Current Concepts of Cervical Disc Arthroplasty David
1 Turkov ,
Alan Job
1Donald
1 MD ,
Rohit B Verma
Results/Conclusion Disc/Study
Mean blood loss Surgical time
(cc)
Reduction in
Reduction in
NDI (%)
VAS neck pain arm pain (cm)
ProDisc-C
83.5
Reduction in VAS
Rates of
ASD (%)
reoperation (%)
Results/Conclusion A
(cm)
(Min)
107 32.5
4.6
4.3
1.90
=
(n=106) ACDF
63.5
98.7 31.7
4.3
4.4
8.50
= 41.50
B
C
(n=103) Mobi-C
=
=
36.5
5.4
5.6
4.00
=
=
28.5
4.8
5.3
15.20 85.90
(n=225) ACDF (n=105) M6-C
Figure 3: A: Mobi-C Disc, B: M6-C Disc, C: ProDisc C
31
81
41.8
5.9
6.9
0.00
=
(n=83)
Figure 2: Summary comparing values from 3 different FDA IDE studies (data is missing where unavailable). The results from the review conclude that CDA with any of the FDA approved devices on the market have an equivalent or improved clinical outcome when compared with ACDF, with improved patient reported neck disability indexes (NDI) and VAS neck pain scale. CDA has a lower rate of dysphagia, ASD, and pseudoarthrosis with lower rates of reoperation when compared to ACDF. The data suggests there is no increased rate of reoperation in patients treated with multilevel CDA vs ACDF. In addition, the data from the limited clinical trials suggests that Hybrid CDA and ACDF is safe and decreases risk of ASD. However, the data is
Methods
Figure 1: Hybrid construct of anterior cervical discectomy and fusion (ACDF) adjacent to cervical disc arthroplasty (CDA)
1 MD
and Barbara Zucker School of Medicine at Hofstra/Northwell
Background Anterior cervical discectomy and fusion (ACDF) is the gold standard procedure for surgical management of cervical radiculopathy and myelopathy. ACDF is highly effective in relieving cervical pain, but with fusions being performed at an increased rate and on younger populations, there has been growing concern over the risk of developing adjacent segment disease (ASD) and its associated symptomatic changes. A motion preserving alternative to ACDF, which has been gaining popularity in recent years, is cervical disc arthroplasty (CDA) which involves removing the intervertebral disc and replacing it with an artificial disc that mimics the natural spine biomechanics. The artificial cervical discs have been changing rapidly since their introduction in 1966. Newer discs have better post-surgical outcomes than before. However, the data is not summarized well. We examine the safety, efficacy, and related complications associated with the devices on the market today. In addition, we will look at long-term postoperative outcomes between CDA, ACDF, and hybrid surgical interventions.
Cesar Iturriaga
1 DO ,
A search was performed utilizing databases such as PubMed, Google Scholar, and Clinical Key to identify articles on one-level, two-level, and hybrid approaches to CDA. The articles were reviewed by two authors for relevance and power, with higher emphasis placed on FDA IDE trials.
Future Direction
The current literature suggests that CDA is safe, effective, and has similar or improved clinical outcomes when compared to ACDF, however, there is insufficient studies to show the longterm outcomes. More evidence is needed for multilevel CDA since much of the data is not of high quality. In addition, a study comparing multilevel CDA vs. ACDF vs. the Hybrid approach in the treatment of multilevel degenerative disc disease is needed. The data supporting the efficacy of the M6C disc may also be strengthened by performing an additional prospective investigation with a larger population size and by including an ACDF control group to compare the rates of ASD and the long-term clinical outcomes. The ultimate goal of CDA is to have a single surgical intervention that would decrease any future complications and associated reoperations and to use CDA in patients with multilevel spondylitic changes.
Resources 1. Lauryssen C, Coric D, Dimmig T, Musante D, Ohnmeiss DD, Stubbs HA. Cervical total disc replacement using a novel compressible prosthesis: Results from a prospective Food and Drug Administration-regulated feasibility study with 24-month follow-up. International Journal of Spine Surgery. 2012;6(1):71-77. doi:10.1016/j.ijsp.2012.02.001