Yonsei Med J.  2014 Jul;55(4):1072-1079. 10.3349/ymj.2014.55.4.1072.

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

• Oh CH
• Kim DY
• Ji GY
• Kim YJ
• Yoon SH
• Hyun D
• Kim EY
• Park H
• Park HC

• KMID: 2130835
• DOI: http://doi.org/10.3349/ymj.2014.55.4.1072

Abstract

PURPOSE
Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease.
MATERIALS AND METHODS
Sixty patients who underwent cervical arthroplasty (Mobi-C(R)) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery.
RESULTS
VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded.
CONCLUSION
Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.

Keyword

Total disc replacement; cervical arthroplasty; disc degeneration; clinical outcome; range of motion

MeSH Terms

Adult
Arthroplasty/*methods
Cervical Vertebrae/pathology/surgery
Female
Follow-Up Studies
Humans
Intervertebral Disc/surgery
Intervertebral Disc Degeneration/*surgery
Male
Middle Aged
Range of Motion, Articular/physiology
Retrospective Studies
Spinal Diseases/surgery
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Radiological illustration of representative cases from groups A and B. Cases of Pfirrmann grade III (A) were assigned to Group A, while cases of Pfirrmann grade IV (B) or V (C) were assigned to Group B. Follow-up images were taken at 12 months after operation.

• 

  Fig. 2 Radiological illustration of global and segmental cervical range of motion in dynamic lateral radiographs: (A) global cervical range of motion was defined as the angles formed between lines drawn parallel to the inferior margin of C2 vertebral body (white line) and the inferior margin of C7 vertebral body (black line); (B) segmental cervical range of motion was defined as the angle formed between a line drawn to the upper endplate of the most cranial vertebra (white dot line) and a line drawn to the lower endplate of the most caudal vertebra (black dotted line) at the prosthesis inserted level; (C) adjacent segmental cervical range of motion was defined as the angle formed between a line drawn to the upper endplate of the most cranial vertebra (white dot line) and a line drawn to the lower endplate of the most caudal vertebra (black dotted line) at the disc level above or below the Mobi-C® prosthesis.

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