Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

Gornet, Matthew F.; Schranck, Francine W.; Sorensen, Katrine M.; Copay, Anne G.

doi:10.14444/7090

Cited by 17 publications

(19 citation statements)

References 42 publications

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“…Joaquim and Riew 42 performed a meta-analysis for multilevel CDA and concluded that the literature supports this option. Gornet et al 43 reported on a retrospective series of 139 patients who had 3-or 4-level CDA with 7 years of follow-up, and demonstrated improved patient-reported outcomes and a low reoperation rate. According to the aforementioned reports, 3-or 4-level CDA is feasible for multilevel radiculopathy or myelopathy, with satisfactory outcomes.…”

Section: Indications For Multilevel Cdamentioning

confidence: 99%

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA—with low rates of complications—has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF–CDA according to individual evaluation for each level of degeneration.

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Section: Indications For Multilevel Cdamentioning

confidence: 99%

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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“…8 The VR-12 has been utilized in a broad variety of clinical settings and is increasingly being incorporated in spine literature. 12,34,35 As use of this valuable measure inevitably continues to grow, systematic, procedure-specific validation will be increasingly necessary.…”

Section: Role Of Vr-12 In Spine Surgerymentioning

confidence: 99%

Two-year validation and minimal clinically important difference of the Veterans RAND 12 Item Health Survey Physical Component Score in patients undergoing minimally invasive transforaminal lumbar interbody fusion

Lynch

Elliot

Mohan

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The Physical Component Score of the Veterans RAND 12 Item Health Survey (VR-12 PCS) has been assessed for use at short-term and intermediate-term time points for lumbar fusion populations. This study assesses the long-term validity and establishes minimal clinically important difference (MCID) values of VR-12 PCS in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS A surgical registry was retrospectively reviewed for primary, elective, single-level MIS TLIF procedures with posterior instrumentation. Patients missing preoperative and 2-year postoperative VR-12 PCS survey data were excluded. VR-12 PCS, SF-12 Health Survey Physical Component Summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), and Oswestry Disability Index (ODI) patient-reported outcome measures (PROMs) were recorded preoperatively and postoperatively. Responsiveness of the VR-12 measure was assessed in two ways. First, the mean postoperative PROM scores were compared with preoperative baseline values using a paired Student t-test. Second, MCID values were calculated using both distribution-based and anchor-based methods and used to assess improvement in VR-12 score at the 2-year time point. Discriminant validity of the VR-12 was assessed using cross-sectional and longitudinal anchors. Convergent validity of the VR-12 measure was assessed using Pearson’s correlation coefficient and partial time-independent correlation. Floor and ceiling effects were assessed. RESULTS A total of 74 patients who underwent MIS TLIF were included. The VR-12 PCS demonstrated significant improvements at all time points from 12 weeks to 2 years (p < 0.001 for all). VR-12 PCSs were significantly different for patients classified using cross-sectional anchors (p < 0.001) and longitudinal anchors (p ≤ 0.005). Calculated MCID values ranged from 4.1 to 8.5, and 4.1 was selected as the optimal MCID, which 87.8% of patients achieved. Strong, significant correlations of the VR-12 PCS with SF-12 PCS and PROMIS PF were demonstrated at all time points (p < 0.001 for all). No significant floor or ceiling effects were detected. CONCLUSIONS The VR-12 PCS demonstrated excellent responsiveness, discriminant and convergent validity, and no significant floor or ceiling effects up to 2 years after MIS TLIF. Therefore, VR-12 PCS may serve as a valid measure of long-term physical function.

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“…Another retrospective study examined 139 cervical disc arthroplasties (116 three-level and 23 four-level). From preoperative period to seven years postoperatively, patient-reported outcomes improved ( p < 0.001), including mean NDI (by 45.9%), the Veterans Rand 12-item Health Survey (by 54.1%), and mental component summary (by 41.85%), with an 88% patient satisfaction rate [ 1 ]. Furthermore, Buttacavoli et al retrospectively reviewed 43 patients treated for three-level disc degenerative disease, comparing those who were given artificial disc (ProDisc-L) or circumferential fusion.…”

Section: Reviewmentioning

confidence: 99%

“…Anterior cervical discectomy and fusion (ACDF) has historically been the gold standard for treating degenerative disc disease (DDD) in the cervical spine. However, more recently, cervical disc arthroplasty (CDA) has become more prominent as an alternative to ACDF for treating cervical DDD due to its ability to preserve segmental motion and decrease the risk of adjacent disc disease along with nerve root compression [ 1 ]. Long-term clinical studies on single-level treatments have even demonstrated superior clinical outcomes for CDA when compared with ACDF [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty

Nanney¹,

Villait²,

Sekhon³

et al. 2021

Cureus

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Spinal disc arthroplasty (SDA) has been a rising alternative to fusion for the treatment of degenerative disc disease (DDD). This review aims to provide an overview of the timeline, approvals, and limitations of SDA through analysis of U.S. Food and Drug Administration (FDA)-approved trials. Clinical studies have shown more successful outcomes when comparing cervical disc arthroplasty (CDA) with anterior cervical decompression and fusion, with the key benefits of decreased risk of nerve root compression and adjacent disc disease. CDA is currently approved by the FDA for one-and two-level disc pathologies. However, there are no approved trials for three-level or more cervical pathologies. The FDA approved its usage for the treatment of one-level lumbar disc pathologies in 2007 and recently approved two-level disc pathologies in 2020. Thoracic SDA has not been approved by the FDA, and there are no currently occurring clinical trials. While multilevel SDA has been approved in the cervical and lumbar spine, it has not been approved in more than two adjacent vertebral levels. Based on these clinical studies, future research is needed to compare the success of SDA for three-level or more disc pathologies. There have been recent publications showing promising results, though no FDA-approved clinical trials exist. Furthermore, a hybrid construct has been a recent surgical method to treat multilevel DDD. In this approach, arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels to treat two-and three-level disc disease. Hybrid arthroplasty compared with SDA is currently being studied in clinical trials. As such, long-term research with FDA-approved clinical trials is needed to understand the benefits and limitations of different approaches in the treatment of DDD.

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Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

Cited by 17 publications

References 42 publications

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Two-year validation and minimal clinically important difference of the Veterans RAND 12 Item Health Survey Physical Component Score in patients undergoing minimally invasive transforaminal lumbar interbody fusion

Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty

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