High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses

2012 ◽  
Vol 17 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Christopher Brenke ◽  
Johann Scharf ◽  
Kirsten Schmieder ◽  
Martin Barth
Keyword(s):  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Analog Scale ◽  
Osteophyte Formation ◽  
High Prevalence ◽  
The Mean ◽  
Neck Disability

Object Cervical disc arthroplasty (CDA) has been increasingly used for the treatment of cervical disc herniations. However, the impact of CDA on adjacent-segment degeneration and the degree of heterotopic ossification (HO) of the treated segment remain a subject of controversy. Due to a product failure of the Galileo-type disc prosthesis, 22 of these devices were explanted. The radiological and clinical course in each case was investigated in detail with an emphasis on the incidence of HO and facet joint degeneration 18 months following the operation. Intraoperative findings regarding ossification and implant fixation were documented. Thus, the authors were able to describe the true rate of adjacent-segment degeneration and HO following CDA and the clinical relevance thereof. Methods In all 22 patients, functional radiographic imaging was performed prior to surgery, 3 and 12 months after surgery, and prior to disc prosthesis explantation. At all time points, the range of motion (ROM) in the operated and adjacent segments was determined. A motion index was calculated using the preoperative and all postoperative ROMs (preoperative ROM/postoperative ROM). Computed tomography was used preoperatively to measure the height of the index segment, extent of HO, and the degree of the progression of facet arthrosis, and was used postoperatively prior to prosthesis explantation. Patients completed clinical questionnaires that included a visual analog scale and the Neck Disability Index. Results The motion index of the index segment declined gradually from 1.4 at 3 months postoperative to 1.2 prior to explantation, while the motion index of the adjacent upper segment increased from 0.9 to 1.3. The mean ROM of the index segment was 10.4° ± 6.7°, and fusion was observed in 2 (9%) of the 22 patients. Prosthesis migration was present in 3 patients (13.6%). Severe HO (Grades 3 and 4) was present in 17.4%. Computed tomography showed a significant increase of segmental height of the index segment (1.6 ± 1.1 mm, p = 0.035), and a significant increase of left-sided lateral osteophytes (1.7 ± 2.1 mm, p = 0.009). The incidence of severe osteophyte formation (> 2 mm) occurred in 40%. Intraoperative findings reflected the results from CT, with primary lateral proliferation of osteophytes found in approximately 25% of patients. The mean visual analog scale scores were 3.8 ± 2.7 (neck) and 2.4 ± 2.5 (arms), and the mean Neck Disability Index score was 30 ± 22. No correlation was found between radiological and clinical parameters. Conclusions In this study, a higher incidence of HO after CDA could be demonstrated using CT, compared with studies using fluoroscopy only. However, patient selection and/or the operative technique might have contributed to the high prevalence of osteophyte formation. Thus, the exact indication for CDA has to be reconsidered. Because implant migration was detected, using fixation in the present CDA model appears suboptimal.

Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial

Neurosurgery ◽  
2020 ◽  
Author(s):  
Kee Kim ◽  
Greg Hoffman ◽  
Hyun Bae ◽  
Andy Redmond ◽  
Michael Hisey ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Pain Outcomes ◽  
Neck Disability

Abstract BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.

scholarly journals Evaluation of Adjacent Segment Degeneration after Cervical Spine Surgery: Arthroplasty versus Fusion

