A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

Gao, Xinlin; Yang, Yi; Líu, Hao; Meng, Yang; Zeng, Junfeng; Wu, Tingkui; Hong, Ying

doi:10.1016/j.wneu.2018.10.231

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…In our study, the overall and segmental alignment after CDR improved significantly. However, consistent with previous studies, a loss of global and segmental lordosis was observed at the last follow-up [9,17,18]. Notwithstanding, both CL and SA at the last follow-up were significantly no worse than those before surgery.…”

Section: Discussionsupporting

confidence: 91%

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

Wang

Meng

Líu

et al. 2021

BMC Musculoskelet Disord

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Background Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR. Methods This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters. Results The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05). Conclusion CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.

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Section: Discussionsupporting

confidence: 91%

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

Wang

Meng

Líu

et al. 2021

BMC Musculoskelet Disord

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“…Over the last 2 decades the use of CDR has increased, with 3 times more procedures performed in 2006 than in 2013 [16]. While CDR has been shown to have good long-term outcomes for treatment of both myelopathy and radiculopathy [2-7,10,11], further study of the early postoperative period is warranted as there may be unique differences in early symptomatic improvement between these populations. This information would be valuable to counsel patients preoperatively regarding the time to clinical improvement following CDR for either cervical myelopathy or radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…In recent series, CDR has been shown to result in better immediate postoperative range of motion and improved long-term outcomes compared to ACDF [2-9]. In addition, there is evidence suggesting lower rates of adjacent segment degeneration with CDR compared with ACDF [7,10,11].…”

Section: Introductionmentioning

confidence: 99%

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

et al. 2019

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Objective: Cervical disc replacement (CDR) is an effective long-term treatment for both cervical radiculopathy and myelopathy. However, there may be unique differences in the early postoperative clinical improvement for patients with and without myelopathy. In addition, previous studies using CDR to treat cervical myelopathy were underpowered to determine risk factors for relatively postoperative medical complications. Methods: Two different cohorts were studied. A local cohort of patients undergoing CDR by a single surgeon was utilized to study the early postoperative course of clinical improvement. In addition, a national cohort of patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program database was utilized to study differences in postoperative medical complications after CDR. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohorts, and perioperative outcomes and complications were compared to patients without myelopathy. Results: A total of 43 patients undergoing CDR were included in the institutional cohort, of those 16 patients (37% of cohort) had a preoperative diagnosis of cervical myelopathy. A total of 3,023 patients undergoing CDR were included in the national cohort, of those 411 (13% of cohort) had a preoperative diagnosis of cervical myelopathy. In the institutional cohort, the nonmyelopathy group had a lower initial Neck Disability Index (NDI) and saw a faster improvement in NDI by 2 weeks postoperative. However, at 24 weeks there was no significant difference between groups in terms of NDI. Interestingly, only the nonmyelopathy cohort had a significant improvement in modified Japanese Orthopaedic Association score by 6 weeks (p < 0.05). In the national cohort, myelopathy was associated with longer operative time and length of stay (p < 0.05). However, there was no significant difference in perioperative complications (p > 0.05) between myelopathy and nonmyelopathy patients. Conclusion: Significant improvements in NDI, visual analogue scale (VAS)-arm pain, and VAS-neck pain are seen in both myelopathy and nonmyelopathy populations undergoing CDR by 6 weeks postoperatively. However, nonmyelopathy populations improve faster by 2 weeks postoperatively. In the national cohort analysis, medical complications were similarly low in both myelopathy and nonmyelopathy groups.

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“…This experience allowed us to generate rational implantation strategies for multilevel CDR and HS. The safety profile and clinical outcomes of multilevel cervical spine surgery have been reported by our team before[ 16 - 18 ].…”

Section: Introductionmentioning

confidence: 96%

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports

Wang¹,

Meng²,

Liu³

et al. 2020

WJCC

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BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease. Surgical techniques are important for resolving patients’ symptoms and maintaining the normal functioning of cervical implants. However, the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit. In this paper, we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes. CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations. All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery. The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression. The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery. The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement. The symptoms of all patients were significantly relieved after surgery. CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

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A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

Cited by 19 publications

References 26 publications

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports

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