Artificial disc replacement and adjacent-segment pathology: 10-year outcomes of a randomized trial

Kontakis, Michael; Marques, Catarina; Löfgren, Håkan; Mosavi, Firas; Skeppholm, Martin; Olerud, Claes; MacDowall, Anna

doi:10.3171/2021.9.spine21904

Cited by 3 publications

(1 citation statement)

References 33 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, there's evidence that certain prosthetic devices can develop heterotopic ossification, leading to full fusion in the operated segment, which could limit cervical movement without necessarily affecting clinical signs [13,14,19,20]. Additionally, the cervical disc arthroplasty cohort has reported increased rates of subsequent surgeries, with the predominant reason being the prosthesis becoming unstable or settling [21][22][23]. Yet, our findings suggest that when considering the degeneration of adjacent segments, both procedures might offer similar outcomes.…”

Section: Grade Vmentioning

confidence: 99%

Comparison of adjacent segment degeneration in patients using cervical cage and disc prosthesis in anterior cervical surgery

Karaaslan,

Biber,

Ozdemir

et al. 2024

j-ebr

View full text Add to dashboard Cite

To examine the prevalence of adjacent segment degeneration associated with the use of cages and disc prostheses in patients who underwent cervical disc surgery via an anterior cervical approach. Methods: We retrospectively reviewed the medical records of 60 patients who underwent cervical disc surgery via an anterior cervical approach at our clinic between 2018 and 2023. The patients were divided into two groups based on the type of implant used: those with a cervical cage (Group 1) and those with a cervical disc prosthesis (Group 2). Patients' demographic and clinical details, including age, gender, smoking habits, followup durations, and any additional comorbid diseases, were recorded. Radiological evaluations focused on degeneration rates in the segments adjacent to where either the cage or disc prosthesis was implanted. Results: In the study comparing two groups, participants' average ages were 48.9 in Group 1 and 48.1 in Group 2 (p=0.720). Group 1 had a higher proportion of smokers (p=0.052) and more discopathy (p=0.196). In terms of disc degenerations, variations existed but were not statistically significant (p=0.259). Utilizing the Pfirrmann grading, Group 1 had more Grade III degeneration (p=0.088) and a significantly higher presence of ossification or osteophytes (p=0.038). Both groups showed high rates of adjacent segment degeneration, yet Group 1 had notably more proximal degeneration (p=0.012). Stenosis and facet hypertrophy differences were not significant (p=0.417, p=0.071). Follow-up duration averaged around 38 months for both groups (p=0.929). Conclusions: No substantial difference in the overall incidence of adjacent segment degeneration between the two procedures. Nevertheless, further large-scale and long-term studies are essential to draw comprehensive conclusions regarding the optimal surgical intervention for cervical disc ailments.

show abstract

Section: Grade Vmentioning

confidence: 99%

Comparison of adjacent segment degeneration in patients using cervical cage and disc prosthesis in anterior cervical surgery

Karaaslan,

Biber,

Ozdemir

et al. 2024

j-ebr

View full text Add to dashboard Cite

show abstract

A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy

Lee,

Trenchfield,

Berthiaume

et al. 2024

Clinical Spine Surgery

View full text Add to dashboard Cite

Study Design: Retrospective Cohort. Objective: To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy. Background: Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty. Methods: A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2–C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes. Results: A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2–C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: −11.66 ± 19.2 vs −1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale–neck: −2.69 ± 2.78 vs −0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale–arm: −2.47 ± 3.15 vs −0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index. Conclusion: ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures. Level of Evidence: III.

show abstract

Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology

Altorfer,

Avrumova,

Abjornson

et al. 2024

J Am Acad Orthop Surg

View full text Add to dashboard Cite

For years, anterior cervical diskectomy and fusion has been considered the benchmark for patients with cervical radiculopathy/myelopathy. However, concerns regarding adjacent segment pathology have promoted the popularity of cervical disk arthroplasty (CDA) with its motion-preserving properties. To replicate the natural cervical disk's six degrees of freedom and compressibility in cervical spine implants, designers need to carefully consider the level of constraint for stability and material selection. Recent CDA designs have incorporated strategies to facilitate unrestricted or semirestricted motion, deploying various articulating components and materials with distinct wear and compressibility properties. To optimize outcomes, patient selection considering additional degeneration of the cervical spine is critical. Clinical long-term studies have been reported in industry-funded FDA investigational device exemption and nonindustry-funded data for one-level and two-level CDA. There are limited data available on three-level and four-level CDA. Adverse events such as heterotopic ossification, osteolysis, migration, subsidence, and failure have been described, where analysis from explanted devices yields insight into in vivo wear and impingement performance. CDA has shown short-term cost advantages, such as decreased procedural expenses. Nonetheless, long-term analysis is necessary to assess possible economic tradeoffs. Advancements in designs may lead to improved implant longevity while evidence-based decision making will guide and responsibly manage the rapid advancement in CDA technology.

show abstract

Artificial disc replacement and adjacent-segment pathology: 10-year outcomes of a randomized trial

Cited by 3 publications

References 33 publications

Comparison of adjacent segment degeneration in patients using cervical cage and disc prosthesis in anterior cervical surgery

Comparison of adjacent segment degeneration in patients using cervical cage and disc prosthesis in anterior cervical surgery

A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy

Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology

Contact Info

Product

Resources

About