Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up

Abstract

ObjectiveThe long‐term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid‐ to long‐term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non‐surgically treated adjacent segments.MethodsWe retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2‐C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre‐ and postoperative values were compared using paired t‐tests or Wilcoxon rank‐sum tests. Independent Student t‐tests or Mann–Whitney U tests analyzed continuous data between CDA and HS groups, while chi‐square or Fisher exact tests assessed categorical data.ResultsSixty‐four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow‐up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2‐C7 ROM (p < 0.05), but at the last follow‐up, the C2‐C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow‐up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%).ConclusionCDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid‐to‐long‐term follow‐up. ASDeg is similar in non‐surgical segments after 70 months of follow‐up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.

Anterior Full‐endoscopic Single‐port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two‐segment Cervical Spondylotic Myelopathy: A Technical Note

“… 4 , 5 The decompressive fusion of multiple segments is more prone to complications such as dysphagia, wound infection, and higher revision rates. 6 , 7 For noncontinuous multilevel cervical spondylotic myelopathy, when skip anterior cervical discectomy and fusion is used, the middle segment will bear more stress generated by the upper and lower fusion segments and accelerate the degeneration, which is faster than the upper and lower adjacent segments. 8 Some have used long‐segment anterior fusion including normal middle segment (IS) for the treatment of discontinuous cervical spondylotic myelopathy, in order to reduce the stress on the fusion structure on IS and avoid adjacent segment degeneration (ASD) of IS.…”