) in patients with a minimum of 10 years of follow-up data. METHODS During the period from December 2003 to August 2008, 54 patients underwent CDR with a Bryan cervical disc prosthesis performed by the same group of surgeons, and all of the patients in this group with at least 10 years of follow-up data were enrolled in this retrospective analysis of cases. Postoperative bone formation was graded in radiographic images by using the McAfee classification for heterotopic ossification. Preoperative degeneration was evaluated in radiographs based on a quantitative scoring system. After univariate analysis, the authors performed multifactor logistic regression analysis to identify significant factors. To determine the cutoff points for the significant factors, a receiver operating characteristic (ROC) curve analysis was conducted. RESULTS Study patients had a mean age of 43.6 years and an average follow-up period of 120.3 months. The patients as a group had a 68.2% overall incidence of bone formation. Based on univariate analysis results, data for patient sex, disc height, and the presence of anterior osteophytes and endplate sclerosis were included in the multivariate analysis. According to the analysis results, the identified independent risk factors for postoperative bone formation included disc height, the presence of anterior osteophytes, and endplate sclerosis, and according to a quantitative scoring system for degeneration of the cervical spine based on these variables, the ROC curve indicated that the optimal cutoff scores for these risk factors were 0.5, 1.5, and 1.5, respectively. CONCLUSIONS Among the patients who were followed up for at least 10 years after CDR, the incidence of postoperative bone formation was relatively high. The study results indicate that the degree of degeneration in the target level before surgery has a positive correlation with the incidence of postoperative ossification. Rigorous indication criteria for postoperative ossification should be applied in patients for whom CDR may be a treatment option.
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Affiliation(s)
- Feifei Zhou
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Shuyang Li
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yanbin Zhao
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yilong Zhang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | | | - Fengshan Zhang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Shengfa Pan
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yu Sun
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
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14
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Ge CY, Wang J, Zhang BF, Hui H, Shan LQ, Zhao QP, Hao DJ. Spontaneous Fusion After Cervical Disc Arthroplasty: A Case Report and Literature Review. J Pain Res 2020; 13:771-776. [PMID: 32368130 PMCID: PMC7183536 DOI: 10.2147/jpr.s242646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report a rare case of spontaneous fusion (SF) following cervical disc arthroplasty (CDA), to review the related literature, and to propose a new measure to prevent it. Methods The course of a patient with SF is described here. The potential causes, risk factors, and preventive measure of SF after CDA published in previous studies have also been reviewed and discussed. Results A 63-year-old man presented with a 6-month history of progressive neck pain and developed left C-7 radiculopathy 4 years ago. Magnetic resonance imaging revealed disc herniation at the C6–C7 levels resulting in compression of the left C-7 nerve root. The patient underwent CDA at the C6–C7 levels, during which a PRESTIGE cervical disc device was implanted. He failed to follow-up regularly as recommended postoperatively because he was completely free from the pain in his neck and left upper limb. Four years later, he was readmitted with a 2-month history of occasional neck stiffness. Plain radiographs indicated complete radiographic fusion of the C6–C7 levels with trabecular bone bridging surrounding the cervical disc prosthesis, and dynamic imaging showed no motion. He was seen at regular follow-up visits for up to 60 months without special treatment, as his symptoms of neck stiffness were minor and his symptom has not worsened since then. Conclusion SF after CDA is a rare condition that can be attributed to patient- or prosthesis-related causes, and its risk factors are diverse. SF after CDA did not affect the patient’s clinical outcome, and no special treatment was required for it. Practitioners should be aware of this rare complication and advise patients of the risks before performing CDA.
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Affiliation(s)
- Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Jing Wang
- Department of Ophthalmology, Xi'an Fourth Hospital, Xi'an 710004, Shaanxi Province, People's Republic of China
| | - Bin-Fei Zhang
- Department of Trauma Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Hao Hui
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Le-Qun Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Qin-Peng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
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15
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Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature. World Neurosurg 2020; 140:534-540. [PMID: 32353543 DOI: 10.1016/j.wneu.2020.04.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Recently, there has been significant interest in understanding the cost-effectiveness of treatments in spine surgery as health care systems in the United States move toward value-based care and alternative payment models. Previous studies have shown comparable outcomes of cervical disc arthroplasty (CDA) and anterior cervical discectomy fusion; however, there is a lack of consensus on the cost-effectiveness of CDA to support full adoption. Evidence of the limitations of these cost-analysis studies also exists in the literature, including industry funding, potential selection bias, and varying methods of calculating value. The goal of this narrative review is to provide an overview of the cost-effectiveness of CDA compared with anterior cervical discectomy and fusion, and potential limitations with cost-analysis studies in spine surgery.
