Cervical disc arthroplasty with Prestige-LP for the treatment of contiguous 2-level cervical degenerative disc disease

Abstract

The objective of this study is to present the long-term results and to evaluate the safety and effectiveness of the Prestige-LP cervical disc replacement in treatment of patients with symptomatic 2-level cervical degenerative disc disease.Twenty-four patients with 48 Prestige-LP disc were analyzed before surgery and at 1 week, 3 months, 6 months, 12 months, 24 months, and 60 months after surgery. Clinical assessments included 36-Short Form (SF-36), Japanese Orthopedic Assessment (JOA), visual analog scale (VAS), and Neck Disability Index (NDI) scores. Radiographic assessments included cervical lordosis (CL), disc height (DH), range of motion (ROM) of the total cervical spine, functional spinal unit (FSU) as well as upper and lower operated segment. Complications at the 5-year follow-up were collected as well.Mean follow-up period was 64.22 months. There was clinical improvement in terms of SF-36, JOA, NDI, and VAS from the preoperative to the final follow-up (P < .05). Overall, ROM of the total cervical spine, FSU, and upper and lower operated segment were maintained during the follow-up. Statistically significant (P < .05) improvements in the trend of CL and DH were noted at the follow-up. Eight patients were observed an appearance of heterotopic ossification at the 5-year follow-up, with 6 patients appeared at Class II and 2 patients at Class III. Adjacent segment degeneration assessed by radiographic evidence was found in 2 patients.Two-level cervical disc arthroplasty with Prestige-LP showed significant improvement in clinical outcomes at 5 years. It not only effectively preserves the motion of both total cervical spine and operated segments, but also restores normal CL and DH up to 5 years postoperation.

Long-Term Functional and Symptomatic Outcomes of Cervical Disc Prostheses

“…In the study by Zeng et al where 53 ACDF patients were compared with 45 ACDR patients, the VAS-neck and VASarm scores were similar across the groups; however, patients who underwent arthroplasty with Prestige-LP Discs showed more improvement in the NDI score (32) . In some studies, arthroplasty was apparently better even in case of implantation of contiguous 2-level degenerative disc disease (39) . Arthroplasty technique was effective and safe in the study by Gao et al (39) , which found that it maintains physiologic motion at 5 years with satisfactory clinical outcomes and a relatively low occurrence rate and adjacent degeneration.…”

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

“…Factors that might have led to the decrease in segmental ROM reported in the studies include the following: (1) the cohort of subjects has greater impairment in ROM preoperatively [68]; (2) fear of moving the neck to the extremes of flexion and extension during dynamic X-ray; (3) and postoperative neck pain [30]. 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].…”

“…Although CTDR was designed to preserve segmental ROM and prevent the development of ASD, deviation of postoperative ROM from the preoperative values has been reported in clinical trials. Segmental ROM has been reported to decrease shortly after surgery and could persist up to 6-month follow-up in some studies [30,58,[64][65][66][67]. Factors that might have led to the decrease in segmental ROM reported in the studies include the following: (1) the cohort of subjects has greater impairment in ROM preoperatively [68]; (2) fear of moving the neck to the extremes of flexion and extension during dynamic X-ray; (3) and postoperative neck pain [30].…”

“…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.…”

Complications and Complication Avoidance With Cervical Total Disc Replacement

“…In an RCT comparing the Prestige LP artificial disc to ACDF, Lanman et al 23 reported no significant difference in vascular events between arthroplasty and ACDF (0.5% and 0%, respectively). In a study of 24 patients undergoing arthroplasty with the Prestige LP for contiguous 2-level cervical disease by Gao et al, 20 no patients developed infection or local hematoma. Other studies comparing ACDF and arthroplasty routinely report no superficial or deep wound infections postoperatively.…”