J Korean Neurosurg Soc.  2017 Jan;60(1):30-39. 10.3340/jkns.2015.0506.004.

Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

• Kim KT
• Cho DC
• Sung JK
• Kim YB
• Kim DH

• KMID: 2365584
• DOI: http://doi.org/10.3340/jkns.2015.0506.004

Abstract

OBJECTIVE
To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria.
METHODS
Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2-7 range of motion (ROM), FSU, and the adjacent segment were also checked.
RESULTS
The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient's satisfaction rates for surgery were 88.2% in group A and 88.8% in group B.
CONCLUSION
TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient's biomechanical characteristics and economic status should be understood and treated using the optimal procedure.

Keyword

Total disc replacement; Foraminotomy; Cervical disc; Radiculopathy

MeSH Terms

Follow-Up Studies*
Foraminotomy*
Humans
Radiculopathy*
Range of Motion, Articular
Total Disc Replacement*

Figure

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  Fig. 1 A : Sagittal balance was measured as the angle between the lower margin of C2 and C7 on a static neutral lateral radiograph. B : Functional segmental unit (FSU; upper and lower endplate of the operative lesion) height was measured as the length from the upper endplate of the superior segment to the lower endplate of the inferior segment at the operated level.

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  Fig. 2 Range of motion was measured as the difference of the angle on a simple dynamic radiograph.

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  Fig. 3 Case 1 in the total disc replacement (A). At 5 years after surgery, severe heterotophic ossification was shown on a computed tomography scan, but no clinical symptoms were observed. Case 2 in the posterior cervical foraminotomy (B). The patient complained of recurrent arm pain 4 years after the surgery, so we performed anterior cervical fusion as the revision surgery.

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