Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register

MacDowall, Anna; Skeppholm, Martin; Lindhagen, Lars; Robinson, Yohan; Löfgren, Håkan; Michaëlsson, Karl; Olerud, Claes

doi:10.3171/2018.7.spine18657

Cited by 13 publications

(11 citation statements)

References 28 publications

(43 reference statements)

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“…30 Posterior foraminotomy preserves motion at the index level, but no protection against deterioration at the adjacent cervical segments has been realized in practice. 13,17 Posterior foraminotomy surgery decreased in the US from 3.4/100,000 in 1992 to 1.2/100,000 in 2005. 27 The national Swedish Spine Register (Swespine) was founded in 1993.…”

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confidence: 99%

Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

MacDowall

Heary

Holy

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort.METHODSAll patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November 15, 2017, with cervical degenerative disc disease and radiculopathy were assessed. Using propensity score matching, patients treated with posterior foraminotomy were compared with those undergoing ACDF. The primary outcome measure was the Neck Disability Index (NDI), a patient-reported outcome score ranging from 0% to 100%, with higher scores indicating greater disability. A minimal clinically important difference was defined as > 15%. Secondary outcomes were assessed with additional patient-reported outcome measures (PROMs).RESULTSA total of 4368 patients (2136/2232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients, and 3721 patients underwent ACDF. After meticulous propensity score matching, 570 patients with a mean age of 54 years remained in each group. Both groups had substantial decreases in their NDI scores; however, after 5 years, the difference was not significant (2.3%, 95% CI −4.1% to 8.4%; p = 0.48) between the groups. There were no significant differences between the groups in EQ-5D or visual analog scale (VAS) for neck and arm scores. The secondary surgeries on the index level due to restenosis were more frequent in the foraminotomy group (6/100 patients vs 1/100), but on the adjacent segments there was no difference between groups (2/100).CONCLUSIONSIn patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements at the 5-year follow-up that were comparable and did not achieve a clinically important difference from one another, even though the reoperation rate favored the ACDF group. This study design obtains population-based results, which are generalizable.

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confidence: 99%

Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

MacDowall

Heary

Holy

et al. 2020

Journal of Neurosurgery: Spine

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“…However, they performed combined analysis using Bryan and Prestige artificial discs and found significant differences in symptomatic ASD requiring surgery as early as after 7 years 40 . Surprisingly, MacDowall et al 51 conducted a retrospective study based on a Swedish database and found that CDA had a similar secondary surgery rate at the adjacent level but a higher secondary surgery rate at the index level with significant difference. However, based on our long-term results, CDA had a significantly lower rate of total secondary surgery, secondary surgery at the adjacent level, and secondary surgery at the index level, which is consistent with mid-term to long-term results 17 However, this finding is contrary to the short-term to mid-term result reported by Zhang et al 52 that the secondary surgery rate at the adjacent level showed no significant difference.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Long‐term Results Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Wang

