Cervical disc arthroplasty versus cervical discectomy and fusion for single-level cervical spondylosis: mid-term follow-up of a randomized controlled trial

doi:10.3969/j.issn.2095-4344.2015.09.008

Abstract

Abstract:

BACKGROUND: Anterior cervical discectomy and fusion is the gold stanard for the surgical treatment of degenerative cervical disease. However, with the increasing numer of cases and long-term clinical follow-up data, more and more negative problems happen. The short-term clinical outcomes of cervical disc arthroplasty in the treatment of single-level cervical spondylosis have been recognized, but the mid- and long-term effects are still unclear.
OBJECTIVE: To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Discover cervical disc arthroplasty in the treatment of single-level cervical spondylosis.
METHODS: From January 2009 to October 2011, 71 patients with single-level cervical disc disease, ineffective by conservative therapy, were randomly divided into arthroplasty group (n=34) and fusion group (n=37), receiving Discover cervical disc arthroplasty and anterior cervical discectomy and fusion, respectively. All patients were determined with Visual Analogue Scale (VAS) score, Japanese Orthopedics Association (JOA) score, Neck Disability Index (NDI) score and radiographic examinations before surgery, at 3, 6, 12, 24, 48 months afte surgery, as well as at final follow-up. Complications and secondary treatment were recorded during follow-up.
RESULTS AND CONCLUSION: The 71 patients were followed up for average 33.5 months. The VAS scores of neck and arm, JOA score and NDI score were significantly improved at each follow-up time point as compared with preoperative score in all patients (P < 0.05), and these indexes were better in the arthroplasty group than in fusion at 3, 6, 12 and 24 months postoperatively (P < 0.05). In the arthroplasty group, the range of motion of repairing segment and the whole activity of cervical vertebra were higher than that in the fusion group at each follow-up time piont postoperatively (P < 0.05). None of patients experienced serious complications of neurovascular injury during perioperative period. During follow-up, there were 3 patients with heterotopic ossification, 1 patient with prosthesis antedisplacement (< 3 mm) and 2 patients undering the revision surgery due to cranial adjacent degeneration, in the arthroplasty group. While in the fusion group, 9 patients accepted the revision surgery, with pseudarthrosis and fusion failure in 1, screw breakage in 1, cranial disc degeneration and neurological deficit in 3 and spinal cord decompression due to caudal disc degeneration in 2. The mid-term outcome of Discover cervical disc arthroplasty is better than anterior cervical discectomy and fusion in the treatment of single-level cervical spondylosis.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Tissue Engineering, Intervertebral Disk, Bone Grafting, Cervical Spondylosis, Randomized Controlled Trials

CLC Number:

R318

Luo Cheng, Qu Xia, Chen Bo, Peng Zhong-yi, Zou Yong-gen . Cervical disc arthroplasty versus cervical discectomy and fusion for single-level cervical spondylosis: mid-term follow-up of a randomized controlled trial[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1358-1364.

Figures/Tables 4

References

[1] Goffin J, Geusens E, Vantomme N, et al. Long-term follow–up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004;17(2):79-85.
[2] Grob D, Porchet F, Jeszenszky D, et al. A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects. Eur Spine J. 2010;19(2):297-306.
[3] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plat-ing: a 5- to 11-year radiologic and clinical follow-up study. Spine. 2005;30(19):2138-44.
[4] Riew KD, Buchowski JM, Sasso R, et al. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. J Bone Joint Surg Am. 2008;90(11):2354-2364.
[5] Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J. 2009; 18(2):218-231.
[6] Baba H, Furusawa N, Imura S, et al. Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine. 1993;18(15):2167-2173.
[7] Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4(6 suppl):190s-194s.
[8] Singh K, Phillips FM, Park DK, et al. Factors affecting reoperations after anterior cervical discectomy and fusion within and outside of a federal drug administration investigational device exemption cervical disc replacement trial. Spine J. 2012;12(5):372-378.
[9] Mummaneni PV, Haid RW. The future in the care of the cervical spine: interbody fusion and arthroplasty. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2004. J Neurosurg Spine. 2004;1(2):155-159.
[10] Chen J, Wang X, Bai W, et al. Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J. 2012;21(4):674-680.
[11] Leung C, Casey AT, Goffin J, et al. Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery. 2005; 57(4):759-763.
[12] Yang YC, Nie L, Cheng L, et al. Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up. Int Orthop. 2009;33(4):1037-1042.
[13] Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine. 2009;34(2): 101-107.
[14] Fernstrom U. Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acts Chir Scand Suppl. 1966;357(1):154-159．
[15] Sasso RC, Anderson PA, Riew KD, et al. Results of cervical arthroplasty compared with anterior discectomy and fusion：four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am. 2011;93(18): 1684- 1692.
[16] Burkus JK, Haid RW, Traynelis VC, et al. Long-term clinical and radiographic outcomes of cervical disc replacement with the prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine. 2010;13(3):308- 318.
[17] 张雪松,张永刚,王岩,等.单节段人工椎间盘置换治疗颈椎病的中长期疗效[J].中国脊柱脊髓杂志,2012,22(10):879-883.
[18] Fehlings MG, Smith JS, Kopjar B, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine north America cervical spondylotic myelopathy study. J Neurosurg Spine. 2012;16(5):425-432.
[19] Zigler JE, Delamarter R, Murrey D, et al. ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single-level cervical symptomatic degenerative disc disease. Spine. 2013;38:203-209.
[20] 贡雯韵,袁文,侯洋,等. Discover颈人工椎间盘置换治疗颈椎病的临床研究[J].中国脊柱脊髓杂志,2013,23(1):11-15.
[21] Rozankovic M, Marasanov SM, Vukic M. Cervical disc replacement with discover versus fusion in a single level cervical disc disease: a prospective single center randomized trial with a minimum two-year follow-up. J Spinal Disord Tech. 2014;9(8):1-20.
[22] Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up. J Spinal Disord Tech. 2010;23(6):367-371.
[23] Yu L, Song YM, Yang X, et al. Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with anterior cervical decompression and fusion. Orthopedics. 2011;34(10):e651-e657.
[24] Goffin J, van Loon J, Van Calenbergh F, et al. A clinical analysis of 4- and- 6- year follow-up results after cervical disc replacement surgery using the Byran Cervical Disc Prosthesis. J Neurosurg Spine. 2010;12(3):261-269.
[25] Coric D, Kim P, Clemente JD, et al. Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine. 2013;18(1):36-42.
[26] 田伟,吕艳伟,刘亚军,等.中国大陆人工颈椎间盘置换修复后异位骨化发生率的Meta分析[J].中华骨科杂志,2013,33(8):785-791.
[27] Anderson PA, Sasso RC, Riew KD. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine. 2008;33(12):1305-1312.
[28] Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32(21):2310-2317.
[29] Jawahar A, Cavanaugh DA, Kerr EJ 3rd, et al. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J. 2010; 10(12):1043-1048.
[30] Nunley PD, Jawahar A, Kerr EJ 3rd, et al. Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty: 2- to 4-year follow-up of 3 prospective randomized trials. Spine. 2012;37(6):445-451.
[31] Yin S, Yu X, Zhou SL, et al. Is Cervical disc arthroplasty superior to fusion for treatment of symptomatic cervical disc disease? A meta–analysis. Clin Orthop Relat Res. 2013;471 (6): 1904-1919.