Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases

Abstract

The object of this study is to compare radiographic outcomes of anterior cervical decompression and fusion (ACDF) versus cervical disc replacement using the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) in terms of range of motion (ROM), Functional spinal unit (FSU), overall sagittal alignment (C2-C7), anterior intervertebral height (AIH), posterior intervertebral height (PIH) and radiographic changes at the implanted and adjacent levels. The study consisted of 105 patients. A total of 63 Bryan disc were placed in 51 patients. A single level procedure was performed in 39 patients and a two-level procedure in the other 12. Fifty-four patients underwent ACDF, 26 single level cases and 28 double level cases. The Bryan group had a mean follow-up 19 months (12-38). Mean follow-up for the ACDF group was 20 months (12-40 months). All patients were evaluated using static and dynamic cervical spine radiographs as well as MR imaging. All patients underwent anterior cervical discectomy followed by autogenous bone graft with plate (or implantation of a cage) or the Bryan artificial disc prosthesis. Clinical evaluation included the visual analogue scale (VAS), and neck disability index (NDI). Radiographic evaluation included static and dynamic flexion-extension radiographs using the computer software (Infinitt PiviewSTAR 5051) program. ROM, disc space angle, intervertebral height were measured at the operative site and adjacent levels. FSU and overall sagittal alignment (C2-C7) were also measured pre-operatively, postoperatively and at final follow-up. Radiological change was analyzed using chi(2) test (95% confidence interval). Other data were analyzed using the mixed model (SAS enterprises guide 4.1 versions). There was clinical improvement within each group in terms of VAS and NDI scores from pre-op to final follow-up but not significantly between the two groups for both single (VAS p=0.8371, NDI p=0.2872) and double (VAS p=0.2938, NDI p=0.6753) level surgeries. Overall, ROM and intervertebral height was relatively well maintained during the follow-up in the Bryan group compared to ACDF. Regardless of the number of levels operated on, significant differences were noted for overall ROM of the cervical spine (p<0.0001) and all other levels except at the upper adjacent level for single level surgeries (p=0.2872). Statistically significant (p<0.0001 and p=0.0172) differences in the trend of intervertebral height measurements between the two groups were noted at all levels except for the AIH of single level surgeries at the upper (p=0.1264) and lower (p=0.7598) adjacent levels as well as PIH for double level surgeries at the upper (p=0.8363) adjacent level. Radiological change was 3.5 times more observed for the ACDF group. Clinical status of both groups, regardless of the number of levels, showed improvement. Although clinical outcomes between the two groups were not significantly different at final follow-up, radiographic parameters, namely ROM and intervertebral heights at the operated site, some adja...

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

“…This pathophysiology of CSM determines that the relief of the anterior compression of the spinal cord is the most direct treatment of CSM. In the past few years, cervical motion preserved through implantation of artificial disc prosthesis has been proved to be an effective and safe alternative option in 1 and 2 level pathologies [10,17,23,39]. However, anterior cervical discectomy and fusion (ACDF) remains the gold standard in the surgical treatment of the patients with multilevel CSM, resulting in well established results and less complications [19,28,36].…”

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

“…Numerous methods, such as cage augmentation [23], bone substitutes, allograft, artificial replacement [24], and bone morphogenetic protein have been developed in an effort to avoid this complication. Cage characteristics depend on the composition of the cage.…”

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

“…In fact, just four separate research groups have carried out sizeable RCTs of cervical disc arthroplasty vs fusion, although their results have been presented in multiple publications addressing different subtopics within the same trials or by individual groups of authors participating in the multicentre studies [3,25,29,37,38,[44][45][46]. Collectively, these and one other small RCT [42] have shown statistically superior or comparable results for arthroplasty in relation to patient-rated outcomes such as the Neck Disability Index (NDI), neck and arm pain and quality of life (SF36).…”

“…Collectively, these and one other small RCT [42] have shown statistically superior or comparable results for arthroplasty in relation to patient-rated outcomes such as the Neck Disability Index (NDI), neck and arm pain and quality of life (SF36). The maintenance of segmental mobility with disc arthroplasty, expected to contribute to a reduced development of adjacent level change, has also been documented in three trials [29,38,44]. Although these studies possess the acknowledged scientific rigour of RCTs, they are not without their limitations.…”