2013 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Saeed Hamidi ◽  
Neda Fahimi ◽  
Ehsan Jangholi ◽  
Mohammad Ali Fahimi ◽  
Ali Farshad ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Increased Risk ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Anterior Cervical Discectomy and Fusion (ACDF) is an effective treatment for disc herniations; but some studies demonstrated that in the untreated levels adjacent to a fusion, increased motion might lead to an increased risk of adjacent segment degeneration (ASD). On the other hand, methods of cervical Disc Arthroplasty (CDA) have improved. The aim of this study is to evaluate and compare the rate of ASD in patients who underwent ACDF or CDA cervical spine surgery.Methods and Materials: This prospective study was performed on 84 patients with cervical radiculopathy due to single-level disc herniation referred to hospitals in Tehran, Iran from June 2011 to December 2012. All subjects were randomly allocated to Group A or Group B to undergo ACDF or CDA, respectively. The validated Neck Disability Index (NDI) questionnaire was used to assess the cervical neck pain.Results: The mean of age in Group A was 51.7 ± 9.1 years and in Group B was 49.3 ±9.2. The differences in cervical radiculopathy in the two groups were not statistically significant. The difference in mean Visual Analogue Scale (VAS) score in the two groups at each assessment time was statistically significant. Mean NDI score before the surgery was 46.9 ± 6.1 in group A, and 41.3 ±4.7 in group B. The mean NDI score improved significantly in group B. Twenty-seven of the patients in Group A experienced ASD at 12 months compared to one patient (2.3%) in Group B (p<0.05).Conclusion: According to the findings of this study, CDA leads to reduced VAS and NDI score compared to ACDF. Also increased ASD in ACDF was demonstrated when compared with CDA after 1-year follow-up.

Cervical Disc Arthroplasty is an Acceptable Treatment Option for Adjacent Segment Degeneration After Fusion

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
DesRaj M. Clark ◽  
Bobby G. Yow ◽  
Andres S. Piscoya ◽  
William B. Roach ◽  
Scott C. Wagner
Keyword(s):  
Treatment Option ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Arthroplasty

scholarly journals P.229 Epidemiology and Outcomes of Neck Pain Following Surgery for Degenerative Cervical Radiculopathy

2021 ◽  
Vol 48 (s3) ◽  
pp. S86-S86
Author(s):  
MA MacLean ◽  
A Dakson ◽  
F Xavier ◽  
SD Christie ◽  
C Investigators
Keyword(s):  
Neck Pain ◽  
Short Form ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Research Network ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Arm Pain ◽  
Composite Scale ◽  
Neck Disability

Background: Many studies have demonstrated improved arm pain (AP) following surgery for degenerative cervical radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to improve. The purpose of this study was to determine whether surgery for DCR improves NP. Methods: A ambispective cohort study of the Canadian Spine Outcomes Research Network (CSORN) registry for patients who received 1-level, 2-level, 3-level ADCF (anterior cervical discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR. Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP), Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS). Results: We identified 603 patients with DCR. CDA patients were the youngest (ANOVA; p<0.001). Patients reported similar pre-operative AP, NP, disability, and health-related quality of life, regardless of procedure (ANOVA; all P>0.05). All procedures offered a statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all P<0.001). Mean change from baseline in NP, AP, and disability, were similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP, and NDI exceeded minimal clinically important differences for nearly all procedures. Conclusions: Patients undergoing surgery for DCR can expect a clinically significant, approximate 50% reduction in NP, AP, and neck-related disability.

Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study

2021 ◽  
Author(s):  
Luca Ricciardi ◽  
Alba Scerrati ◽  
Pasquale De Bonis ◽  
Massimo Miscusi ◽  
Sokol Trungu ◽  
...  
Keyword(s):  
Smoking Status ◽  
Neck Disability Index ◽  
Case Series ◽  
Fusion Rate ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Segmental Mobility ◽  
Postoperative Hematoma ◽  
The Mean

