Assessment of adjacent-segment mobility after cervical disc replacement versus fusion: RCT with 1 year’s results

Nabhan, A.; Ishak, Basem; Steudel, W. I.; Ramadhan, Syahrul; Steimer, O.

doi:10.1007/s00586-010-1588-2

Cited by 46 publications

(23 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the quality of motion in terms of COR might not be perfectly maintained or restored and might explain why clinical and radiographic results in terms of adjacent segment degeneration do not differ between CDR and ACDF in selected studies [22]. A mismatch between the physiologic kinematics and that after a CDR implantation might also explain why several studies using QMA did not identify differences regarding adjacent segment motion comparing ACDF and a variety of CDRs used [18,24,28].…”

Section: Discussionmentioning

confidence: 99%

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

et al. 2012

View full text Add to dashboard Cite

Introduction To better understand cervical kinematics following cervical disc replacement (CDR), the in vivo behavior of a minimally constrained CDR was assessed. Methods Radiographic analysis of 19 patients undergoing a 1-level CDR from C4-5 to C6-7 (DISCOVER, DepuySpine, USA) was performed. Neutral-lateral and flexionextension radiographs obtained at preop, postop and late follow-up were analyzed for segmental angle and global angle (GA C2-7). Flexion-extension range of motion was analyzed using validated quantitative motion analysis software (QMAÒ, Medical Metrics, USA). The FSU motion parameters measured at the index and adjacent levels were angular range of motion (ROM), translation and center of rotation (COR). Translation and COR were normalized to the AP dimension of the inferior endplate of the caudal vertebra. All motion parameters, including COR, were compared with normative reference data. Results The average patient age was 43.5 ± 7.3 years. The mean follow-up was 15.3 ± 7.2 months. C2-7 ROM was 35.9°± 15.7°at preop and 45.4°± 13.6°at follow-up (Dp\ .01). Based on the QMA at follow-up, angular ROM at the CDR level measured 9.8°± 5.9°and translation was 10.1 ± 7.8 %. Individuals with higher ROM at the CDR level had increased translation at that level (p \ .001, r = 0.97), increased translation and ROM at the supra-adjacent level (p \ .001, r = .8; p = .005, r = .6). There was a strong interrelation between angular ROM and translation at the supra-adjacent level (p \ .001, r = .9) and caudal-adjacent level (p\.001, r = .9). The location of the COR at the CDRand supra-adjacent levels was significantly different for the COR-X (p \ .001). Notably, the COR-Y at the CDR level was significantly correlated with the extent of CDR-level translation (p = .02, r = .6). Shell angle, which may be influenced by implant size and positioning had no impact on angular ROM but was correlated with COR-X (p = .05, r = -.6) and COR-Y (p = .04, r = -.5). Conclusion The COR is an important parameter for assessing the ability of non-constrained CDRs to replicate the normal kinematics of a FSU. CDR size and location, both of which can impact shell angle, may influence the amount of translation by affecting the location of the COR. Future research is needed to show how much translation is beneficial concerning clinical outcomes and facet loading.

show abstract

Section: Discussionmentioning

confidence: 99%

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

et al. 2012

View full text Add to dashboard Cite

show abstract

“…However, the findings of these studies are ambiguous: some trials [3, 7-9, 26, 33, 38, 48] suggested better neurologic outcomes and lower incidence of developing adjacent segment degeneration with arthroplasty versus fusion, whereas others [20,[29][30][31] reported no difference between two procedures.…”

Section: Introductionmentioning

confidence: 99%

Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis

Yin

Zhou

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim. Questions/purposes We investigated whether cervical disc arthroplasty was associated with (1) better function (neck disability index, pain assessment, SF-36 mental and physical health surveys, neurologic status) than fusion, (2) a lower incidence of reoperation and major complications, and (3) a lower risk of subsequent adjacent segment degeneration. Methods We conducted a comprehensive search in MEDLINE 1 , EMBASE, and Cochrane Central Register of Controlled Trials and identified 503 papers. Of these, we identified 13 reports from 10 randomized controlled trials involving 2227 patients. We performed a meta-analysis of functional scores, rates of reoperation, and major complications. The strength of evidence was evaluated by using GRADE profiler software. Of the 10 trials, six trials including five prospective multicenter FDA-regulated studies were sponsored by industry. The mean followups of the 10 trials ranged from 1 to 5 years. Results Compared with anterior cervical decompression and fusion, cervical disc arthroplasty had better mean neck disability indexes (95% CI, À0.25 to À0.02), neurologic status (risk ratio [RR], 1.04; 95% CI, 1.00-1.08), with a reduced incidence of reoperation related to the index surgery (RR, 0.42; 95% CI, 0.22-0.79), and major surgical complications (RR, 0.45; 95% CI, 0.27-0.75) at a mean of 1 to 3 years. However, the operation rate at adjacent levels after two procedures was similar (95% CI, 0.31-1.27). The three studies with longer mean followups of 4 to 5 years also showed similar superiority of all four parameters of cervical disc arthroplasty compared with fusion. Conclusions For treating symptomatic cervical disc disease, cervical disc arthroplasty appears to provide better function, a lower incidence of reoperation related to index surgery at 1 to 5 years, and lower major complication rates compared with fusion. However, cervical disc arthroplasty did not reduce the reoperation rate attributable to adjacent segment degeneration than fusion. Further, it is unclear whether these differences in subsequent surgery including arthroplasty revisions will persist beyond 5 years.

show abstract

“…Both anterior cervical decompression and fusion (ACDF) and cervical disc arthroplasty (CDA) have been demonstrated by many level I studies to achieve clinical success, relieve symptoms of neural compression, and improve health-related quality of life. 2 , 4 , 17-19 However, the effect of CDA on reoperation rates has not been observed in all studies, [20][21][22][23][24][25] nor confi rmed in all metaanalyses. 8 -16 Recent investigational device exemption (IDE) studies have demonstrated lower rates of reoperation in patients who undergo CDA than in patients who undergo ACDF.…”

mentioning

confidence: 99%

Costs of Cervical Disc Replacement Versus Anterior Cervical Discectomy and Fusion for Treatment of Single-Level Cervical Disc Disease

Radcliff

Zigler

2015

Spine

View full text Add to dashboard Cite

show abstract

Assessment of adjacent-segment mobility after cervical disc replacement versus fusion: RCT with 1 year’s results

Abstract: Disc prostheses have been designed to restore and maintain cervical segmental motion and reduce the accelerated degeneration of the adjacent level.

Cited by 46 publications

References 46 publications

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis

Costs of Cervical Disc Replacement Versus Anterior Cervical Discectomy and Fusion for Treatment of Single-Level Cervical Disc Disease

Contact Info

Product

Resources

About