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.