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Singh R, Khan S, Ambade RE, Kanani K, Agrawal V, Patel SK. Revolutionizing Relief: Cervical Radiculopathy With Neurological Deficits Rescued by Cervical Disc Replacement. Cureus 2024; 16:e59923. [PMID: 38854171 PMCID: PMC11161573 DOI: 10.7759/cureus.59923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/05/2024] [Indexed: 06/11/2024] Open
Abstract
Cervical radiculopathy is a common condition characterized by neck pain radiating to the upper and lower limbs, often accompanied by tingling sensations, numbness, and weakness. We present the case of a 32-year-old male who presented with left-sided cervical radiculopathy and neurological deficits. Clinical examination revealed left C5/C6/C7 hypoesthesia, diminished grip strength, reduced power in the left upper and lower extremities, and a positive Spurling test. Magnetic resonance imaging (MRI) of the cervical spine revealed multilevel cervical disc herniations at C4-C5 and C5-C6 levels, resulting in stenosis. The patient underwent anterior cervical discectomies with artificial disc replacement (cervical disc arthroplasty (CDA)) at the C5-C6 level. The surgical procedure was uneventful, and the patient experienced prompt relief from neurological symptoms within two weeks postoperatively. Follow-up radiographs at one week post-surgery demonstrated a preserved range of motion at each operated level with the artificial disc in situ. This case highlights the successful management of cervical radiculopathy with neurological deficits using anterior cervical discectomy and artificial disc replacement. The timely intervention led to the resolution of symptoms and restoration of function, demonstrating the efficacy of this surgical approach in alleviating radicular symptoms and preserving cervical spine mobility. Further studies and long-term follow-up are warranted to validate the long-term outcomes and durability of artificial disc replacement in such cases.
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Affiliation(s)
- Rahul Singh
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sohael Khan
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ratnakar E Ambade
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kashyap Kanani
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vipul Agrawal
- Department of Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddharth K Patel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Arnautovic A, Mijares J, Begagić E, Ahmetspahić A, Pojskić M. Four-level ACDF surgical series 2000-2022: a systematic review of clinical and radiological outcomes and complications. Br J Neurosurg 2024:1-12. [PMID: 38606493 DOI: 10.1080/02688697.2024.2337020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The primary objective of this investigation is to systematically scrutinize extant surgical studies delineating Four-Level Anterior Cervical Discectomy and Fusion (4L ACDF), with a specific emphasis on elucidating reported surgical indications, clinical and radiological outcomes, fusion rates, lordosis correction, and the spectrum of complication rates. METHODS The literature review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing the MEDLINE (PubMed), Embase, and Scopus databases. This analysis encompasses studies implementing the 4L ACDF procedure, with detailed extraction of pertinent data pertaining to surgical methodologies, types of employed interbody cages, clinical and radiological endpoints, rates of fusion, and the incidence of complications. RESULTS Among the 15 studies satisfying inclusion criteria, a marginal increment in the year 2022 (21.4%) was discerned, with a preponderance of study representation emanating from China (35.7%) and the United States (28.6%). 50% of the studies were single-surgeon studies. Concerning follow-up, studies exhibited variability, with 42.9% concentrating on periods of five years or less, and an equivalent proportion extending beyond this timeframe. Across the amalgamated cohort of 2457 patients, males constituted 51.6%, manifesting a mean age range of 52.2-61.3 years. Indications for surgery included radiculopathy (26.9%) and myelopathy (46.9%), with a predilection for involvement at C3-7 (24.9%). Meta-analysis yielded an overall complication rate of 16.258% (CI 95%: 14.823%-17.772%). Dysphagia (4.563%), haematoma (1.525%), hoarseness (0.205%), C5 palsy (0.176%) were the most prevalent complications of 4L ACDF. Fusion rates ranging from 41.3% to 94% were documented. CONCLUSION The 4L ACDF is commonly performed to address mylopathy and radiculopathy. While the surgery carries a complication rate of around 16%, its effectiveness in achieving bone fusion can vary considerably.
