Cervical Disc Arthroplasty Compared with Arthrodesis for the Treatment of Myelopathy

Riew, K. Daniel; Buchowski, Jacob M.; Sasso, Rick C.; Zdeblick, Thomas A.; Metcalf, Newton; Anderson, Paul A.

doi:10.2106/jbjs.g.01608

Cited by 113 publications

(106 citation statements)

References 20 publications

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“…A cadaveric biomechanical study of the cervical spine characterized this motion compensation after anterior cervical discectomy and fusion at different levels 10 . In vitro studies supported the conclusion that anterior cervical discectomy and fusion at the operated level increases intersegmental motion as well as load and intradiscal pressure at the adjacent levels and may induce progressive disc degeneration at these levels 9 . Some studies have also shown a relationship between the loss of range of motion at the operated level after this procedure and persistent neck pain, poor functional recovery, cervical instability, or even development of accelerated adjacent-level disc degeneration, which is one of the main reasons for the failure of this treatment 2,[11][12][13][14] .…”

Section: Discussionmentioning

confidence: 59%

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A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

Gao

Liu

et al. 2013

The Journal of Bone and Joint Surgery

118

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Section: Discussionmentioning

confidence: 59%

“…A nterior cervical discectomy and fusion is one of the most commonly performed spinal procedures 8,9 . The clinical outcome of this procedure is satisfactory in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

Gao

Liu

et al. 2013

The Journal of Bone and Joint Surgery

118

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“…However, the weaknesses of the abovementioned studies included small case numbers, lack of a control group, or relatively short follow-up. Riew et al analyzed data from a cohort of patients with myelopathy 29 who were enrolled in the US FDA-IDE trials of the There are a few common conditions other than DDD that cause CSM (ossification of posterior longitudinal ligament [OPLL]), hypertrophy of the ligamentum flavum, or kyphotic deformity). However, similar to the FDA IDE trials, the present study did not include pathologies other than spondylosis and DDD.…”

Section: Discussionmentioning

confidence: 99%

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

Fay

Huang

et al. 2014

SPI

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Object Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. Methods A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Results Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24–56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. Conclusions The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

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“…23 Tension applied by dentate ligaments preferentially stretches the lateral aspect of the spinal cord on neck flexion, 17 which corresponds to lateral column atrophy noted in autopsy studies. Segmental OPLL has been shown to permit abnormal mobility between adjacent VB segments, with a range of motion > 35° at C1-7 associated with progressive myelopathy.…”

mentioning

confidence: 98%

Diffusion tensor imaging in the assessment of ossification of the posterior longitudinal ligament: a report on preliminary results in 3 cases and review of the literature

Jones

Lerner

Kim

et al. 2011

FOC

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Cervical spondylotic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) is a common neurosurgical disease that carries high morbidity. OPLL and other degenerative processes cause narrowing of the central canal, with subsequent spinal cord injury. Repeated minor trauma and vascular aberrations have been purported to underlie cervical spondylotic myelopathy, although the exact pathophysiological mechanism is unclear. Regardless, detection of early axonal damage may allow more timely surgical intervention and prediction of functional outcome. Diffusion tensor (DT) imaging of the cervical spine is a novel technique with improved sensitivity compared with conventional anatomical MR imaging that is currently available on most clinical scanners. This review describes the theoretical basis, application, and analysis of DT imaging as it pertains to neurosurgery. Particular emphasis is placed on OPLL.

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Cervical Disc Arthroplasty Compared with Arthrodesis for the Treatment of Myelopathy

Cited by 113 publications

References 20 publications

A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

Diffusion tensor imaging in the assessment of ossification of the posterior longitudinal ligament: a report on preliminary results in 3 cases and review of the literature

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