Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation

Barrey, Cédric; Campana, S.; Persohn, Sylvain; Perrin, Gilles; Skalli, Wafa

doi:10.1007/s00586-011-1974-4

Cited by 77 publications

(49 citation statements)

References 45 publications

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“…Two-level fusion constructs also exhibited substantially decreased ROM at the operative level in addition to increased ROM at both superior and inferior adjacent levels. In a study involving 12 cervical spine specimens, Barrey et al 19 demonstrated similar findings of decreased ROM in FE, LB, and AR for two-level arthrodesis compared to twolevel CDR. The authors further quantified the ROM increase in adjacent segments in two-level arthrodesis, indicating a 20%-38.5% increase at the superior level and a 25%-47% increase at the inferior level.…”

Section: Cadaveric and Biomechanical Studiesmentioning

confidence: 70%

“…[19][20][21][22][23] With regard to range of motion (ROM), the first comparison of two-level CDR to two-level ACDF was performed by Cho et al 20 The authors compared ROM in flexion/extension (FE), axial rotation (AR), and lateral bending (LB) in seven C3-T2 cervical spine specimens. Compared to the intact spine with no intervention, two-level ACDF demonstrated significantly decreased C4-T1 ROM in FE, AR, and LB, while two-level arthroplasty demonstrated significantly increased ROM in FE and AR.…”

Section: Cadaveric and Biomechanical Studiesmentioning

confidence: 99%

“…Of the studies included in this review, six were identified as having conflicts of interest related to the receipt of financial support or assistance with study conduct by the company producing the artificial disc implant. 19,23,[27][28][29] The presence of these conflicts may inherently bias these studies toward producing at least noninferior, if not superior, comparative results. In the general orthopedic literature, Okike et al 34 demonstrated that studies with conflicts of interest involving royalties, stock options, consulting fees, or employee status were more likely to report positive findings.…”

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confidence: 99%

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Two-level cervical disc replacement: perspectives and patient selection

Narain¹,

Hijji²,

Bohl³

et al. 2017

OAS

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Introduction: Cervical disc replacement (CDR) is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature. Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored. Methods: The PubMed database was searched for all articles published on the subject of twolevel CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri-and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two-level CDR. Conclusion: Two-level CDR is noninferior to two-level anterior cervical discectomy and fusion in terms of both outcomes and costs. While a few studies suggested superiority of two-level CDR, the presence of significant conflicts of interest by the study authors may introduce bias. Further prospective, randomized trials without conflicts of interest are necessary to determine if two-level CDR demonstrates truly superior outcomes.

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Section: Cadaveric and Biomechanical Studiesmentioning

confidence: 70%

Section: Cadaveric and Biomechanical Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Two-level cervical disc replacement: perspectives and patient selection

Narain¹,

Hijji²,

Bohl³

et al. 2017

OAS

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“…A recent experimental study by Barrey et al [33] showed that 1 and 2-level TDA generates better biomechanical conditions than arthrodesis at adjacent levels limiting contribution of these segments to global ROM and reducing the amount of their internal stresses. The current status of clinical evidence on this issue remains uncertain.…”

Section: Adjacent Segment Degenerationmentioning

confidence: 99%

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Aghayev¹,

Baerlocher²,

Hasdemir³

et al. 2012

The Spine Journal

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Background The Swiss Federal Office of Public Health demanded a nationwide HTA-registry for cervical total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of cervical TDA. Materials and methods Three hundred thirty-two cases treated between 3.2005 and 6.2006 who were eligible for 5 years follow-ups were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 84.6, 74.4, 50.6 and 64.8 %, respectively. Outcome measures were neck and arm pain, medication, quality of life, intraoperative and postoperative complication and revision rates. In addition, segmental mobility, ossification, adjacent and distant segment degeneration were analyzed at the 5-year follow-up. Results There was significant, clinically relevant and lasting reduction of neck (preop/postop 60/21 VAS points) and arm pain (preop/postop VAS 67/17) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.39/0.82 EQ-5D points) until the 5-year follow-up. The rates for intraoperative and early postoperative complications were 0.6 and 7.2 %, respectively. In 0.6 % an early and in 3.9 % a late revision surgery was performed. At the 5-year follow-up, the average range of motion of the mobile segments (88.2 %) was 10.2°. In 40.7 % of the patients osteophytes at least potentially affecting range of motion were seen. Conclusions Cervical TDA appeared as safe and efficient in long-term pain alleviation, consequent reduction of pain killer consumption and in improvement of quality of life. The improvement is stable over the 5 years postoperative period. The vast majority of treated segments remained mobile after 5 years, although 40.7 % of patients showed osteophytes.

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“…However, ACDF can potentially result in iatrogenic effects such as pseudarthrosis and early adjacent degenerative level by increase of stresses at adjacent levels [1][2][3][4]. Experimental studies demonstrated that fusion could generate increase in mechanical forces with hypermobility and increase in intradiscal pressure on adjacent discs above and below the intervertebral segment fused, and thus may explain the mechanism of early adjacent disc degeneration [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

et al. 2012

Self Cite

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Background The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels. Materials and methods Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv TM implant, Scient'x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview TM , Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects.Results Both local and C3-C7 lordosis significantly increased postoperatively (?8°and ?13°at 2 years, respectively). At instrumented level ROM in flexionextension (FE) was measured to 10.2°preoperatively versus 7.5°at 1 year and 6.1°at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels. Conclusion Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.

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Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation

Cited by 77 publications

References 45 publications

Two-level cervical disc replacement: perspectives and patient selection

Two-level cervical disc replacement: perspectives and patient selection

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

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