Does neck pain as chief complaint influence the outcome of cervical total disc replacement?

  • S. FinkenstaedtEmail author
  • A. F. Mannion
  • T. F. Fekete
  • D. Haschtmann
  • F. S. Kleinstueck
  • U. Mutter
  • H. J. Becker
  • D. Bellut
  • F. Porchet
Original article



We investigated whether outcomes after cervical total disc replacement (cTDR) are influenced by preoperative neck pain as the chief complaint.


This was a retrospective study using data in our local spine surgery outcomes database, linked to EUROSPINE Spine Tango Registry. Patients completed questionnaires at baseline enquiring about the “chief complaint” [neck pain (NP), arm/shoulder pain (AP) or neurological deficits (ND)] and including the Core Outcome Measures Index (COMI); these were completed again at 24 months postoperatively, along with a rating of “global treatment outcome” (on a five-point scale, later dichotomized as “good” or “poor”). Differences in outcomes between the groups were examined using ANOVA. Multivariable regression analysis examined the effect of the chief pain location on 24-month outcomes, controlling for age, gender, comorbidity, baseline pain and COMI scores.


One hundred and fifty-nine consecutive patients were included, with a chief complaint of NP in 31%, AP in 38% and ND in 31%. The chief complaint groups did not differ in relation to their baseline COMI scores or their reductions in score from before surgery to 24 months after surgery (reduction: NP group, 4.4 ± 2.9 points; AP group, 4.7 ± 2.7; ND group, 4.3 ± 2.9; p = 0.78). Similarly, the percentage of patients reporting a “good global treatment outcome” at 24 months postoperatively did not differ between the groups (NP, 79%; AP, 77%; ND, 85%; p  = 0.64). The findings were consistent when controlling for possible confounders in multiple regression.


Having neck pain as opposed to arm pain or neurological deficits as preoperative chief complaint had no significant impact on clinical outcome after cTDR.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Neck pain Cervical total disc replacement cTDR Cervical arthroplasty 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2019_6052_MOESM1_ESM.pptx (329 kb)
Supplementary file1 (PPTX 329 kb)


