Artificial Cervical Disk Replacement for the Treatment of Adjacent Segment Disease After Anterior Cervical Decompression and Fusion

Abstract

Our follow-up shows that ACDR is an effective treatment for post-ACDF ASD. It can maintain the ROMs of the replaced segment as well as the adjacent unfused segment.

Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic Review and Meta-Analysis

“…After exclusion of duplicate or irrelevant references, 287 potentially relevant articles remained for assessment (Figure 1). After applying the selection criteria, 1 two-armed study 13 and 8 single-arm studies 2,5,14-19 were selected for analysis, yielding 5 cohorts evaluating ACDF and 5 evaluating TDR. The 2-armed study was assessed to be of Level 2b evidence, and the single-arm studies were assessed to be of Level 4 evidence.…”

“…In the only direct comparative study, Lee et al observed significantly less incidences of radiologic ASP following TDR (2/19, 11%) compared to ACDF (8/22, 36%, P = .04) after treatment of primary ASD. In the largest single-arm ASD studies available, Bin et al 14 and Xu et al 24 observed 3/32 (9%) and 27/108 (25%) cases of suggestive recurrent ASD following TDR and ACDF treatment. If one procedure can be comprehensively shown to afford greater degenerative control in ASD, then this will assist clinicians in deciding optimal management in the future.…”

Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics

“…However, in longer term follow-up, ROM became comparable to preoperative values [30,58,[64][65][66][67]. Other studies have reported preserved segmental ROM compared with preoperative ROM at 1-2year [14,20,55,[69][70][71][72], 3-5-year [73][74][75][76][77][78][79][80], 7-year [81], and 8-year follow-up [82]. Interestingly, some studies even reported significantly more mobile segments over 1-year follow-up [48] than at 5-year follow-up [83].…”

“…As the follow-up time increases, there will be an increased rate of ROM-limiting HO, which is functionally similar, if not identical, to the fused segments in ACDF [43]. While HO is gradually fusing the spinal segments, the formation of ROM-limiting HO is preceded by years of preservation of segmental mobility [14,20,30,55,58,[64][65][66][67][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. The years of preserved segmental mobility may serve, in theory, as a "grace period" to delay the formation of ASD in CTDR, compared with ACDF ( Fig.…”

Künstliche Bandscheibe HWS

“…Die Implantation einer Bandscheibenprothese ist auch im Rahmen erweiterter Indikationen wie z. B. bei zervikaler Myelopathie [5], mehrsegmentaler Pathologie [6], als Hybridversorgung in Kombination ACDF bei mehrsegmentaler Pathologie [7,8], Radikulopathie bei ausgeprägter knöcherner Foramenstenose [9] als auch zur Behandlung der Anschlussdegeneration nach vorheriger Fusion [10] möglich. Diese erweiterten Indikationen werden aber teils kontrovers diskutiert, sodass die Bandscheibenprothesenimplantation in diesem Indikationsspektrum nicht uneingeschränkt empfohlen werden kann.…”