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Affiliation(s)
- Alisa Arnautovic
- George Washington University School of Medicine, Washington, DC, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Mijares
- George Washington University School of Medicine, Washington, DC, USA
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Adi Ahmetspahić
- Department of Neurosurgery, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- School of Medicine, Josip Juraj Strossmayr University, Osijek, Croatia
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Muralidharan A, Gong D, Piche JD, Al-Saidi N, Hey HWD, Aleem I. Multilevel Cervical Disk Arthroplasty: Moving Beyond Two Levels. Clin Spine Surg 2023; 36:363-368. [PMID: 37684714 DOI: 10.1097/bsd.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Abstract
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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Affiliation(s)
| | - Davin Gong
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Joshua D Piche
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Neil Al-Saidi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | | | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
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Lee NJ, Lehman RA. Current Evidence for Hybrid Constructs: Simultaneous ACDF/Arthroplasty and Arthroplasty Adjacent to Previous ACDF. Clin Spine Surg 2023; 36:398-403. [PMID: 37752636 DOI: 10.1097/bsd.0000000000001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
It is not surprising that the utilization of hybrid constructs, combining cervical disc arthroplasty with anterior cervical disc arthroplasty, has steadily increased over the last decade. Known limitations exist with multi-level anterior cervical disc arthroplasty and cervical disc arthroplasty procedures. Hybrid surgery offers the possibility to address patient-specific pathology in a more tailored manner by restoring functional mobility and promoting fusion where appropriate. This review discusses the current evidence, both biomechanical and clinical, of hybrid surgery for 2-level and 3-level cervical disease.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
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Ko CC, Feng BK, Kuo YH, Kuo CH, Tu TH, Chang CC, Cheng H, Huang WC, Wu JC. Incidence and Risk Factor of Implant Dislocation After Cervical Disk Arthroplasty: A Retrospective Cohort Analysis of 756 Patients. Neurosurgery 2023; 93:330-338. [PMID: 36805569 DOI: 10.1227/neu.0000000000002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Implant dislocation after cervical disk arthroplasty (CDA) is obviously a critical complication, but no information about the incidence and associated risk factor has been reported. OBJECTIVE To investigate the incidence and risk factor of implant dislocation after CDA by a retrospective cohort analysis. METHODS A retrospective review of a consecutive series of CDA performed between January 2009 and March 2021 at a single institution was conducted. Analyses of chart records and radiological data established the incidence and associated risk factor of implant dislocation after CDA. A Kaplan-Meier survival estimation of implant survival was performed. RESULTS A total of 756 consecutive patients were included in this analysis. Five patients (0.7%) had a migration and even dropout of the artificial disk. The overall cumulative survival rate of the implant reached approximately 99.3% of the 756 patients. Preoperative kyphosis was significantly related to implant dislocation ( P = .016), with an odds ratio of 15.013. CONCLUSION The incidence of implant dislocation after CDA is as low as 0.7% or 5/756 patients. Preoperative kyphosis significantly increases the risk of postoperative implant dislocation by a factor of 15. The migrating implants could be revealed on radiographs as early as 0.9 to 1.4 months postoperatively and were revised to anterior cervical diskectomy and fusion within half a year. No new event of implant dislocation occurred half a year postoperatively. The overall cumulative survival rate of the implant reached 99.3% of the 756 patients. In conclusion, CDA remains a safe and reliable procedure.
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Affiliation(s)
- Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bo-Kai Feng
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tu TH, Wang CY, Chen YC, Wu JC. Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions. J Neurosurg Spine 2023; 38:372-381. [PMID: 36681966 DOI: 10.3171/2022.11.spine22880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
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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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Ching-Ying Wang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Yu-Chun Chen
- 2Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
- 4Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
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Geoghegan CE, Mohan S, Lynch CP, Cha EDK, Jacob KC, Patel MR, Prabhu MC, Vanjani NN, Pawlowski H, Singh K. Validation of Neck Disability Index Severity among Patients Receiving One or Two-Level Anterior Cervical Surgery. Asian Spine J 2023; 17:86-95. [PMID: 35527536 PMCID: PMC9977990 DOI: 10.31616/asj.2021.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. PURPOSE To evaluate the validity of established severity thresholds for Neck Disability Index (NDI) among patients undergoing anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA). OVERVIEW OF LITERATURE Few studies have examined the validity of established NDI threshold values among patients undergoing ACDF or CDA. METHODS A surgical database was reviewed to identify patients undergoing cervical spine procedures. Demographics, operative characteristics, comorbidities, NDI, Visual Analog Scale (VAS), and 12-item Short Form (SF-12) physical and mental composite scores (PCS and MCS) were recorded. NDI severity was categorized using previously established threshold values. Improvement from preoperative scores at each postoperative timepoint and convergent validity of NDI was evaluated. Discriminant validity of NDI was evaluated against VAS neck and arm and SF-12 PCS and MCS. RESULTS All 290 patients included in the study demonstrated significant improvements from baseline values for all patient-reported outcome measures (PROMs) at all postoperative timepoints (p<0.001) except SF-12 MCS at 2 years (p =0.393). NDI showed a moderate- to-strong correlation (r≥0.419) at most timepoints for VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS (p<0.001, all). NDI severity categories demonstrated significant differences in mean VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS at all timepoints (p<0.001, all). Differences between NDI severity groups were not uniform for all PROMs. VAS neck values demonstrated significant intergroup differences at most timepoints, whereas SF-12 MCS showed significantly different values between most severity groups. CONCLUSIONS Neck disability is strongly correlated with neck and arm pain, physical function, and mental health and demonstrates worse outcomes with increasing severity. Previously established severity categories may be more applicable to pain than physical function or mental health and may be more uniformly applied preoperatively for cervical spine patients.
