Long-term Clinical Outcomes of Cervical Disc Arthroplasty

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

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Clinical Outcomes for Worker’s Compensation Patients After Cervical Disc Arthroplasty

The Spine Journal ◽

10.1016/j.spinee.2011.08.263 ◽

2011 ◽

Vol 11 (10) ◽

pp. S105-S106

Author(s):

Matthew Gornet ◽

Brett Taylor ◽

Todd Lanman ◽

John Peloza ◽

Randall Dryer ◽

...

Keyword(s):

Clinical Outcomes ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Worker's Compensation ◽

Disc Arthroplasty ◽

Worker’S Compensation

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Clinical Outcomes of Bryan Cervical Disc Arthroplasty A Prospective, Randomized, Controlled, Single Site Trial With 48-Month Follow-up

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3181bb8568 ◽

2010 ◽

Vol 23 (6) ◽

pp. 367-371 ◽

Cited By ~ 111

Author(s):

Ben J. Garrido ◽

Tarek A. Taha ◽

Rick C. Sasso

Keyword(s):

Clinical Outcomes ◽

Single Site ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Randomized Controlled

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Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

The International Journal of Spine Surgery ◽

10.14444/7090 ◽

2020 ◽

Vol 14 (s2) ◽

pp. S41-S49

Author(s):

Matthew F. Gornet ◽

Francine W. Schranck ◽

Katrine M. Sorensen ◽

Anne G. Copay

Keyword(s):

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Long Term Outcomes ◽

Disc Arthroplasty

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Cervical disc arthroplasty for less-mobile discs

Journal of Neurosurgery Spine ◽

10.3171/2019.2.spine181472 ◽

2019 ◽

Vol 31 (3) ◽

pp. 310-316 ◽

Cited By ~ 4

Author(s):

Tsung-Hsi Tu ◽

Chu-Yi Lee ◽

Chao-Hung Kuo ◽

Jau-Ching Wu ◽

Hsuan-Kan Chang ◽

...

Keyword(s):

Clinical Outcomes ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Segmental Mobility ◽

Disc Arthroplasty ◽

Flexion Extension ◽

Index Level

OBJECTIVEThe published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°–9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.METHODSA series of consecutive patients who underwent CDA at the level of C5–6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5–6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5–6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.RESULTSA total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.CONCLUSIONSPreoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

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Risk factors for anterior bone loss in cervical disc arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine171018 ◽

2018 ◽

Vol 29 (2) ◽

pp. 123-129 ◽

Cited By ~ 12

Author(s):

David Christopher Kieser ◽

Derek Thomas Cawley ◽

Takashi Fujishiro ◽

Simon Mazas ◽

Louis Boissière ◽

...

Keyword(s):

Risk Factors ◽

Bone Loss ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Range Of Movement ◽

Disc Arthroplasty ◽

Increased Risk ◽

Significant Difference ◽

Potential Risk Factors

OBJECTIVEThe objective of this study was to identify the risk factors of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and the subsequent effect of this phenomenon.METHODSThe authors performed a retrospective radiological review of 185 patients with a minimum 5-year follow-up after CDA (using Bryan, Discocerv, Mobi-C, or Baguera C). Postoperative radiographs were examined and compared to the initial postoperative films to determine the percentage of ABL. The relationship of ABL to potential risk factors was analyzed.RESULTSComplete radiological assessment was available in 145 patients with 193 CDRs and 383 endplates (average age 45 years, range 25–65 years, 54% women). ABL was identified in 63.7% of CDRs (48.7% mild, 11.9% moderate, 3.1% severe). Age (p = 0.770), sex (p = 0.200), postoperative alignment (p = 0.330), midflexion point (p = 0.509), maximal flexion (p = 0.080), and extension (p = 0.717) did not relate to ABL. There was no significant difference in the rate of severe ABL between implants. Multilevel surgery conferred an increased risk of any and severe ABL (p = 0.013 for both). The upper endplate, defined as superior to the CDA, was more commonly involved (p = 0.008), but there was no significant difference whether the endplate was between or not between implants (p = 0.226). The development of ABL did not affect the long-term range of movement (ROM) of the CDA, but did increase the overall risk of autofusion. ABL was not associated with pain or functional deficits. No patients required a reoperation or revision of their implant during the course of this study, and there were no cases of progressive ABL beyond the first year.CONCLUSIONSABL is common in all implant types assessed, although most is mild. Age, sex, postoperative alignment, ROM, and midflexion point do not relate to this phenomenon. However, the greater the number of levels operated, the higher the risk of developing ABL. The development of ABL has no long-term effect on the mechanical functioning of the disc or necessity for revision surgery, although it may increase the rate of autofusion.

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The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty

Neurosurgery ◽

10.1093/neuros/nyaa271 ◽

2020 ◽

Cited By ~ 1

Author(s):

Yi-Hsuan Kuo ◽

Chao-Hung Kuo ◽

Hsuan-Kan Chang ◽

Li-Yu Fay ◽

Tsung-Hsi Tu ◽

...

Keyword(s):

Cobb Angle ◽

Clinical Outcomes ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Cervical Lordosis ◽

Segmental Mobility ◽

Disc Arthroplasty ◽

T1 Slope ◽

Index Level ◽

Cervical Spinal Alignment

Abstract BACKGROUND Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck. OBJECTIVE To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA. METHODS The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (<28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed. RESULTS The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG. CONCLUSION In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.

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