Symptomatic Adjacent Segment Disease Following Cervical Total Disc Replacement: Reexamining the Clinical and Radiological Evidence with Established Criteria

2012 ◽  
Vol 12 (9) ◽  
pp. S25
Author(s):  
Pierce D. Nunley ◽  
Ajay Jawahar ◽  
David A. Cavanaugh ◽  
Charles Gordon ◽  
Eubulus J. Kerr ◽  
...  
Keyword(s):  
Total Disc Replacement ◽  
Adjacent Segment Disease ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Cervical Total Disc Replacement ◽  
Radiological Evidence

Adjacent Segment Disease After Cervical Total Disc Replacement: Clinical and Radiological Evidence After Four- to Seven-Years Follow-Up

2012 ◽  
Vol 12 (9) ◽  
pp. S63
Author(s):  
Ajay Jawahar ◽  
Pierce D. Nunley ◽  
David A. Cavanaugh ◽  
Charles R. Gordon ◽  
Eubulus J. Kerr ◽  
...  
Keyword(s):  
Total Disc Replacement ◽  
Adjacent Segment Disease ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Cervical Total Disc Replacement ◽  
Radiological Evidence

Early development and progression of heterotopic ossification in cervical total disc replacement

2012 ◽  
Vol 16 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Soo Eon Lee ◽  
Chun Kee Chung ◽  
Tae Ahn Jahng
Keyword(s):  
Clinical Outcome ◽  
Heterotopic Ossification ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Segmental Motion ◽  
Cervical Total Disc Replacement ◽  
The Mean ◽  
Grade Iii

Object The purpose of cervical total disc replacement (TDR) is to decrease the incidence of adjacent segment disease through motion preservation. Heterotopic ossification (HO) is a well-known complication after hip and knee arthroplasties. There are few reports regarding HO in patients undergoing cervical TDR, however; and the occurrence of HO and its effects on cervical motion have rarely been reported. Moreover, temporal progression of HO has not been fully addressed. One goal of this study involved determining the incidence of HO following cervical TDR, as identified from plain radiographs, and demonstrating the progression of HO during the follow-up period. A second goal consisted of determining whether segmental motion could be preserved and identifying the relationship between HO and clinical outcomes. Methods The authors conducted a retrospective clinical and radiological study of 28 consecutive patients who underwent cervical TDR with Mobi-C prostheses (LDR Medical) between September 2006 and October 2008. Radiological outcomes were evaluated using lateral dynamic radiographs obtained preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. The occurrence of HO was interpreted on lateral radiographs using the McAfee classification. Cervical range of motion (ROM) was also measured. The visual analog scale (VAS) and Neck Disability Index (NDI) were used to evaluate clinical outcome. Results The mean follow-up period was 21.6 ± 7.0 months, and the mean occurrence of HO was at 8.0 ± 6.6 months postoperatively. At the last follow-up, 18 (64.3%) of 28 patients had HO: Grade I, 6 patients; Grade II, 8 patients; Grade III, 3 patients; and Grade IV, 1 patient. Heterotopic ossification progression was proportional to the duration of follow-up; HO was present in 3 (10.7%) of 28 patients at 1 month; 7 (25.0%) of 28 patients at 3 months; 11 (42.3%) of 26 patients at 6 months; 15 (62.5%) of 24 patients at 12 months; and 17 (77.3%) of 22 patients at 24 months. Cervical ROM was preserved in Grades I and II HO but was restricted in Grades III and IV HO. Clinical improvement according to the VAS and NDI was not significantly correlated with the occurrence of HO. Conclusions The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began unexpectedly to appear early after surgery. Heterotopic ossification progression was proportional to the time that had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion; however, the occurrence of HO did not affect clinical outcome. The results of this study indicate that a high incidence of HO with the possibility of spontaneous fusion is to be expected during long-term follow-up and should be considered before performing cervical TDR.

Total disc replacement versus anterior cervical discectomy and fusion

2018 ◽  
Vol 100-B (8) ◽  
pp. 991-1001 ◽  
Author(s):  
C. Findlay ◽  
S. Ayis ◽  
A. K. Demetriades
Keyword(s):  
Outcome Measures ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Total Disc Replacement ◽  
Adjacent Segment Disease ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Short Term ◽  
Patient Reported

Aims The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis. Patients and Methods Databases including Medline, Embase, and Scopus were searched. Inclusion criteria involved prospective randomized control trials (RCTs) reporting the surgical treatment of patients with symptomatic degenerative cervical disc disease. Two independent investigators extracted the data. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The primary outcome measures were overall and neurological success, and these were included in the meta-analysis. Standardized patient-reported outcomes, including the incidence of further surgery and adjacent segment disease, were summarized and discussed. Results A total of 22 papers published from 14 RCTs were included, representing 3160 patients with follow-up of up to ten years. Meta-analysis indicated that TDR is superior to ACDF at two years and between four and seven years. In the short-term, patients who underwent TDR had better patient-reported outcomes than those who underwent ACDF, but at two years this was typically not significant. Results between four and seven years showed significant differences in Neck Disability Index (NDI), 36-Item Short-Form Health Survey (SF-36) physical component scores, dysphagia, and satisfaction, all favouring TDR. Most trials found significantly less adjacent segment disease after TDR at both two years (short-term) and between four and seven years (medium- to long-term). Conclusion TDR is as effective as ACDF and superior for some outcomes. Disc replacement reduces the risk of adjacent segment disease. Continued uncertainty remains about degeneration of the prosthesis. Long-term surveillance of patients who undergo TDR may allow its routine use. Cite this article: Bone Joint J 2018;100-B:991–1001.

scholarly journals Are Controversial Issues in Cervical Total Disc Replacement Resolved or Unresolved?: A Review of Literature and Recent Updates

2018 ◽  
Vol 12 (1) ◽  
pp. 178-192 ◽  
Author(s):  
Chun-Kun Park ◽  
Kyeong-Sik Ryu
Keyword(s):  
Surgical Outcomes ◽  
Wear Debris ◽  
Total Disc Replacement ◽  
Young Patients ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Controversial Issues ◽  
Hybrid Surgery ◽  
Cervical Total Disc Replacement

<p>Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.</p>

The Feasibility of Optimal Surgical Result Prediction according to the Centre of Rotation Shift after Multilevel Cervical Total Disc Replacement

2018 ◽  
Vol 1 (2) ◽  
pp. 6
Author(s):  
Jun Ho Lee
Keyword(s):  
Rating Scale ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Numeric Rating Scale ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Consecutive Series ◽  
Cervical Total Disc Replacement ◽  
Successful Group ◽  
Centre Of Rotation

Objective: This study investigates the relation between shifted locations of centre of rotation (COR) at each cervical level and subsequent surgical outcomes after multilevel cervical total disc replacement (MCTDR) and identifies radiological parameter that corresponded to change of COR after MCTDR. Methods: The study included a consecutive series of 24 patients who were treated with MCTDR following diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and the location of COR at TDR implanted level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief.Results: The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal locations at each cervical levels, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level after surgery in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X-axis.Conclusions: The crucial determinants for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR implanted levels, was the restoration of COR from ventro-cranial location at degenerated cervical motion segment close to normal coordinates by posterior and inferior shifts after MCTDR. The position of COR along the X-axis after MCTDR was an important factor to determine maintenance of C2-7 RO.

Sign in / Sign up

Export Citation Format

Share Document