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Affiliation(s)
- Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Wang Z, Luo G, Yu H, Zhao H, Li T, Yang H, Sun T. Comparison of discover cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical degenerative disc diseases: A meta-analysis of prospective, randomized controlled trials. Front Surg 2023; 10:1124423. [PMID: 36896262 PMCID: PMC9989026 DOI: 10.3389/fsurg.2023.1124423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Objective This study aims to evaluate the clinical efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) in Cervical degenerative disc diseases. Methods Two researchers independently conducted a search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails (CENTRAL) for randomized controlled trials (RCTs) following the Cochrane methodology guidelines. A fixed-effects or random-effects model was applied based on different heterogeneity. Review Manager (Version 5.4.1) software was used to perform data analysis. Results A total of 8 RCT studies were included in this meta-analysis. The results indicate that the DCDA group had a higher incidence of reoperation (P = 0.03) and a lower incidence of ASD (P = 0.04) than the CDA group. There was no significant difference between two groups regarding NDI score (P = 0.36), VAS ARM score (P = 0.73), VAS NECK score (P = 0.63), EQ-5D score (P = 0.61) and dysphagia incidence (0.18). Conclusion DCDA and ACDF have similar results in terms of NDI scores, VAS scores, EQ-5D scores, and dysphagia. In addition, DCDA can reduce the risk of ASD but increases the risk of reoperation.
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Affiliation(s)
- Ziqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Gan Luo
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Hongwei Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Hui Zhao
- School of Medicine, Nankai University, Tianjin, China
| | - Tianhao Li
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Houzhi Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Tianwei Sun
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
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Schupper AJ, Steinberger J, Gologorsky Y. Multilevel Cervical Arthroplasty: Expanding Indications. World Neurosurg 2022; 164:116. [PMID: 35460905 DOI: 10.1016/j.wneu.2022.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yakov Gologorsky
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Alves ÓL. Cervical Total Disc Replacement: Expanded Indications. Neurosurg Clin N Am 2021; 32:437-448. [PMID: 34538470 DOI: 10.1016/j.nec.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical total disc replacement (cTDR) is now a firm alternative to anterior cervical discectomy and fusion (ACDF) for degenerative disc disease (DDD). Robust level 1 data from Federal Drug Administration-approved clinical trials demonstrated that cTDR is in any case equally safe and effective compared with ACDF for 1- or 2-level DDD. Furthermore, from early postoperative to long-term follow-up of 10 to 15 years, cTDR rates superiorly in many primary clinical outcomes. According to the published literature, at least nine different cTDR devices share this consistent pattern. On the other hand, the surgical treatment of more than 2-level disc disease is haunted by an elusive paradox. It is easily understandable that 3- and 4-level ACDF, with the well-known associated limitations, is not the superlative intervention for a spine segment anatomically designed to provide motion, as cervical spine is. Furthermore, multilevel ACDF exacerbates many of the clinical and biomechanical complications related with single-level fusion. However, as cTDR is not immaculate of constraints and failures, its clinical safety and efficacy and cost-effectiveness in multilevel anterior compressive pathology need to be established. This article analyses the current available evidence supporting the expanded indication of cTDR to 3- and 4-level disc disease, either stand-alone or adjacent to fusion, from a less stringent European perspective.
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Affiliation(s)
- Óscar L Alves
- Hospital Lusíadas Porto; Centro Hospitalar de Gaia/Espinho, Rua Cónego Ferreira Pinto, 191, 4050-256 Porto, Portugal.
