Clinical StudiesOutcomes following cervical disc arthroplasty: A retrospective review
Introduction
Cervical radiculopathy and myelopathy are common diagnoses in adult patients that have been shown to cause significant disability and loss of productivity [1], [2], [3]. Patients commonly present with a constellation of symptoms, including dermatomal pain and paresthesias, weakness, and myelopathic signs including hyperreflexia, gait disturbance, and positive rudimentary reflexes [4], [5], [6], [7]. In the active duty military population, cervical radiculopathy often leads to difficulty performing training or mission-specific functions, which can prevent deployment, decrease force strength and adversely affect overall unit readiness. Spine-related pain syndromes comprise a significant percentage of unit attrition, and represents the leading cause of medical discharge across all military branches of service [8].
Several surgical options are available for the treatment of cervical radiculopathy and myelopathy, following an appropriate trial of non-operative management. These options include posterior decompression and fusion, anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). CDA has been espoused in the literature as a viable alternative to ACDF, with the added theoretical benefit of preventing adjacent segment degeneration, though this remains to be proved [9], [10], [11], [12], [13]. Currently accepted indications for CDA include foraminal osteophytosis causing radiculopathy or myelopathy, or reconstruction after neural decompression. Relative contraindications include pre-operative corticosteroids, renal failure, rheumatoid arthritis, osteoporosis, and a diagnosis of cancer. Absolute contraindications include deformity, immobile segments, instability, and facet joint degeneration [6], [7]. Based on our increasing experience in performing CDA, we sought to determine the outcomes of all patients who underwent this procedure at a single institution over a 4 year period.
Section snippets
Materials and methods
Following approval from our Institutional Review Board, the surgical database at this institution was queried to identify all patients who had undergone CDA between August 2008 and August 2012. This search yielded a total of 316 patients. Of these, 34 were lost to follow-up, leaving 282 patients for review. All construct types (single level CDA, hybrid, and multilevel CDA) were included. All data were collected via a retrospective chart analysis, which included inpatient and outpatient clinical
Results
There were 219 males (77.7%) and 63 females (22.3%). The average length of follow-up was 11.2 months (standard deviation 11.0 months). The average patient age was 42.1 (±8.4) years. The average BMI was 27.8 (±3.7) kg/m2. The most common levels addressed at the time of surgery were C5–6 and C6–7 (56.7% and 58.9%, respectively). The next most frequently diseased levels were C4–5 (19.5%), C3–4 (8.2%), and C7–T1 (2.5%). The majority of patients underwent single level CDA (59.9%), and 22.3% underwent
Discussion
To our knowledge, this is the largest, non-funded, single center review of CDA. When analyzing all construct types that included CDA at our institution, we found an 88.7% rate of complete pre-operative symptom relief and a 92.2% rate of return to full activity, with maintenance of 7.5 degrees at each CDA level on average. This included a majority subset population of active duty service members, which demonstrated a 90.4% rate of return to active duty. Furthermore, our review demonstrates a low
Conclusions
CDA is increasing in popularity for the treatment of cervical radiculopathy and myelopathy. To our knowledge, this is the largest, non-funded, single center study on this topic. Our review found an 89% rate of complete pre-operative symptom relief, with greater than 90% of patients returning to their pre-operative level of activity and an acceptably low rate of complications. While there are currently no long-term studies demonstrating the superiority of CDA over ACDF, short and mid-term
Conflicts of Interest/Disclosures
R.A.L. has received institutional grants from the Defense Advanced Research Projects Agency (DARPA), Defense Medical Research and Development Program (DMRDP), DePuy and Centinel Spine. No outside funding sources were utilized for this study. The authors have no potential conflicts of interest to report. Institutional Review Board approval with publication clearance was obtained for this study. The views expressed in this manuscript are those of the authors and do not reflect the official policy
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Return to sport and active military duty after cervical disc arthroplasty: A systematic review
2023, Journal of OrthopaedicsDoes the Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy?
2019, World NeurosurgeryCitation Excerpt :These depend on the individual factors of each patient, technical differences between surgical methods, and the surgeon's propensity and experience. ACDF, CDR, and PCF have a good effect on the treatment of cervical radiculopathy, providing decreased pain, improved function, and quality of life, as well as restored working ability.12-14 In this study, the mean age was smaller in the CDR group, as expected, since the indication for CDR is the maintenance of cervical motion for patients, especially in younger patients.
Does cervical disc arthroplasty have lower incidence of dysphagia than anterior cervical discectomy and fusion? A meta-analysis
2016, Clinical Neurology and NeurosurgeryCitation Excerpt :CDA has emerged as a promising potential alternative to ACDF in appropriately selected patients, who have symptomatic cervical disc disease or spondylosis causing radiculopathy and/or myelopathy [27]. A recent retrospective study identified an 8.9% incidence of dysphagia in the patients with CDA [28]. However, the difference in the incidences of dysphagia between CDA and ACDF has not been clearly established.
Cervical Disc Replacement vs Anterior Cervical Discectomy and Fusion
2015, Operative Techniques in OrthopaedicsCitation Excerpt :Hybrid constructs with ACDF and CDA at different levels are sometimes pursued. A retrospective review showed a lower rate of symptom control postoperatively, a higher rate of dysphagia, and persistent axial neck pain.24 In another study, the patients treated with hybrid constructs had faster recovery of range of motion and have had similarly good results as those with other, nonhybrid, constructs for degenerative cervical disease.31
Two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty-Long-term evidence update
2020, International Journal of Spine Surgery