Comparative study of outcomes between allograft intervertebral disc transplantation and anterior cervical discectomy and fusion: a retrospective cohort study at least 5 years of follow-up

Abstract

Purpose Adjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis. Methods All patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment. Results There were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months (P = 0.039), 24 months (P = 0.035), 60 months (P = 0.039) and the last follow-up (P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups (P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group. Conclusion The allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.

Full endoscopic laminotomy decompression versus anterior cervical discectomy and fusion for the treatment of single-segment cervical spinal stenosis: a retrospective, propensity score-matched study

“…The change in disc height after endoscopic surgery was attributed to the natural degradation of the disc tissues as well as to disc degeneration aggravated by surgical disruption of the normal disc structure. These changes may lead to localized loss of cervical curvature and poor spinal alignment [16]. In addition, we did not observe any evidence of fracture of the lamina and facet joints or significant spondylolisthesis in the endoscopic group, and the ST was < 3 mm in all the patients.…”

“…The pathological basis of CSS is progressive compression of the spinal cord and nerve roots caused by cervical stenosis, leading to a series of neurological dysfunction symptoms due to ischemic changes in the nerves [1][2][3]. The clinical symptoms of CSS are complex, including myelopathy, radiculopathy, and myelo-radiculopathy [16,26]. For CSS patients whose conservative treatments are ineffective or have progression of neurological symptoms, surgical intervention is usually recommended [27].…”

“…The anatomy of the anterior cervical spine is complex and variable, and prolonged intraoperative traction on structures such as the vascular sheath, trachea and esophagus is likely to lead to postoperative complications such as throat pain, hoarseness, and dysphagia [2,6]. Dysphagia is the most common complication following anterior cervical spine surgery [16,32], with a prevalence of ACDF ranging from 1.7 to 67% [32]. In addition, long-term complications of ACDF, such as pseudoarthrosis formation, implant nonunion, and instrumentation failure, are also important factors that can severely impair patient prognosis [2,9].…”

“…The impact of surgery as documented on cervical spine imaging is closely related to patient prognosis, and spine stability and sagittal sequence balance affects cervical micromotor joint motion, which is key to postoperative symptom relief and maintenance. Fusion techniques can lead to Li et al Journal of Orthopaedic Surgery and Research (2024) 19:227 reduced range of motion of the cervical vertebral body, which significantly increases stress loading on adjacent segments and accelerates the progression of disc degeneration [16,36]. Postoperative ROM changes in adjacent segments in this study were less in the endoscopic group, whereas the ACDF group had a significantly increased change in ROM at 12 months postoperatively and at the last follow-up, with a statistically significant difference.…”

“…(1) Disc Height Index (DHI) Following the methodology of previous studies [16], The superior adjacent segment ROM (SROM) and the inferior adjacent segment ROM (IROM) were measured respectively using this method, as shown in Fig. 4B and C.…”