Clinical Studies
Outcomes following cervical disc arthroplasty: A retrospective review

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Abstract

Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. We performed a retrospective review of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty from August 2008 to August 2012. The clinical outcomes and complications associated with the procedure were evaluated. A total of 219 consecutive patients were included in the review, with an average follow-up of 11.2 (±11.0) months. Relief of pre-operative symptoms was noted in 88.7% of patients, and 92.2% of patients were able to return to full pre-operative activity. There was a low rate of complications related to the anterior cervical approach (3.2% with recurrent laryngeal nerve injury, 8.9% with dysphagia), with no device/implant related complications. Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.

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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