Segmental range of motion after cervical total disc arthroplasty at long-term follow-up: a systematic review and meta-analysis

Abstract

OBJECTIVE As an alternative procedure to anterior cervical discectomy and fusion, total disc arthroplasty (TDA) facilitates direct neural decompression and disc height restoration while also preserving cervical spine kinematics. To date, few studies have reported long-term functional outcomes after TDA. This paper reports the results of a systematic review and meta-analysis that investigated how segmental range of motion (ROM) at the operative level is maintained with long-term follow-up. METHODS PubMed and MEDLINE were queried for all published studies pertaining to cervical TDA. The methodology for screening adhered strictly to the PRISMA guidelines. All English-language prospective studies that reported ROM preoperatively, 1 year postoperatively, and/or at long-term follow-up of 5 years or more were included. A meta-analysis was performed using Cochran’s Q and I2 to test data for statistical heterogeneity, in which case a random-effects model was used. The mean differences (MDs) and associated 95% confidence intervals (CIs) were reported. RESULTS Of the 12 studies that met the inclusion criteria, 8 reported the long-term outcomes of 944 patients with an average (range) follow-up of 99.86 (60–142) months and were included in the meta-analysis. There was no difference between preoperative segmental ROM and segmental ROM at 1-year follow-up (MD 0.91°, 95% CI −1.25° to 3.07°, p = 0.410). After the exclusion of 1 study from the comparison between preoperative and 1-year ROM owing to significant statistical heterogeneity according to the sensitivity analysis, ROM significantly improved at 1 year postoperatively (MD 1.92°, 95% CI 1.04°–2.79°, p < 0.001). However, at longer-term follow-up, the authors again found no difference with preoperative segmental ROM, and no study was excluded on the basis of the results of further sensitivity analysis (MD −0.22°, 95% CI −1.69° to −1.23°, p = 0.760). In contrast, there was a significant decrease in ROM from 1 year postoperatively to final long-term follow-up (MD −0.77°, 95% CI −1.29° to −0.24°, p = 0.004). CONCLUSIONS Segmental ROM was found to initially improve beyond preoperative values for as long as 1 year postoperatively, but then ROM deteriorated back to values consistent with preoperative motion at long-term follow-up. Although additional studies with further longitudinal follow-up are needed, these findings further support the notion that cervical TDA may successfully maintain physiological spinal kinematics over the long term.

A randomized controlled trial with extended long-term follow-up: Quality of cervical spine motion after anterior cervical discectomy (ACD) or anterior cervical discectomy with arthroplasty (ACDA)

“…A recent systematic review and meta-analysis shows that sROM initially improves after ACDA, but at the long-term (average of 5-years), sROM diminishes back to values similar to those preoperatively, which is in line with our findings ( Zavras et al, 2022 ). A recent publication by Wu et al also demonstrated that ROM increases after ACDA in younger patients, but decreases in elderly patients after 2 years ( Wu et al, 2019 ).…”

Long-Term Complication of Three-Level Cervical Artificial Total Disc Replacement: A Case Report

“…An REE greater than 2 mm increases the chance of developing grade three or four HO, which accelerates the degeneration of adjacent segments. Although inferior-segment degeneration rates are equally prevalent in both cTDR and ACDF cases, superior-segment degeneration rates are not [ 9 , 10 ]. Some studies have found that HO is less prevalent in multilevel cTDR than in single-level procedures at a two-year follow-up, while others have found no significant differences [ 11 , 12 ].…”

Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques

“…However, some studies have reported that ROM may decrease owing to heterotropic ossification, mechanical malfunction of the device, or implant wear. As a result of comparing several studies, Hence, Zavras et al [ 73 ] reported that ROM immediately postoperatively improved compared to ROM preoperatively, and no significant change in follow-up up to 1 year was observed. However, in the long-term follow-up (average, 99.86 months), the ROM deteriorated significantly, and efforts to maintain a good long-term ROM were necessary [ 73 ].…”