Abstract Background Anterior cervical diskectomy and fusion (ACDF) has been providing good surgical, clinical, and radiologic outcomes in patients suffering from cervical degenerative disk disease (DDD). However, the role of anterior plating is still debated, especially in three-level procedures. This study aimed to investigate long-term clinical and radiologic outcomes and complications after three-level contiguous ACDF without plating for cervical DDD. Methods Two institutional databases were retrieved (January 2009–December 2014) for patients treated with three-level contiguous ACDF without plating. Minimum follow-up (FU) was 5 years. Demographical data, smoking status, implant types, Neck Disability Index (NDI), visual analog scale (VAS) for neck pain, complications, fusion rate, adjacent segment degeneration (ASD), cervical lordosis (CL), and residual segmental mobility were evaluated. Results We enrolled 21 patients. Tantalum and carbon fiber cages were implanted, respectively, in 13 and 8 patients. The mean FU length was 5.76 ± 0.87 years. Mean NDI score was 78.29 ± 9.98% preoperatively and 8.29 ± 1.67% at last FU (p < 0.01), whereas mean VAS score decreased from 7.43 ± 1.14 preoperatively to 0.95 ± 0.95 at last FU (p < 0.01). Complications were one postoperative hematoma, one superficial wound infection, and five cases of postoperative dysphagia (recovered within 3 days). The fusion rate was 90% and ASD was reported in three (14%) cases. The mean CL was 6.33 ± 2.70 degrees preoperatively, 8.19 ± 1.97 degrees 3 months after surgery (p = 0.02), and 7.62 ± 1.96 degrees at latest FU. There was no residual mobility on every operated segment at last FU. The smoking status was an independent risk factor for nonfusion in this case series (p = 0.02). Conclusions Three-level contiguous ACDF without plating seems to be an effective treatment for cervical DDD. Properly designed comparative clinical trials are needed to further investigate this topic.

scholarly journals Cervical Total Disc Arthroplasty

2012 ◽  
Vol 2 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Rahul Basho ◽  
Kenneth A. Hood
Keyword(s):  
Cervical Spine ◽  
Surgical Techniques ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Arthroplasty ◽  
Definitive Answer ◽  
Investigational Device Exemption ◽  
Early Results

Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer.

scholarly journals Agreement between Original and Rasch-Approved Neck Disability Index

2020 ◽  
Author(s):  
ZE LU ◽  
Joy C. MacDermid ◽  
Goris Nazari
Keyword(s):  
Neck Pain ◽  
Neck Disability Index ◽  
Secondary Data ◽  
Study Data ◽  
Mean Difference ◽  
Patient Status ◽  
High Prevalence ◽  
The Mean ◽  
Mean Differences ◽  
Neck Disability

Abstract Background: Given the high prevalence of neck pain, the neck disability index (NDI) has been used widely to evaluate patient status and treatment outcomes. Modified versions have been proposed as solutions to measurement deficits in the NDI. However, the original 10-item NDI scored out of 50 is still the commonly administered. Examining the extent of agreement between traditional and Rasch-based versions using Bland-Altman (B&A) plots will inform our understanding of score differences that might rise from using different versions. Therefore, the objective of current study was to describe the extent of agreement between different versions of NDI. Methods: The current study was a secondary data analysis where the study data was compiled from two prospectively collected data source. We performed a comprehensive literature search to identify Rasch-approved NDI within four databases including Embase, Medline, PubMed, and Google Scholar. Modified version to identify Rasch analyses which provided alternative forms and scoring. We graphed B&A plots and calculated the mean difference and the 95% limits of agreement (LoA; ±1.96 times the standard deviation). Results: Two Rasch approved alternative versions (8- and 5- item) were identified from 303 screened publications. We analyzed data from 201 (43 males and 158 females) patients attending community clinics for neck pain. We found that the mean difference was approximately 10% of the total score between the 10-item and 5-item (-4.6 points), whereas the 10-item versus 8-item and 8-item versus 5-item had smaller mean differences (-2.3 points). The B&A plots displayed wider 95% LoA for the agreement between 10-item and 8-item (LoA: -12.0, 7.4) and 5-item (LoA: -14.9, 5.8) compared with the LoA for the 8-item and 5-item (LoA: -7.8, 3.3). Conclusion: Two Rasch-based NDI solutions (8 vs 5 items) that differ in number of items and conceptual construction are available to provide interval level scoring. They both scores that are substantially different from the traditional ordinal NDI, which does not provide interval level scoring. Smaller differences between the two Rasch solutions exist and may relate to the items included. Due to the size and unpredictable nature of the bias between measures, they should not be used interchangeably.

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