Incidence and risk factors of axial symptoms after cervical disc arthroplasty: a minimum 5-year follow-up study

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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Eight-Year Clinical and Radiological Follow-Up of the Bryan Cervical Disc Arthroplasty

Spine ◽

10.1097/brs.0b013e3181dc9b51 ◽

2011 ◽

Vol 36 (8) ◽

pp. 639-646 ◽

Cited By ~ 75

Author(s):

Gerald M. Y. Quan ◽

Jean-Marc Vital ◽

Steve Hansen ◽

Vincent Pointillart

Keyword(s):

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty

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Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty

Neurosurgical FOCUS ◽

10.3171/2017.1.focusvid.16389 ◽

2017 ◽

Vol 42 (videosuppl1) ◽

pp. V4 ◽

Cited By ~ 1

Author(s):

Chih-Chang Chang ◽

Jau-Ching Wu ◽

Peng-Yuan Chang ◽

Mei-Yin Yeh ◽

Yi-Hsuan Kuo ◽

...

Keyword(s):

Large Scale ◽

Primary Stability ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Artificial Disc ◽

Joint Function ◽

Disc Arthroplasty ◽

The Us ◽

Randomized Control

There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.

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