  1. 1.
    Disease GBD, Injury I, Prevalence C (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1789–1858. CrossRefGoogle Scholar
  2. 2.
    Cohen SP, Hooten WM (2017) Advances in the diagnosis and management of neck pain. BMJ 358:j3221. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Leven D, Meaike J, Radcliff K, Qureshi S (2017) Cervical disc replacement surgery: indications, technique, and technical pearls. Curr Rev Musculoskelet Med 10:160–169. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sasso WR, Smucker JD, Sasso MP, Sasso RC (2017) Long-term clinical outcomes of cervical disc arthroplasty: a prospective, randomized, controlled trial. Spine (Phila Pa 1976) 42:209–216. CrossRefGoogle Scholar
  5. 5.
    Auerbach JD, Jones KJ, Fras CI, Balderston JR, Rushton SA, Chin KR (2008) The prevalence of indications and contraindications to cervical total disc replacement. Spine J 8:711–716. CrossRefPubMedGoogle Scholar
  6. 6.
    Saifi C, Fein A, Cazzulino A, Lehman R, Phillips FM, An HS, Riew KD (2017) Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the united states from 2006 to 2013. Spine J. CrossRefPubMedGoogle Scholar
  7. 7.
    Kong L, Cao J, Wang L, Shen Y (2016) Prevalence of adjacent segment disease following cervical spine surgery: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 95:e4171. CrossRefGoogle Scholar
  8. 8.
    Maharaj MM, Mobbs RJ, Hogan J, Zhao DF, Rao PJ, Phan K (2015) Anterior cervical disc arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF): a systematic review and meta-analysis. J Spine Surg 1:72–85. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Upadhyayula PS, Yue JK, Curtis EI, Hoshide R, Ciacci JD (2017) A matched cohort comparison of cervical disc arthroplasty versus anterior cervical discectomy and fusion: evaluating perioperative outcomes. J Clin Neurosci 43:235–239. CrossRefPubMedGoogle Scholar
  10. 10.
    Lanman TH, Burkus JK, Dryer RG, Gornet MF, McConnell J, Hodges SD (2017) Long-term clinical and radiographic outcomes of the prestige LP artificial cervical disc replacement at 2 levels: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 27:7–19. CrossRefPubMedGoogle Scholar
  11. 11.
    Dong L, Wang D, Chen X, Liu T, Xu Z, Tan M, Hao D (2017) A comprehensive meta-analysis of the adjacent segment parameters in cervical disk arthroplasty versus anterior cervical discectomy and fusion. Clin Spine Surg. CrossRefPubMedGoogle Scholar
  12. 12.
    Moatz B, Tortolani PJ (2012) Cervical disc arthroplasty: pros and cons. Surg Neurol Int 3:S216–224. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Manchikanti L, Singh V, Rivera J, Pampati V (2002) Prevalence of cervical facet joint pain in chronic neck pain. Pain Physician 5:243–249PubMedGoogle Scholar
  14. 14.
    Phillips FM, Geisler FH, Gilder KM, Reah C, Howell KM, McAfee PC (2015) Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 40:674–683. CrossRefGoogle Scholar
  15. 15.
    Suchomel P, Jurak L, Benes V 3rd, Brabec R, Bradac O, Elgawhary S (2010) Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J 19:307–315. CrossRefPubMedGoogle Scholar
  16. 16.
    Kleinstueck FS, Fekete T, Jeszenszky D, Mannion AF, Grob D, Lattig F, Mutter U, Porchet F (2011) The outcome of decompression surgery for lumbar herniated disc is influenced by the level of concomitant preoperative low back pain. Eur Spine J 20:1166–1173. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hessler C, Boysen K, Regelsberger J, Vettorazzi E, Winkler D, Westphal M (2012) Patient satisfaction after anterior cervical discectomy and fusion is primarily driven by relieving pain. Clin J Pain 28:398–403. CrossRefPubMedGoogle Scholar
  18. 18.
    Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026. CrossRefPubMedGoogle Scholar
  19. 19.
    Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient's perspective. Part 1: the Core Outcome Measures Index in clinical practice. Eur Spine J 18(Suppl 3):367–373. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kleinstuck FS, Grob D, Lattig F, Bartanusz V, Porchet F, Jeszenszky D, O'Riordan D, Mannion AF (2009) The influence of preoperative back pain on the outcome of lumbar decompression surgery. Spine (Phila Pa 1976) 34:1198–1203. CrossRefGoogle Scholar
  21. 21.
    Turel MK, Kerolus MG, Adogwa O, Traynelis VC (2017) Cervical arthroplasty: what does the labeling say? Neurosurg Focus 42:E2. CrossRefPubMedGoogle Scholar
  22. 22.
    Findlay C, Ayis S, Demetriades AK (2018) Total disc replacement versus anterior cervical discectomy and fusion. Bone Joint J 100-B:991–1001. CrossRefPubMedGoogle Scholar
  23. 23.
    Aghayev E, Barlocher C, Sgier F, Hasdemir M, Steinsiepe KF, Wernli F, Porchet F, Hausmann O, Ramadan A, Maestretti G, Ebeling U, Neukamp M, Roder C (2013) Five-year results of cervical disc prostheses in the SWISSspine registry. Eur Spine J 22:1723–1730. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Davis RJ, Nunley PD, Kim KD, Hisey MS, Jackson RJ, Bae HW, Hoffman GA, Gaede SE, Danielson GO 3rd, Gordon C, Stone MB (2015) Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine 22:15–25. CrossRefPubMedGoogle Scholar
  25. 25.
    Fekete TF, Loibl M, Jeszenszky D, Haschtmann D, Banczerowski P, Kleinstuck FS, Becker HJ, Porchet F, Mannion AF (2018) How does patient-rated outcome change over time following the surgical treatment of degenerative disorders of the thoracolumbar spine? Eur Spine J 27:700–708. CrossRefPubMedGoogle Scholar
  26. 26.
    Fekete TF, Porchet F (2010) Overview of disc arthroplasty-past, present and future. Acta Neurochir (Wien) 152:393–404. CrossRefGoogle Scholar
  27. 27.
    Yin W, Bogduk N (2008) The nature of neck pain in a private pain clinic in the United States. Pain Med 9:196–203. CrossRefPubMedGoogle Scholar
  28. 28.
    Manchikanti L, Dunbar EE, Wargo BW, Shah RV, Derby R, Cohen SP (2009) Systematic review of cervical discography as a diagnostic test for chronic spinal pain. Pain Physician 12:305–321PubMedGoogle Scholar
  29. 29.
    Jaumard NV, Welch WC, Winkelstein BA (2011) Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 133:071010. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Liu J, Ebraheim NA, Haman SP, Sanford CG, Jr., Sairyo K, Faizan A, Woldenberg L, Goel VK (2006) How the increase of the cervical disc space height affects the facet joint: an anatomy study. Spine (Phila Pa 1976) 31:E350–E354. CrossRefGoogle Scholar
  31. 31.
    Carrera GF, Haughton VM, Syvertsen A, Williams AL (1980) Computed tomography of the lumbar facet joints. Radiology 134:145–148. CrossRefPubMedGoogle Scholar
  32. 32.
    Falco FJ, Manchikanti L, Datta S, Wargo BW, Geffert S, Bryce DA, Atluri S, Singh V, Benyamin RM, Sehgal N, Ward SP, Helm S 2nd, Gupta S, Boswell MV (2012) Systematic review of the therapeutic effectiveness of cervical facet joint interventions: an update. Pain Physician 15:E839–E868PubMedGoogle Scholar
  33. 33.
    Harrell F (2001) Regression modeling strategies. With applications to linear models, logistic and ordinal regression, and survival analysis. Springer, Berlin. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • S. Finkenstaedt
    • 1
    Email author
  • A. F. Mannion
    • 1
  • T. F. Fekete
    • 1
  • D. Haschtmann
    • 1
  • F. S. Kleinstueck
    • 1
  • U. Mutter
    • 1
  • H. J. Becker
    • 1
  • D. Bellut
    • 1
  • F. Porchet
    • 1
  1. 1.Spine CenterSchulthess ClinicZurichSwitzerland

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