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16
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Hollyer MA, Gill EC, Ayis S, Demetriades AK. The safety and efficacy of hybrid surgery for multilevel cervical degenerative disc disease versus anterior cervical discectomy and fusion or cervical disc arthroplasty: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:289-303. [PMID: 31848789 DOI: 10.1007/s00701-019-04129-3] [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: 07/31/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multilevel cervical degenerative disc disease (CDDD) can be treated surgically with anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), or a hybrid surgery (HS) of the two in which both procedures are used at different vertebral levels. A systematic review and meta-analysis was performed to compare the clinical and radiographical outcomes of HS against ACDF or CDA alone. METHODS Three electronic databases were searched for articles published before December 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS Eight papers were identified as eligible with a total of 424 patients. Post-operative C2-C7 range of motion (ROM) was significantly greater after HS than ACDF (p = 0.004; mean difference (MD) 6.14°). The ROM of the superior adjacent segment was significantly lower after HS than ACDF (p < 0.0001; MD - 2.87°) as was the ROM of the inferior adjacent segment (p = 0.0005; MD - 3.11°). HS patients' return to work was shorter than those who underwent ACDF (p < 0.00001; MD - 32.01 days) and CDA (p < 0.00001; MD - 32.92 days). There were no statistically significant differences in functional outcomes following CDA compared with HS. There was no significant difference in operation time, intra-operative blood loss, or post-operative complications between any of the procedures. CONCLUSION The number of included studies was small, the heterogeneity between them was substantial, and the quality of evidence was very low. Large randomised controlled trials are required to provide strong evidence that would enable recommendation of one intervention over another.
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Affiliation(s)
- Marcus A Hollyer
- University of Edinburgh Medical School, Edinburgh, UK.
- Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, UK.
- Mater Infirmorum Hospital (Belfast Health and Social Care Trust), 45-51 Crumlin Road, Belfast, BT14 6AB, UK.
| | - Emma C Gill
- University of Edinburgh Medical School, Edinburgh, UK
| | - Salma Ayis
- Primary Care and Public Health Sciences, Kings College London, London, UK
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, UK
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
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17
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Hou WX, Zhang HX, Wang X, Yang HL, Luan XR. Application of a modified surgical position in anterior approach for total cervical artificial disc replacement. World J Clin Cases 2020; 8:38-45. [PMID: 31970168 PMCID: PMC6962081 DOI: 10.12998/wjcc.v8.i1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Total cervical artificial disc replacement (TDR) has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods. Positioning the surgical patient is a critical part of the procedure. Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure, ensuring adequate and safe anesthesia, and allowing the surgeon to operate comfortably during lengthy procedures. The surgical posture is the traditional position used in anterior cervical approach; in general, patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.
AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.
METHODS In the modified position group, the patients had a soft pillow under their neck, and their jaw and both shoulders were fixed with wide tape. The analyzed data included intraoperative blood loss, position setting time, total operation time, and perioperative blood pressure and heart rate.
RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups (P > 0.05). Compared with the traditional position group, the modified position group showed a statistically significantly longer position setting time (P < 0.05). However, the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group (P < 0.05).
CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group, thus reducing the risks of surgery while increasing the position setting time. The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.
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Affiliation(s)
- Wen-Xiu Hou
- Third Ward of Orthopedics Department, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hao-Xuan Zhang
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Xia Wang
- Third Ward of Orthopedics Department, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hai-Ling Yang
- Department of Nursing, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Xiao-Rong Luan
- Third Ward of Orthopedics Department, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
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Harris L, Dyson E, Elliot M, Peterson D, Ulbricht C, Casey A. Delayed periprosthetic collection after cervical disc arthroplasty. J Neurosurg Spine 2019; 32:584-591. [PMID: 31835247 DOI: 10.3171/2019.9.spine19900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Abstract
Cervical disc arthroplasty is a treatment option for symptomatic cervical disc disease. There is a paucity of literature on long-term safety outcomes, durability, and device-related failure rates. The M6-C artificial cervical disc is a device with titanium alloy endplates and a complex polymeric centerpiece. To date, trials have exhibited acceptable safety profiles.This case series describes the presentation, management, and pathological findings of a delayed prevertebral periprosthetic mass anterior to the M6-C disc. Four patients at 3 different institutions underwent cervical disc replacement with the M6-C disc. Two to seven years postoperatively, they presented with dysphagia secondary to a compressive mass anterior to the disc. Case notes were reviewed to collect data on symptoms, management, and outcomes. The patients were systemically well and presented with progressive dysphagia. They had imaging findings of a mass anterior to the disc. They underwent a decompressive procedure, with 2 patients undergoing device removal and fusion. In 2 cases, a soft-tissue mass was seen intraoperatively, with frank pus. In 3 cases, Propionibacterium acnes was identified and antibiotic treatment given. Histopathology demonstrated mixed inflammatory infiltrates with foreign body-type granulomas. Postoperatively, the dysphagia resolved.The development of delayed dysphagia in a patient with an M6-C disc should prompt investigation to identify a mass lesion. To the authors' knowledge, this is the first report of delayed infection, or suspected delayed-type hypersensitivity reaction, following M6-C disc implantation. It is important for this to be added to the device safety concerns. Further prospective studies are needed to establish the incidence and the long-term safety and failure rates of the M6-C disc.
