Anterior Bone Loss in Cervical Disc Arthroplasty Correlates with Increased Cervical Lordosis

Kuo, Chao‐Hung; Kuo, Yi-Hsuan; Wu, Jau‐Ching; Chang, Hsuan-Kan; Ko, Chin-Chu; Tu, Tsung Hsi; Chang, Chih-Chang; Yeh, Mei-Yin; Fay, Li Yu; Huang, Wen-Cheng; Cheng, Henrich

doi:10.1016/j.wneu.2022.03.139

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…Previous studies have supposed that ABL is a phenomenon unique to CDR and may not occur after ACDF ( 11 , 12 , 20 ); however, in this study, we found that ABL was also frequently observed in patients treated with ACDF using Zero-P spacer, which is composed of an anterior Zero-P titanium plate and posterior polyetheretherketone (PEEK) cage. In our study, ABL was identified in 66.4% of patients after CDR and 57.6% of patients after ACDF, which is consistent with previous studies.…”

Section: Discussioncontrasting

confidence: 68%

The association of cervical sagittal alignment with anterior bone loss following single-level anterior cervical surgery

Shen,

Wu,

Yang

et al. 2024

Quant Imaging Med Surg

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Background Anterior bone loss (ABL) is a common phenomenon after cervical disc replacement (CDR), which can also be observed after anterior cervical discectomy and fusion (ACDF). This study aimed to investigate the incidence and severity of ABL in single-level CDR and ACDF and explore the association of cervical sagittal alignment with ABL. Methods This is a single-center retrospective cohort study. A total of 113 patients treated with CDR and 99 patients treated with ACDF were retrospectively reviewed from January 2014 to December 2018 in West China Hospital. Radiological data were collected at pre-operation, 1 week, 3 months postoperatively, and the last follow-up. The incidence and severity of ABL after both CDR and ACDF were evaluated. Cervical sagittal alignment parameters, including C0–C2 angle, cervical lordosis (CL), C2–C7 sagittal vertical axis (cSVA), T1 slope, functional spinal unit angle, disc angle, and surgical level slope, were evaluated. Results ABL was identified in 75 (66.4%) patients in the CDR group and 57 (57.6%) patients in the ACDF group. There were no significant differences in the incidence, severity, and location of ABL between the ACDF and CDR groups. For patients who underwent ACDF, the proportion of females was significantly higher in the ABL group (64.9% vs. 33.3%, P=0.002), whereas the body mass index (BMI) was significantly lower in the ABL group compared to the non-ABL group (22.72±3.09 vs. 24.60±3.04, P=0.002). No effect of ABL on the short-term clinical outcomes of ACDF and CDR was observed. In the ACDF group, patients with ABL had significantly smaller postoperative CL (11.83°±8.24° vs. 15.25°±8.32°, P=0.04) and cSVA (17.77±10.08 vs. 23.35±9.86 mm, P=0.007). In the CDR group, no significant differences were found in the cervical sagittal parameters between patients with and without ABL (CL: 12.58±8.70 vs. 15.46±8.50, P=0.10; cSVA: 20.95±8.54 vs. 19.40±9.43, P=0.38). Conclusions ABL is common after both CDR and ACDF with comparable incidence and severity. Cervical sagittal alignment was closely related to ABL after ACDF yet had less influence on ABL after CDR.

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Section: Discussioncontrasting

confidence: 68%

The association of cervical sagittal alignment with anterior bone loss following single-level anterior cervical surgery

Shen,

Wu,

Yang

et al. 2024

Quant Imaging Med Surg

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“…The US IDE studies were specifically designed around safety and effectiveness, whereas the stud- ies performed outside the US laid emphases on avoidance of complications, patient selection, and expanding indications. 34,35 The US IDE studies and numerous randomized trials significantly enhanced the proportion of high-quality level I evidence in the CDA literature (24.2% of the current bibliometric analysis) in comparison with general spine publications (4.7%-20%). 36,37 The US published the most CDA-related articles, followed by China, South Korea, and Taiwan.…”

Section: Trends Of Cda Practice and Researchmentioning

confidence: 99%

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA—with low rates of complications—has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF–CDA according to individual evaluation for each level of degeneration.

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“…Therefore, it is reasonable to infer that multilevel CDA is a superior surgical option for several reasonsincluding achieving direct decompression anteriorly, avoidance of posterior muscular tension-band injury, and the preservation of neck mobility-compared with other cervical fusion surgery. As there is a clear trend of spinal surgery pushing beyond the envelope of CDA, 11 the effectiveness, clinical results, and safety of 4-level CDA should be examined.…”

Section: Introductionmentioning

confidence: 99%

Four-Level Cervical Disc Arthroplasty

Chang,

et al. 2024

Int J Spine Surg

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Background: Multilevel anterior cervical discectomy and fusion inevitably yields a higher chance of pseudarthrosis or require more reoperations than single-level procedures. Therefore, multilevel cervical disc arthroplasty (CDA) could be an alternative surgery for cervical spondylosis, as it (particularly 3-and 4-level CDA) could preserve more functional motility than single-level disc diseases. This study aimed to investigate the clinical and radiological outcomes of 4-level CDA, a relatively infrequently indicated surgery.Methods: The medical records of consecutive patients who underwent 4-level CDA were retrospectively reviewed. These highly selected patients typically had multilevel disc herniations with mild spondylosis. The inclusion criteria were symptomatic cervical spondylotic myelopathy, radiculopathy, or both, that were medically refractory. The clinical outcomes were assessed. The radiographic outcomes, including global and individual segmental range of motion (ROM) at C3-7, and any complications were also analyzed.Results: Data from a total of 20 patients (mean age: 56 ± 8 years) with an average follow-up of 34 ± 20 months were analyzed. All patients reported improved clinical outcomes compared with that of preoperation, and the ROMs at C3-7 were not only preserved but also trended toward an increase (35 ± 8 vs 37 ± 10 degrees, pre-vs postoperation, P = 0.271) after the 4-level CDA. However, global cervical alignment remained unchanged. There was one permanent C5 radiculopathy, but no other neurological deteriorations or any reoperations occurred.Conclusion: For these rare but unique indications, 4-level CDA yielded clinical improvement and preserved segmental motility with low rates of complications. Four-level CDA is a safe and effective surgery, maintaining the ROM in patients with primarily disc herniations and mild spondylosis.Clinical Relevance: For patients with mild spondylosis, whose degeneration at the cervical spine is not so severe, CDA is more suitable.Level of Evidence: 4.

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Anterior Bone Loss in Cervical Disc Arthroplasty Correlates with Increased Cervical Lordosis

Cited by 10 publications

References 19 publications

The association of cervical sagittal alignment with anterior bone loss following single-level anterior cervical surgery

The association of cervical sagittal alignment with anterior bone loss following single-level anterior cervical surgery

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Four-Level Cervical Disc Arthroplasty

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