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Lee CY, Wu CL, Chang HK, Wu JC, Huang WC, Cheng H, Tu TH. Cervical disc arthroplasty for Klippel-Feil syndrome. Clin Neurol Neurosurg 2021; 209:106934. [PMID: 34543827 DOI: 10.1016/j.clineuro.2021.106934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Klippel-Feil syndrome (KFS) is a congenital musculoskeletal condition characterized by improper segmentation of the cervical spine. This study aimed to evaluate outcomes of KFS patients who underwent cervical disc arthroplasty (CDA). METHODS Consecutive patients who underwent anterior cervical surgery were retrospectively reviewed. Those patients with KFS who received discectomy adjacent to the congenitally fused vertebral segments were extracted and grouped into either the fusion or the CDA group. Clinical and radiological evaluations included visual analog scales, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, C2-7 range of motion (ROM), C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), and T1-slope. RESULTS Among 2320 patients, there were 41 with KFS (prevalence = 1.77%), who were younger than the entire cohort (53.3 vs 56.4 years). Thirty KFS patients had adjacent discs and were grouped into the CDA and fusion groups (14 vs 16). Type-I KFS with C3-4 involvement was the most common for both groups (92.8% vs 81.2% with 57% vs 50%, respectively). Post-operation, both groups demonstrated improvement of all the patient reported outcomes. The C2-7 ROM significantly decreased in the fusion group than that of pre-operation (12.8 ± 6° vs 28.1 ± 11.5°). In contrast, the CDA group successfully preserved C2-7 and segmental ROM without additional complications. CONCLUSIONS KFS is rare (prevalence = 1.77%) among cervical spine surgery patients, and it rarely affects the overall cervical spinal alignment, except that it decreases segmental mobility. CDA is a feasible option for KFS because it not only avoids long-segment fusion but also preserves segmental and global mobility.
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Affiliation(s)
- Chu-Yi Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ching-Lan Wu
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
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Fiani B, Nanney JM, Villait A, Sekhon M, Doan T. Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty. Cureus 2021; 13:e16739. [PMID: 34513367 PMCID: PMC8405360 DOI: 10.7759/cureus.16739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
Spinal disc arthroplasty (SDA) has been a rising alternative to fusion for the treatment of degenerative disc disease (DDD). This review aims to provide an overview of the timeline, approvals, and limitations of SDA through analysis of U.S. Food and Drug Administration (FDA)-approved trials. Clinical studies have shown more successful outcomes when comparing cervical disc arthroplasty (CDA) with anterior cervical decompression and fusion, with the key benefits of decreased risk of nerve root compression and adjacent disc disease. CDA is currently approved by the FDA for one- and two-level disc pathologies. However, there are no approved trials for three-level or more cervical pathologies. The FDA approved its usage for the treatment of one-level lumbar disc pathologies in 2007 and recently approved two-level disc pathologies in 2020. Thoracic SDA has not been approved by the FDA, and there are no currently occurring clinical trials. While multilevel SDA has been approved in the cervical and lumbar spine, it has not been approved in more than two adjacent vertebral levels. Based on these clinical studies, future research is needed to compare the success of SDA for three-level or more disc pathologies. There have been recent publications showing promising results, though no FDA-approved clinical trials exist. Furthermore, a hybrid construct has been a recent surgical method to treat multilevel DDD. In this approach, arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels to treat two- and three-level disc disease. Hybrid arthroplasty compared with SDA is currently being studied in clinical trials. As such, long-term research with FDA-approved clinical trials is needed to understand the benefits and limitations of different approaches in the treatment of DDD.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Jacob M Nanney
- College of Medicine, University of Kentucky, Lexington, USA
| | - Akash Villait
- Osteopathic Medicine, Midwestern University Arizona College of Osteopathic Medicine, Glendale, USA
| | - Manraj Sekhon
- Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Thao Doan
- School of Medicine, University of Texas Medical Branch, Galveston, USA
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Hsu CH, Kuo YH, Kuo CH, Ko CC, Wu JC, Huang WC. Late complication of cervical disc arthroplasty: heterotopic ossification causing myelopathy after 10 years. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21351. [PMID: 35855090 PMCID: PMC9265189 DOI: 10.3171/case21351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) is a well-documented complication of cervical disc arthroplasty (CDA), although it rarely causes adverse clinical effects. Despite high-grade HO possibly limiting segmental mobility, it is reportedly seldom associated with symptoms. OBSERVATIONS The authors report a case of a 46-year-old male patient who underwent hybrid CDA and anterior cervical discectomy and fusion for 3-level cervical disc herniation that caused myeloradiculopathy. The surgery was successful; the patient experienced nearly complete recovery postoperatively. The follow-up images, including computed tomography and magnetic resonance imaging scans, showed satisfactory decompression at the indexed levels without residual osteophytes or ossification of the posterior longitudinal ligament. However, 10 years later, the patient presented with symptomatic compressive myelopathy caused by severe HO that prompted a secondary surgery. LESSONS Although it is generally reported in the literature that HO is clinically innocuous, in this patient, it gradually and progressively developed and caused myelopathy, requiring a secondary surgery. Symptomatic HO can be expected over time, and patients with a high risk of HO deserve long-term follow-up after CDA. Further investigations are warranted to corroborate these risk factors, including multilevel calcified disc herniation, severe spondylosis, and suboptimal placement of the device during primary CDA surgery.
