Comparison of Fusion versus Nonunion After 4-Level and 5-Level Anterior Cervical Diskectomy and Fusion With Anterior Plate Fixation

Bakare, Adewale A.; Smitherman, Adam D.; Fontes, Ricardo B. V.; O’Toole, John E.; Deutsch, Harel; Traynelis, Vincent C.

doi:10.1227/neu.0000000000002108

Cited by 3 publications

(4 citation statements)

References 25 publications

(70 reference statements)

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“…didates for CDA. [45][46][47] Due to arthrodesis-related consequences, 22,39,[48][49][50][51] multilevel CDA is particularly appealing for young patients with multilevel cervical spondylotic myelopathy caused by disc-related problems or congenital stenosis. Chang et al 1 reported a retrospective series of 37 patients younger than 50 years with cervical myelopathy who were treated with either hybrid CDA-ACDF (2-level CDA plus 1-level ACDF, 20 patients) or 3-level ACDF (17 patients).…”

Section: Figmentioning

confidence: 99%

“…20,21 Even with the most advanced instrumentation and biologics, multilevel ACDF is inevitably plagued-at least for some patients-with pseudarthrosis, loss of neck motion, and increased risk of ASD. 22,23 These issues are likely to be more prominent as the constructs get longer. Thus, CDA has emerged as an ideal alternative in these clinical scenarios, with the benefit of obviating fusion and preserving motion to improve the postoperative quality of life in patients with multilevel disc pathology.…”

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confidence: 99%

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Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA—with low rates of complications—has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF–CDA according to individual evaluation for each level of degeneration.

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Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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“…With the increasing prevalence of multilevel cervical degenerative disease, ACDF remains the more common treatment approach once a patient has been directed toward surgical management. There are significant complications with ACDF as the length of the fusion construct increases, including a higher rate of pseudoarthrosis and ASD, as well as a greater degree of motion loss 6–8 . Given that these issues are more prominent with longer constructs, there has been a justifiable interest in exploring CDA as a potential alternative.…”

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confidence: 99%

Multilevel Cervical Disk Arthroplasty

Muralidharan,

Gong,

Piche

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Cervical disk arthroplasty (CDA) is well-studied for 1-level and 2-level cervical pathology. There is an increasing trend towards its utilization for greater than 2-level disease as an alternative to the gold standard, anterior cervical discectomy and fusion (ACDF). The number of high-level, prospective studies or randomized trials regarding multilevel CDA is limited but continues to grow as the procedure gains popularity. In appropriately indicated patients with multilevel disease caused by disk herniations or spondylosis without extensive facet arthropathy, CDA shows promising results. Multilevel CDA should be avoided in patients with prior spinal trauma, significant degenerative spondylolisthesis with translation, arthrodesis without mobility, severely incompetent facet joints, ossification of the posterior longitudinal ligament, or kyphotic deformity. With overall similar risk profiles to ACDF but lower theoretical rates of pseudarthrosis and adjacent segment disease, multilevel CDA has been shown to preserve, or perhaps even increase, preoperative cervical range of motion. There are negligible differences in postoperative neck and arm pain, VAS scores, modified Japanese Orthopaedic Association scores, and Neck Disability Index scores when comparing multilevel CDA and ACDF. Despite current indications for multilevel CDA largely being based on single and 2-level data, careful patient selection is critical. Expansion of indications can be expected as literature continues to emerge regarding outcomes and complications in multilevel CDA, as well as with improvements in prosthesis design.

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“…In the article appearing in volume 91, pages 764-774 of Neurosurgery , entitled “Comparison of Fusion versus Nonunion After 4-Level and 5-Level Anterior Cervical Diskectomy and Fusion With Anterior Plate Fixation,” 1 Figure 3 was included in error.…”

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confidence: 99%