Differences between arthroplasty and anterior cervical fusion in two-level cervical degenerative disc disease
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Although arthroplasty is an accepted option for two-level disease, there is a paucity of data regarding outcomes of two-level cervical arthroplasty. The current study was designed to determine differences between two-level cervical arthroplasty and anterior fusion.
Seventy-seven consecutive patients who underwent two-level anterior cervical operations for degenerative disc disease were divided into the arthroplasty (37 patients) and fusion (40 patients) groups. Clinical outcomes were measured by Visual Analogue Scale (VAS) of neck and arm pain, Japanese Orthopedic Association (JOA) scores, and Neck Disability Index (NDI). Every patient was evaluated by radiography and computed tomography for fusion or detection of heterotopic ossification.
Thirty-seven patients (with 74 levels of Bryan discs) were compared with 40 patients who had two-level anterior fusion (mean follow-up of 39.6 ± 6.7 months). There was no difference in sex, but the mean age of the arthroplasty group was significantly younger (52.1 ± 9.1 vs. 63.0 ± 10.6 years, p < 0.001). The mean estimated blood loss was similar (p = 0.135), but the mean operation time was longer in the arthroplasty group (315.5 ± 82.0 versus 224.9 ± 61.8 min, p < 0.001). At 24 months post-operation, the arthroplasty group had increased their range of motion than pre-operation (23.5° versus 20.1°, p = 0.018). There were significant improvements in neck or arm VAS, JOA scores, and NDI in both groups. However, there were no differences in clinical outcomes or adverse events between the two groups.
Clinical outcomes of two-level arthroplasty and anterior cervical fusion are similar 39.6 months after surgery. Cervical arthroplasty preserves mobility at the index levels without increased adverse effects.
KeywordsBryan disc Cervical arthroplasty Degenerative disc disease (DDD) Heterotopic ossification Anterior cervical discectomy and fusion (ACDF)
No funds were received in support of this work and no benefits in any form have been and will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study, or the findings specified in this paper.
- 7.Wu JC, Huang WC, Tu TH, Tsai HW, Ko CC, Wu CL, Cheng H (2012) Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up. J Neurosurg Spine 16(2):163–171. doi: 10.3171/2011.10.SPINE11497 PubMedCrossRefGoogle Scholar
- 9.Heidecke V, Burkert W, Brucke M, Rainov NG (2008) Intervertebral disc replacement for cervical degenerative disease–clinical results and functional outcome at two years in patients implanted with the Bryan cervical disc prosthesis. Acta Neurochir (Wien) 150(5):453–459. doi: 10.1007/s00701-008-1552-7 (discussion 459)CrossRefGoogle Scholar
- 10.Burkus JK, Haid RW, Traynelis VC, Mummaneni PV (2010) Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 13(3):308–318. doi: 10.3171/2010.3.SPINE09513 PubMedCrossRefGoogle Scholar
- 11.Coric D, Nunley PD, Guyer RD, Musante D, Carmody CN, Gordon CR, Lauryssen C, Ohnmeiss DD, Boltes MO (2011) Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article. J Neurosurg Spine 15(4):348–358. doi: 10.3171/2011.5.SPINE10769 PubMedCrossRefGoogle Scholar
- 13.Murrey D, Janssen M, Delamarter R, Goldstein J, Zigler J, Tay B, Darden B (2009) Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9(4):275–286 pii:S1529-9430(08)00201-5PubMedCrossRefGoogle Scholar
- 14.Upadhyaya CD, Wu JC, Trost G, Haid RW, Traynelis VC, Tay B, Coric D, Mummaneni PV (2012) Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials. J Neurosurg Spine 16(3):216–228. doi: 10.3171/2011.6.SPINE10623 PubMedCrossRefGoogle Scholar
- 16.Heller JG, Sasso RC, Papadopoulos SM, Anderson PA, Fessler RG, Hacker RJ, Coric D, Cauthen JC, Riew DK (2009) Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34(2):101–107. doi: 10.1097/BRS.0b013e31818ee263 CrossRefGoogle Scholar
- 19.Beaurain J, Bernard P, Dufour T, Fuentes JM, Hovorka I, Huppert J, Steib JP, Vital JM, Aubourg L, Vila T (2009) Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J 18(6):841–850. doi: 10.1007/s00586-009-1017-6 PubMedCentralPubMedCrossRefGoogle Scholar
- 21.Leung C, Casey AT, Goffin J, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V (2005) Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery 57(4):759–763; (discussion 759-763). pii:00006123-200510000-00017Google Scholar
- 23.Peng CW, Yue WM, Basit A, Guo CM, Tow BP, Chen JL, Nidu M, Yeo W, Tan SB (2011) Intermediate results of the prestige LP cervical disc replacement: clinical and radiological analysis with minimum two-year follow-up. Spine (Phila Pa 1976) 36(2):E105–E111. doi: 10.1097/BRS.0b013e3181d76f99 CrossRefGoogle Scholar