Early clinical and biomechanical results following cervical arthroplasty

Duggal, Neil; Pickett, Gwynedd E.; Mitsis, Demytra; Keller, Jana L.

doi:10.3171/foc.2004.17.3.9

Cited by 129 publications

(64 citation statements)

References 32 publications

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“…Concerns regarding these issues led to the design and development of the cervical disc arthroplasty. Compared with anterior cervical discectomy and fusion, the cervical disc arthroplasty offers the theoretical biomechanical advantage of preservation of motion at the index level, which reduces stresses at the adjacent levels [12,13]. The equivalency or superiority of the cervical disc arthroplasty as an alternative to anterior cervical discectomy and fusion has been seen in FDA Investigational Device Exemption and other studies [5,7,8,10,22,30,32,34,35,37,38,[42][43][44].…”

Section: Discussionmentioning

confidence: 99%

“…The cervical disc arthroplasty is designed to maintain disc space height and motion at the index segment and prevent abnormal loading stresses and motion at adjacent segments that theoretically lead to accelerated degeneration [12,13]. During the past decade, the cervical disc arthroplasty has emerged as an alternative to fusion and has been shown to provide the pain relief and functional improvements similar or superior to those of anterior cervical discectomy and fusion in FDA Investigational Device Exemption clinical trials [5,8,10,22,30,32,35,38,44].…”

Section: Introductionmentioning

confidence: 99%

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Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Zhong

Zhu

Zhuang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Anterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare cervical disc arthroplasty with anterior cervical discectomy and fusion regarding (1) the overall frequency of reoperation at the index and adjacent levels; (2) the frequency of reoperation at the index level; and (3) the frequency of reoperation at the adjacent levels. Methods PubMed, EMBASE, and the Cochrane Register of Controlled Trials databases were searched to identify RCTs comparing cervical disc arthroplasty with anterior cervical discectomy and fusion and reporting the frequency of reoperation. We also manually searched the reference lists of articles and reviews for possible relevant studies. Twelve RCTs with a total of 3234 randomized patients were included. Eight types of disc prostheses were used in the included studies. In the anterior cervical discectomy and fusion group, autograft was used in one study and allograft in 11 studies. Nine of 12 studies were industry sponsored. Pooled risk ratio (RR) and associated 95% CI were calculated for the frequency of reoperation using random-effects or fixed-effects models depending on the heterogeneity of the included studies. A funnel plot suggested the possible presence of publication bias in the available pool of studies; that is, the shape of the plot suggests that smaller negative or nodifference studies may have been performed but have not been published, and so were not identified and included in this meta-analysis. Results The overall frequency of reoperation at the index and adjacent levels was lower in the cervical disc arthroplasty group (6%; 108/1762) than in the anterior cervical discectomy and fusion group (12%; 171/1472) (RR, 0.54; 95% CI, 0.36-0.80; p = 0.002). Subgroup analyses were performed according to secondary surgical level. Compared with anterior cervical discectomy and fusion, cervical disc arthroplasty was associated with fewer reoperations at the index level (RR, 0.50; 95% CI, 0.37-

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Zhong

Zhu

Zhuang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…One of the main disadvantages of the procedure, however, is that the adjacent segments to a fusion are subjected to increased ROM and intradiscal pressures, which may lead to adjacent segment degeneration. Cervical disc arthroplasty is designed to preserve motion and avoid the limitations of fusion [10,11]. Although more relevant literature, including RCTs, comparing the two interventions have been reported, the evidence regarding whether cervical disc arthroplasty is superior to anterior cervical decompression and fusion remains insufficient owing to the ambiguous results.…”

Section: Discussionmentioning

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

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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.

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“…On average, Oswestry NDI scores improved by 51.4 points. Duggal et al [7] also Fig. 2 SF-36 physical component score compared outcomes in patients suffering from soft disc herniations with those patients with spondylotic ridging causing foraminal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study

Cheng

Lin

Zhang

et al. 2008

International Orthopaedics (SICOT)

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In this prospective study, our aim was to compare the functional results and radiographic outcomes of fusion and Bryan Cervical Disc replacement in the treatment of two-level cervical disc disease. A total of 65 patients with two-level cervical disc disease were randomly assigned to two groups, those operated on with Bryan Cervical Disc replacement (31) and those operated on with anterior cervical fusion with an iliac crest autograft and plate (34). Clinical evaluation was carried out using the visual analogue scale (VAS), the Short Form 36 (SF-36) and the neck disability index (NDI) during a two year follow-up. Radiological evaluation sought evidence of range of motion, stability and subsidence of the prosthesis. Substantial reduction in NDI scores occurred in both groups, with greater percent improvement in the Bryan group (P=0.023). The arm pain VAS score improvement was substantial in both groups. Bryan artificial cervical disc replacement seems reliable and safe in the treatment of patients with two-level cervical disc disease.Résumé Cette étude prospective a pour but de comparer les résultats fonctionnels et radiographiques des patients ayant bénéficié soit d'une fusion, soit d'une athrodèse, soit d'une prothèse discale dans le traitement des lésions dégénératives des disques cervicaux portant sur deux niveaux. 65 patients présentant de telles lésions ont été randomisés en deux groupes, ceux traités par la prothèse discale de Bryan (31) et ceux traités par ostéosynthèse antérieure avec autogreffe illiaque et plaque (34). L'évalua-tion clinique a été réalisée en utilisant le score douleur VAS, (échelle analogique), le score SF-36, la raideur de la nuque index NDI, après deux ans de recul. L'évaluation radiologique permet de mettre en évidence les secteurs de mobilité de stabilité et la migration de la prothèse. Une diminution significative du score NDI est observée dans les deux groupes avec un pourcentage plus important d'amélioration dans le groupe des prothèses de type Bryan (p= 0.023). Le score douleur est nettement amélioré dans les deux groupes néanmoins il semble que la prothèse de type Bryan permet d'avoir des résultats beaucoup plus fiables et beaucoup plus sûrs dans le traitement de ces patients présentant des lésions discales dégénératives cervicales sur deux niveaux.

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Early clinical and biomechanical results following cervical arthroplasty

Cited by 129 publications

References 32 publications

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

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

Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study

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