Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy

Khong, Peter; Bogduk, Nikolai; Ghahreman, Ali; Davies, Mark

doi:10.1016/j.jocn.2012.12.013

Cited by 17 publications

(13 citation statements)

References 21 publications

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“…45 Evidence for the utilization of the new technology for the preservation of spinal motion in the management of CSM is largely anecdotal, although a few case series have been published in recent years. 12,21,31,32 These reports demonstrated that arthroplasty could be effective in 1-or 2-level disease causing myelopathy. However, the weaknesses of the abovementioned studies included small case numbers, lack of a control group, or relatively short follow-up.…”

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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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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“…The effectiveness of cervical disc arthroplasty to maintain a good clinical outcome and motion at the index level has been established in many previously published studies. However, the majority of previous studies of cervical disc arthroplasty were based on a mixed cohort of patients with both myelopathy and radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…reported a 3‐year follow‐up study of 72 myelopathy patients and 53 radiculopathy patients treated with cervical disc arthroplasty and concluded that the clinical and radiographic outcomes in patients with myelopathy were similar to patients with radiculopathy. Khong et al . investigated 46 patients treated with cervical disc arthroplasty and compared success rates in myelopathy patients versus radiculopathy patients and demonstrated that the success rate with cervical disc arthroplasty was similar in both groups up to 5‐year follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Most previous clinical studies which evaluated the efficacy of cervical disc arthroplasty did not enroll the patients with CSM or enrolled a mixed cohort of patients with both myelopathy and radiculopathy. Only a few short‐ or mid‐term follow‐up studies demonstrated that cervical disc arthroplasty had satisfying short‐ to mid‐term outcomes in the treatment of patients with CSM. Therefore, the long‐term efficacy of cervical disc arthroplasty for CSM still requires further patient outcomes to be reported.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of 10‐year Outcomes of Bryan Cervical Disc Arthroplasty for Myelopathy and Radiculopathy

Han

Zhang

et al. 2019

Orthopaedic Surgery

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Objective: To evaluate the long-term efficacy of Bryan cervical disc arthroplasty in the treatment of myelopathy patients compared with radiculopathy patients. Methods:This study is a prospective study. Sixty-six patients (38 patients in myelopathy group and 28 patients in radiculopathy group) who were treated with Bryan cervical disc arthroplasty between 2004 and 2007 and followed for 10 years were included in this study. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and Odom's criteria were used to evaluate the clinical outcomes. X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) were used to evaluate the radiographic outcomes including the global range of motion (ROM), segmental ROM, and segment alignment before the surgery and at last follow-up. The incidence of segmental kyphosis, segmental mobility lost, and the grade of paravertebral ossification (PO) were also evaluated at last follow-up. Results:The JOA score and NDI improved in both groups. Thirty-three of 38 patients in myelopathy group and all patients in radiculopathy group reported good or excellent outcomes according to Odom's criteria. The segmental ROM was (9.5 AE 4.4 ) before surgery and maintained at (9.0 AE 5.5 ) at last follow-up in myelopathy group. The segmental ROM was (9.5 AE 4.6 ) and (9.0 AE 5.3 ) before surgery and at last follow-up in radiculopathy group, respectively. The Bryan prosthesis remained mobile at last follow-up for 30 patients (78.9%) in the myelopathy group and 22 patients (78.6%) in the radiculopathy group. Of the patients in the myelopathy group, 21.1% developed segmental kyphosis, as did 21.4% of patients in the radiculopathy group. The incidence of PO and high-grade PO was 92.1 and 28.9% in the myelopathy group, and was 92.9 and 32.1% in the radiculopathy group. There was no significant difference between both groups.Conclusions: Bryan cervical disc arthroplasty was an effective and safe technique in treating patients with myelopathy. The clinical and radiographic outcomes in the myelopathy group were similar to those in the radiculopathy group at the 10-year follow-up.

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“…3,5,7,11,15,19,22,[27][28][29] As with ACDF, cervical TDR acts to decompress the affected segment, provide stabilization, and preserve intradiscal height while maintaining mobility. 3,22,28 Investigators have suggested that the preservation of mobility may result in a decreased frequency of adjacent-segment degeneration compared with that observed in patients treated with ACDF.…”

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confidence: 99%

Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up

Jackson¹,

Davis

Hoffman³

et al. 2016

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OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7. METHODS This was a prospective, multicenter, randomized, unblinded clinical trial. Patients with symptomatic degenerative disc disease were enrolled to receive 1- or 2-level treatment with either TDR as the investigational device or ACDF as the control treatment. There were 260 patients in the 1-level study (179 TDR and 81 ACDF patients) and 339 patients in the 2-level study (234 TDR and 105 ACDF patients). RESULTS At 5 years, the occurrence of subsequent surgical intervention was significantly higher among ACDF patients for 1-level (TDR, 4.5% [8/179]; ACDF, 17.3% [14/81]; p = 0.0012) and 2-level (TDR, 7.3% [17/234]; ACDF, 21.0% [22/105], p = 0.0007) treatment. The TDR group demonstrated significantly fewer index- and adjacent-level subsequent surgeries in both the 1- and 2-level cohorts. CONCLUSIONS Five-year results showed treatment with cervical TDR to result in a significantly lower rate of subsequent surgical intervention than treatment with ACDF for both 1 and 2 levels of treatment. Clinical trial registration no.: NCT00389597 (clinicaltrials.gov)

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Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy

Cited by 17 publications

References 21 publications

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

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

Comparison of 10‐year Outcomes of Bryan Cervical Disc Arthroplasty for Myelopathy and Radiculopathy

Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up

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