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Affiliation(s)
- Lauren Harris
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Edward Dyson
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Matthew Elliot
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - David Peterson
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Christian Ulbricht
- 1Department of Neurosurgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom; and
| | - Adrian Casey
- 2Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Othman YA, Verma R, Qureshi SA. Artificial disc replacement in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S170. [PMID: 31624736 DOI: 10.21037/atm.2019.08.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Total disc replacement (TDR) is an innovative procedure that has gained traction in spine surgery. A large amount of data in the literature report on the short-term outcomes of TDR surgery favorably. However, surgeons remain reluctant to opt for TDR surgery due to uncertainty of long-term outcomes. Recently, long term data regarding TDR surgery has become available, with some studies showing superior outcomes to fusion surgery. The goal of this review is to synthesize and clinically contextualize the recent literature on TDR surgery. This article also provides brief discussion of the biggest challenges currently facing disc arthroplasties and the ways in which they are being tackled.
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Affiliation(s)
- Yahya A Othman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ravi Verma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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20
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Yang MMH, Ryu WHA, Casha S, DuPlessis S, Jacobs WB, Hurlbert RJ. Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty. J Neurosurg Spine 2019; 31:660-669. [PMID: 31374546 DOI: 10.3171/2019.5.spine19257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) is an accepted motion-sparing technique associated with favorable patient outcomes. However, heterotopic ossification (HO) and adjacent-segment degeneration are poorly understood adverse events that can be observed after CDA. The purpose of this study was to retrospectively examine 1) the effect of the residual exposed endplate (REE) on HO, and 2) identify risk factors predicting radiographic adjacent-segment disease (rASD) in a consecutive cohort of CDA patients. METHODS A retrospective cohort study was performed on consecutive adult patients (≥ 18 years) who underwent 1- or 2-level CDA at the University of Calgary between 2002 and 2015 with > 1-year follow-up. REE was calculated by subtracting the anteroposterior (AP) diameter of the arthroplasty device from the native AP endplate diameter measured on lateral radiographs. HO was graded using the McAfee classification (low grade, 0-2; high grade, 3 and 4). Change in AP endplate diameter over time was measured at the index and adjacent levels to indicate progressive rASD. RESULTS Forty-five patients (58 levels) underwent CDA during the study period. The mean age was 46 years (SD 10 years). Twenty-six patients (58%) were male. The median follow-up was 29 months (IQR 42 months). Thirty-three patients (73%) underwent 1-level CDA. High-grade HO developed at 19 levels (33%). The mean REE was 2.4 mm in the high-grade HO group and 1.6 mm in the low-grade HO group (p = 0.02). On multivariable analysis, patients with REE > 2 mm had a 4.5-times-higher odds of developing high-grade HO (p = 0.02) than patients with REE ≤ 2 mm. No significant relationship was observed between the type of artificial disc and the development of high-grade HO (p = 0.1). RASD was more likely to develop in the lower cervical spine (p = 0.001) and increased with time (p < 0.001). The presence of an artificial disc was highly protective against degenerative changes at the index level of operation (p < 0.001) but did not influence degeneration in the adjacent segments. CONCLUSIONS In patients undergoing CDA, high-grade HO was predicted by REE. Therefore, maximizing the implant-endplate interface may help to reduce high-grade HO and preserve motion. RASD increases in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6-7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.
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Affiliation(s)
- Michael M H Yang
- 1Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Alberta
- 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada; and
| | - Won Hyung A Ryu
- 1Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Alberta
| | - Steven Casha
- 1Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Alberta
| | - Stephan DuPlessis
- 1Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Alberta
| | - W Bradley Jacobs
- 1Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Alberta
| | - R John Hurlbert
- 3Banner University Spine Program, University of Arizona, Tucson, Arizona
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