<p>Safety and efficacy of cervical disc arthroplasty in preventing the adjacent segment disease: a meta-analysis of mid- to long-term outcomes in prospective, randomized, controlled multicenter studies</p>

Abstract

Objectives Cervical disc arthroplasty (CDA) has become an alternative treatment for cervical radiculopathy and myelopathy. This technique preserves appropriate motion at both the index and adjacent disc levels and consequently may prevent adjacent segment degeneration (ASD). The authors performed a meta-analysis to compare the safety and efficacy of CDA to those of the gold standard, anterior cervical discectomy and fusion (ACDF). Both surgical and clinical parameters were employed to verify the hypothesis that CDA can reduce the risk of ASD. Methods The meta-analysis comprised high-quality randomized controlled trials that compared CDA and ACDF treatments of cervical degenerative disc disease. Included papers reported data for at least one of the following outcomes: 1) surgical parameters, 2) questionnaire clinical indices (pre- and postoperative values), and 3) complication rates at 24 months; in addition, for ASD we analyzed 60 month or longer follow-ups. We used mean differences (MDs) or ORs to compare treatment effects between CDA and ACDF. Results Twenty studies with 3,656 patients (2,140 with CDA and 1,516 with ACDF) met the inclusion criteria. CDA surgery, with mean duration longer than that of ACDF, was associated with higher blood loss. Visual analog scale neck pain score was significantly smaller for CDA (mean difference =−2.30, 95% CI [−3.72; −0.87], P =0.002). The frequency of dysphagia/dysphonia (OR =0.69, 95% CI [0.49; 0.98], P =0.04) as well as the long-term ASD rate for CDA was significantly smaller (OR =0.33, 95% CI [0.21; 0.50], P <0.0001). Conclusion A significantly lower probability of ASD reoperations in the CDA cohort after a 60-month or longer follow-up was the most important finding of this study. Despite the moderate quality of this evidence, the pooled data corroborated for the very first time that CDA was efficacious in preventing ASD.

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

“…Over the last 2 decades the use of CDR has increased, with 3 times more procedures performed in 2006 than in 2013 [16]. While CDR has been shown to have good long-term outcomes for treatment of both myelopathy and radiculopathy [2-7,10,11], further study of the early postoperative period is warranted as there may be unique differences in early symptomatic improvement between these populations. This information would be valuable to counsel patients preoperatively regarding the time to clinical improvement following CDR for either cervical myelopathy or radiculopathy.…”

“…In recent series, CDR has been shown to result in better immediate postoperative range of motion and improved long-term outcomes compared to ACDF [2-9]. In addition, there is evidence suggesting lower rates of adjacent segment degeneration with CDR compared with ACDF [7,10,11].…”

Bandscheiben-Prothese bei zervikaler Myelopathie

“…die Rate zu minimieren und zweitens die Implantatassoziierte non-union zu verhindern. Zwar steht der endgültige Beweis, dass die Rate der Anschlusssegmentdegenerationen bei Bandscheibenprothesen geringer ausfällt, noch aus, allerdings finden sich zunehmend Studien, die dies untermauern [9]. Janssen et al [10] konnte innerhalb der Pro-Disc FDA-Studie mit einem 7-Jahresfollow-up eine deutlich geringere Re-OP-Rate bei Verwendung einer single-level Bandscheibenprothese im Vergleich zur single-level ACDF nachweisen.…”

“…Eine Abklärung einer tatsächlich vorliegenden Instabilität, z. B. mittels Funktionsaufnahmen, ist damit elementar [9].…”

Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management

“…Cervical artificial discs (or arthroplasty) aim to preserve motion across operated segments in an effort to reduce the incidence of adjacent level disease, but have limited indications in the treatment of DCM. For soft discs and radiculopathy symptoms, it is gathering an increasing body of evidence, with increasingly long follow-up periods [124]. However, this has to be balanced against a revision rate as high as 7.7% (compared to the 2% in ACDF), revision surgeries that have increased morbidity and cost, with complications such as heterotopic ossification occurring in as high as 47% of patients [118,125-128].…”