et al. 2019

Orthopaedic Surgery

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Objective Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long‐term results. The present study aimed to evaluate the long‐term safety and efficiency of CDA and ACDF for cervical disc disease. Methods We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: “anterior cervical fusion,” “arthroplasty,” “replacement” and “artificial disc”. RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients’ satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P < 0.05. Results A total of 11 randomized controlled trials with 3505 patients (CDA/ACDF: 1913/1592) were included in this meta‐analysis. Compared with ACDF, CDA achieved significantly higher overall success (2.10, 95% CI [1.70, 2.59]), neck disability index (NDI) success (1.73, 95% CI [1.37, 2.18]), neurological success (1.65, 95% CI [1.24, 2.20]), patients’ satisfaction (2.14, 95% CI [1.50, 3.05]), and patients’ recommendation rates (3.23, 95% CI [1.79, 5.80]). Functional outcome measures such as visual analog score neck pain (−5.50, 95% CI [−8.49, −2.52]) and arm pain (−3.78, 95% CI [−7.04, −0.53]), the Short Form‐36 physical component score (SF‐36 PCS) (1.93, 95% CI [0.53, 3.32]), and the Short Form‐36 mental component score (SF‐36 MCS) (2.62, 95% CI [0.95, 4.29]), revealed superiority in the CDA group. CDA also achieved a significantly lower rate of symptomatic ASD (0.46, 95% CI [0.34, 0.63]), total secondary surgery (0.50, 95% CI [0.29, 0.87]), secondary surgery at the index level (0.46, 95% CI [0.29, 0.74]), and secondary surgery at the adjacent level (0.37, 95% CI [0.28, 0.49]). However, no significant difference was found in radiological success (1.35, 95% CI [0.88, 2.08]), NDI score (−2.88, 95% CI [−5.93, 0.17]), total reported AE (1.14, 95% CI [0.92, 1.42]), serious AE (0.89, 95% CI [0.71, 1.11]), device/surgery‐related AE (0.90, 95% CI [0.68, 1.18]), radiological superior ASD (0.63, 95% CI [0.28, 1.43]), inferior ASD (0.45, 95% CI [0.19, 1.11]), and work status (1.33, 95% CI [0.78, 2.25]). Furthermore, subgroup analysis showed different results between US and non‐US groups. Conclusion Our study provided further evidence that compared to ACDF, CDA had a higher long‐term clinical success rate and better functional outcome measurements, and resulted in less symptomatic ASD and fewer secondary surgeries. However, worldwide multicenter RCT with long‐term follow up are still needed for further evaluation in the future.

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“…Regarding the treatment of CSM, anterior cervical surgery has been widely accepted for some patients [ 7 , 8 ]. Nevertheless, with the increasing application of these surgeries, deficiencies and complications related to these procedures have been reported [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy and safety of posterior minimally invasive surgery in cervical spondylosis: a systematic review

Mei

Feng

et al. 2022

J Orthop Surg Res

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Background Posterior minimally invasive surgery has been increasingly used in in recent years for the clinical treatment of cervical spondylosis. However, this treatment remains challenging and has not been comprehensively reported. The aim of this study was to provide a systematic review of posterior minimally invasive treatment for cervical spondylosis to demonstrate the clinical efficacy and safety of this procedure. Method We collected information from patients with myelopathy or radiculopathy cervical spondylosis who underwent posterior minimally invasive surgery and verified the clinical efficacy and safety of these surgeries with different measurement indicators from five electronic databases: the Nurick, visual analog scale score, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), EuroQol Five Dimensions Questionnaire (EQ-5D) score, Short-Form Health Survey Physical Component Summary (SF12-PCS) questionnaire score, Short-Form Health Survey Mental Component Summary (SF12-MCS) questionnaire score, and the MOS item short form health survey (HF-36) score. The decompression effect, cervical spine stability, average surgery time, surgical blood loss volume, length of hospital stay, and related complications were included in the descriptive analysis. Reporting of this protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines checklist. Results We identified 14 observational studies of cervical spondylosis with 479 patients, mainly including 197 cases of myelopathy and 207 cases of radiculopathy. Channel and endoscopic techniques were used. This study was certified by PROSPERO: CRD42021290074. Significant improvements in the quantitative indicators (Neck-VAS in 9 studies, JOA in 7 studies, NDIs in 5 studies, Nurick, ARM-VAS, and EQ-5D in 2 studies each, and the SF12-PCS, SF12-MCS, and HF-36 in 1 study each) were observed between pre- and postoperation (P < 0.05), and satisfactory clinical significance was acquired in the descriptive indicators [average surgery time (94.56 ± 37.26 min), blood loss volume (68.78 ± 103.31 ml), average length of stay (2.39 ± 1.20 d), and cervical spine stability after surgery]. Additionally, we showed that there was a 4.9% postoperative complication rate and the types of complications that may occur. Conclusion Posterior minimally invasive surgery is an effective and safe method for the treatment of cervical spondylosis and is a recommended optional surgical procedure for single-segment myelopathy and radiculopathy.

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Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register

Cited by 13 publications

References 28 publications

Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

Long‐term Results Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Clinical efficacy and safety of posterior minimally invasive surgery in cervical spondylosis: a systematic review

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