Cervical disc arthroplasty: What we know in 2020 and a literature review

Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA’s two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.

Identifying the Characteristics of Patients With Cervical Degenerative Disease for Surgical Treatment From 17-Year Real-World Data: Retrospective Study

Background Real-world data (RWD) play important roles in evaluating treatment effectiveness in clinical research. In recent decades, with the development of more accurate diagnoses and better treatment options, inpatient surgery for cervical degenerative disease (CDD) has become increasingly more common, yet little is known about the variations in patient demographic characteristics associated with surgical treatment. Objective This study aimed to identify the characteristics of surgical patients with CDD using RWD collected from electronic medical records. Methods This study included 20,288 inpatient surgeries registered from January 1, 2000, to December 31, 2016, among patients aged 18 years or older, and demographic data (eg, age, sex, admission time, surgery type, treatment, discharge diagnosis, and discharge time) were collected at baseline. Regression modeling and time series analysis were conducted to analyze the trend in each variable (total number of inpatient surgeries, mean age at surgery, sex, and average length of stay). A P value <.01 was considered statistically significant. The RWD in this study were collected from the Orthopedic Department at Peking University Third Hospital, and the study was approved by the institutional review board. Results Over the last 17 years, the number of inpatient surgeries increased annually by an average of 11.13%, with some fluctuations. In total, 76.4% (15,496/20,288) of the surgeries were performed in patients with CDD aged 41 to 65 years, and there was no significant change in the mean age at surgery. More male patients were observed, and the proportions of male and female patients who underwent surgery were 64.7% (13,126/20,288) and 35.3% (7162/20,288), respectively. However, interestingly, the proportion of surgeries performed among female patients showed an increasing trend (P<.001), leading to a narrowing sex gap. The average length of stay for surgical treatment decreased from 21 days to 6 days and showed a steady decline from 2012 onward. Conclusions The RWD showed its capability in supporting clinical research. The mean age at surgery for CDD was consistent in the real-world population, the proportion of female patients increased, and the average length of stay decreased over time. These results may be valuable to guide resource allocation for the early prevention and diagnosis, as well as surgical treatment of CDD.

Two-adjacent-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical degenerative disc disease: a retrospective cohort study

Background: The aim of the present study was to compare whether anterior cervical discectomy and fusion (ACDF) with a polyether ether ketone (PEEK) cage was superior to anterior cervical corpectomy and fusion (ACCF) with a titanium mesh cage (TMC) in the treatment of two-adjacent-level cervical degenerative disease. Methods: From May 2014 to December 2015, 47 patients with cervical degenerative disease who underwent ACDF with PEEK or ACCF with TMC were included in this retrospective analysis. Perioperative parameters (hospital stay, blood loss, operation time, and complications), clinical outcomes (Japanese Orthopaedic Association scores and visual analogue scale scores for neck and arm pain), and radiological outcomes (the overall cervical sagittal angle, segmental angle of the treated vertebral level, the height of the treated vertebral level, and fusion status) were evaluated. Results: The operative time was significantly shorter (P = 0.006) and blood loss was higher (P = 0.081) in the ACCF with TMC group. The early hardware failure rate was 4% and 0% in the ACCF with TMC group and the ACDF with PEEK group, respectively. The subsidence rate was higher in the ACCF with TMC group (8%) than in the ACDF with PEEK group (0%). Conclusions: The two procedures yielded comparable results in terms of clinical and radiological outcomes during 1-year follow-up. However, when compression at the vertebral level is mild to moderate, we suggest the use of ACDF than ACCF because of the possibility of early hardware failure. Allograft or heterotopic autograft can be avoided in both groups.

Cervical instability following artificial disc replacement

Background: Although there has been increased interest in utilizing artificial disc replacement (ADR) techniques to treat cervical degenerative disease, few reports have focused on their postoperative complication and reoperation rates. Case Description: A 52-year-old male underwent the uneventful placement of a C5-C6 cervical ADR for disc disease and foraminal stenosis. One year later, he experienced the onset of severe neck pain attributed to instability of the ADR construct. This required removal of the C5-6 ADR and subsequent fusion. Conclusion: Strict adherence to appropriate criteria is critical for choosing when to place a cervical ADR. This requires documenting; adequate surgical indications, careful selection of the appropriate ADR device, meticulous surgical technique, proper preservation of the supporting structures, and sufficient neural decompression.

A Decade of Variation in the Surgical Treatment of Cervical Degenerative Disease: An Analysis of 20288 Inpatient Surgery Records from the Period of 2000-2016 (Preprint)

BACKGROUND Cervical degenerative disease (CDD) refers to disease involving degenerative processes that occur in the cervical spine. In recent decades, with the development of more accurate diagnosis and better treatment options, inpatient surgery for CDD has become the mainstay when conservative treatment fails, yet little is known about variations in patient demographic characteristics associated with surgical treatment. OBJECTIVE This study assessed the number of surgical operations, variation in mean age at surgery, the male to female ratio and the average length of hospital stay for CDD patients. METHODS We conducted a real-world study using inpatient surgery data from the department of orthopedics in a hospital in northern China (2000-2016). Regression modeling and time series analysis were used. The length of hospital stay was used to measure improvement associated with treatment. RESULTS This study analyzed 20,288 inpatient surgery records. Over the last 17 years, the number of surgical operations increased (average annual increase of 11.13%), with some fluctuations. In total, 76.38% of surgeries occurred in patients aged 41 - 65 years (15,496), and there was no significant change in mean age at surgery for CDD patients during the study period. The male to female ratio of the patients was 1.83:1 (13,126 vs 7,162). Interestingly, the proportion of surgeries performed on female patients showed an increasing trend from 2000 to 2016 (P < .001). The average length of hospital stay for surgical treatment decreased from 23.21 days to 6.53 days, and showing a steady decline from 2012 onward. CONCLUSIONS This study investigated the demographic characteristics and trends over time among CDD patients who underwent surgical treatment. The mean age at surgery was stable during the 17-year study period, with an increased proportion of female patients and a decreased average length of hospital stay with time. These data may be valuable to guide resource allocation for early prevention, diagnosis and surgical treatment for CDD.