Adjacent Level Radiographic Degenerative Changes Following Single-Level Artificial Disc Replacement or ACDF at Five- to Seven-Year Follow-Up

OBJECTIVE Artificial disc replacement (ADR) is designed to preserve motion and thus protect against adjacent-segment pathology (ASP) and act as an alternative treatment to fusion surgery. The question remains, how well do ADR devices perform after 10 years of follow-up compared with fusion surgery in terms of patient satisfaction, sustainability, and protection against ASP? METHODS This was the 10-year follow-up study of 153 participants who underwent ADR or fusion surgery after anterior decompression due to cervical degenerative radiculopathy (ISRCTN registration no. 44347115). Scores on the Neck Disability Index (NDI), EQ-5D, and visual analog scale for neck and arm pain were obtained from the Swedish Spine Registry and analyzed using ANCOVA. Information about secondary surgical procedures was collected from medical records and presented as Kaplan-Meier curves. MRI and flexion-extension radiography were performed, and ASP was graded according to the Miyazaki classification system. RESULTS Ten participants were lost to follow-up, which left 143 participants (80 underwent ADR and 65 underwent anterior cervical discectomy and fusion). There were no differences between groups in terms of patient-reported outcome measures (10-year difference in NDI scores 1.7 points, 95% CI −5.1 to 8.5, p = 0.61). Nineteen (24%) participants in the ADR group compared with 9 (14%) in the fusion group underwent secondary surgical procedures. The higher reoperation rate of the ADR group was mainly due to 11 female participants with device loosening. The rates of reoperation due to ASP were similar between groups, which was confirmed with MRI assessment of ASP that also showed no differences between the groups (p = 0.21). CONCLUSIONS This was the first 10-year follow-up study to compare ADR with fusion surgery and to provide MRI information for the assessment of ASP. The authors found no benefit of ADR over fusion surgery after anterior decompression for cervical degenerative radiculopathy.

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Clinical outcomes of single-level lumbar artificial disc replacement compared with transforaminal lumbar interbody fusion in an Asian population

Singapore Medical Journal ◽

10.11622/smedj.2015032 ◽

2015 ◽

Vol 56 (04) ◽

pp. 208-211 ◽

Cited By ~ 5

Author(s):

WT Lee ◽

G Liu ◽

J Thambiah ◽

HK Wong

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Asian Population ◽

Transforaminal Lumbar Interbody Fusion ◽

Disc Replacement ◽

Lumbar Interbody Fusion ◽

Artificial Disc ◽

Single Level ◽

Artificial Disc Replacement

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Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing long-term follow-up results from two FDA trials

Evidence-Based Spine-Care Journal ◽

10.1055/s-0031-1298610 ◽

2012 ◽

Vol 3 (S 01) ◽

pp. 59-66 ◽

Cited By ~ 31

Author(s):

Praveen Mummaneni ◽

Beejal Amin ◽

Jau-Ching Wu ◽

Erika Brodt ◽

Joseph Dettori ◽

...

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Disc Replacement ◽

Artificial Disc ◽

Artificial Disc Replacement ◽

Long Term Follow Up

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Five-year adjacent-level degenerative changes in patients with single-level disease treated using lumbar total disc replacement with ProDisc-L versus circumferential fusion

Journal of Neurosurgery Spine ◽

10.3171/2012.9.spine11717 ◽

2012 ◽

Vol 17 (6) ◽

pp. 504-511 ◽

Cited By ~ 44

Author(s):

Jack E. Zigler ◽

Jamieson Glenn ◽

Rick B. Delamarter

Keyword(s):

Total Disc Replacement ◽

Degenerative Changes ◽

Disc Replacement ◽

Height Loss ◽

Adjacent Level ◽

Clinical Trial Registration ◽

Single Level ◽

New Findings ◽

Circumferential Fusion ◽

Adjacent Level Degeneration

Object The authors report the 5-year results for radiographically demonstrated adjacent-level degenerative changes from a prospective multicenter study in which patients were randomized to either total disc replacement (TDR) or circumferential fusion for single-level lumbar degenerative disc disease (DDD). Methods Two hundred thirty-six patients with single-level lumbar DDD were enrolled and randomly assigned to 2 treatment groups: 161 patients in the TDR group were treated using the ProDisc-L (Synthes Spine, Inc.), and 75 patients were treated with circumferential fusion. Radiographic follow-up data 5 years after treatment were available for 123 TDR patients and 43 fusion patients. To characterize adjacent-level degeneration (ALD), radiologists at an independent facility read the radiographic films. Adjacent-level degeneration was characterized by a composite score including disc height loss, endplate sclerosis, osteophytes, and spondylolisthesis. At 5 years, changes in ALD (ΔALDs) compared with the preoperative assessment were reported. Results Changes in ALD at 5 years were observed in 9.2% of TDR patients and 28.6% of fusion patients (p = 0.004). Among the patients without adjacent-level disease preoperatively, new findings of ALD at 5 years posttreatment were apparent in only 6.7% of TDR patients and 23.8% of fusion patients (p = 0.008). Adjacent-level surgery leading to secondary surgery was reported for 1.9% of TDR patients and 4.0% of fusion patients (p = 0.6819). The TDR patients had a mean preoperative index-level range of motion ([ROM] of 7.3°) that decreased slightly (to 6.0°) at 5 years after treatment (p = 0.0198). Neither treatment group had significant changes in either ROM or translation at the superior adjacent level at 5 years posttreatment compared with baseline. Conclusions At 5 years after the index surgery, ProDisc-L maintained ROM and was associated with a significantly lower rate of ΔALDs than in the patients treated with circumferential fusion. In fact, the fusion patients were greater than 3 times more likely to experience ΔALDs than were the TDR patients. Clinical trial registration no.: NCT00295009.

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