J Korean Neurotraumatol Soc.  2009 Dec;5(2):83-88. 10.13004/jknts.2009.5.2.83.

Clinical and Radiological Analysis of Cervical Arthroplasty Compared to Anterior Cervical Discectomy and Fusion in Cervical Disc Disease

• Park ES
• Roh SW
• Park JH
• Jeon SR
• Rhim SC
• Kim CJ

• KMID: 1427363
• DOI: http://doi.org/10.13004/jknts.2009.5.2.83

Abstract

OBJECTIVE
Although anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative cervical disc disease, concerns about adjacent level degeneration and loss of motion have led to suggestions that total disc replacement may be a better alternative.
METHODS
Since April 2006, 35 cases of cervical arthroplasty have been performed at our institute. Here we compare clinical and radiological results in patients who have cervical disc herniations treated with arthroplasty or with ACDF. We evaluated 67 patients treated for cervical disc herniations with radiculopathy and neck pain, of whom 35 underwent cervical arthroplasty using the Mobi-C(R) (LDR medical, Troyes, France) implant and 32 underwent ACDF using the Solis(R) cage (Stryker Spine, Allendale, NJ). Clinical measurements of outcome included the numeric rating scale (NRS) score for radiculopathy and neck pain, neck disability index (NDI) score, duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring overall cervical lordosis (Cobb's angle), segmental lordosis and segmental range-of-movement (ROM) of operated disc levels and adjacent disc levels.
RESULTS
Mean hospital stay (5.52 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.15 vs. 2.92 months, p<0.05) were significantly shorter in the arthroplasty than in the ACDF group. After 12 months, mean NDI and neck and extremity NRS scores had improved in both groups. Patients in the arthroplasty group, but not in the ACDF group, maintained their baseline overall preoperative cervical and segmental lordosis scores after surgery. Segmental ROM of adjacent levels were higher in the ACDF group than in the arthroplasty group, and segmental motion of operated level scores in the arthroplasty group were maintained at the last follow-up assessment. The ROM of adjacent segment were smaller in the arthroplasty group than in the ACDF group, but the difference was not statistically significant (p>0.05). In addition, segmental motion of operated level in the arthroplasty group were maintained at the last follow-up assessment. In two cases of arthroplasty group, new bony growth at the treated level, indicating heterotrophic ossification, was suspected based on radiographic (film) results.
CONCLUSION
Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Postoperative overall cervical and segmental lordosis were reduced in the ACDF group compared with preoperative levels, but not in the arthroplasty group.

Keyword

Anterior cervical discectomy and fusion; Cervical arthroplasty; Outcome

MeSH Terms

Animals
Arthroplasty
Convalescence
Diskectomy
Extremities
Follow-Up Studies
Humans
Length of Stay
Lordosis
Neck
Neck Pain
Radiculopathy
Return to Work
Spine
Total Disc Replacement

Figure

• 

  FIGURE 1 A: Neck disability index (NDI) scores in the arthroplasty and fusion groups (p>0.05). The scores of both groups decreased gradually; however, the greatest decrease was seen in the immediate postoperative period. B: NRS scores of radiculopathy in the arthroplasty and fusion groups (p>0.05). The scores of both groups decreased gradually, but the decreases were greatest in the immediate postoperative period. NRS: nume ical rating scale, VAS: visual analogue scale.

• 

  FIGURE 2 A: Overall cervical lordosis in the arthroplasty and fusion groups. Measurement was performed as shown in the left panel. In the arthroplasty group, cervical lordosis increased immediately after surgery, then decreased to preoperative levels. Cervical lordosis in the fusion group gradually decreased after surgery and did not return to preoperative levels. B: Segmental lordosis in the arthroplasty and fusion groups. Measurement was performed as shown in the left panel. In the arthroplasty group, segmental lordosis score increased immediately after surgery, but then decreased after 6 months and returned to preoperative levels. In the fusion group, however, segmental lordosis increased immediately after surgery, then decreased but did not return to preoperative levels. C: Adjacent ROM of the upper level in the arthroplasty and fusion groups. After surgery, upper ROM decreased in the arthroplasty group but increased in the fusion group (p>0.05). D: Adjacent ROM of the lower level in the arthroplasty and fusion groups. After surgery, lower ROM increased in both groups, but the increase was greater in the fusion group (p>0.05). E: Segmental ROM in the arthroplasty group decreased immediately after surgery before increasing to a level greater than the preoperative level. F: In two cases of arthroplasty group, new bony growth at the treated level, indicating heterotrophic ossification, was suspected based on postoperative X-ray. ROM: range of movement.

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