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Affiliation(s)
- Che-Han Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
- Institute of Biomedical Informatics, and
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and
- School of Medicine
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Ku J, Ku J, Chang HK, Wu JC. Cervical disc arthroplasty at C2–3: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21320. [PMID: 36131581 PMCID: PMC9563647 DOI: 10.3171/case21320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation.
OBSERVATIONS
In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level.
LESSONS
To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.
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Affiliation(s)
- Jason Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Johnson Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Department of Biomedical Imaging and Radiological Sciences, and
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Wang H, Meng Y, Liu H, Wang X, Hong Y. The impact of smoking on outcomes following anterior cervical fusion-nonfusion hybrid surgery: a retrospective single-center cohort study. BMC Musculoskelet Disord 2021; 22:612. [PMID: 34243728 PMCID: PMC8272305 DOI: 10.1186/s12891-021-04501-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is mixed evidence for the impact of cigarette smoking on outcomes following anterior cervical surgery. It has been reported to have a negative impact on healing after multilevel anterior cervical discectomy and fusion, however, segmental mobility has been suggested to be superior in smokers who underwent one- or two-level cervical disc replacement. Hybrid surgery, including anterior cervical discectomy and fusion and cervical disc replacement, has emerged as an alternative procedure for multilevel cervical degenerative disc disease. This study aimed to examine the impact of smoking on intermediate-term outcomes following hybrid surgery. METHODS Radiographical and clinical outcomes of 153 patients who had undergone continuous two- or three-level hybrid surgery were followed-up to a minimum of 2-years post-operatively. The early fusion effect, 1-year fusion rate, the incidence of bone loss and heterotopic ossification, as well as the clinical outcomes were compared across three smoking status groups: (1) current smokers; (2) former smokers; (3) nonsmokers. RESULTS Clinical outcomes were comparable among the three groups. However, the current smoking group had a poorer early fusion effect and 1-year fusion rate (P < 0.001 and P < 0.035 respectively). Both gender and smoking status were considered as key factors for 1-year fusion rate. Upon multivariable analysis, male gender (OR = 6.664, 95% CI: 1.248-35.581, P = 0.026) and current smoking status (OR = 0.009, 95% CI: 0.020-0.411, P = 0.002) were significantly associated with 1-year fusion rate. A subgroup analysis demonstrated statistically significant differences in both early fusion process (P < 0.001) and the 1-year fusion rate (P = 0.006) across the three smoking status groups in female patients. Finally, non-smoking status appeared to be protective against bone loss (OR = 0.427, 95% CI: 0.192-0.947, P = 0.036), with these patients likely to have at least one grade lower bone loss than current smokers. CONCLUSIONS Smoking is associated with poor outcomes following hybrid surgery for multilevel cervical disc disease. Current smokers had the poorest fusion rate and most bone loss, but no statistically significant differences were seen in clinical outcomes across the three groups.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China.
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Sichuan, China.,West China School of Nursing, West China Hospital, Sichuan University, Sichuan, China
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Wang H, Meng Y, Liu H, Wang X, Ding C. A Comparison of 2 Anterior Hybrid Techniques for 3-Level Cervical Degenerative Disc Disease. Med Sci Monit 2020; 26:e927972. [PMID: 33154343 PMCID: PMC7653971 DOI: 10.12659/msm.927972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Novel hybrid surgical techniques that incorporate anterior cervical discectomy and fusion with total disc replacement are widely used. Based on the number of implanted discs, 3-level hybrid surgery can be classified as single fusion combined with double replacement and single replacement combined with double fusion. Few studies to date have directly compared these hybrid techniques. The present study compared the clinical and radiological outcomes of these methods and assessed their characteristics and benefits. Material/Methods Clinical and radiological outcomes were retrospectively evaluated in 64 consecutive patients who underwent 3-level hybrid surgery by single fusion combined with double replacement or single replacement combined with double fusion. Results Significant differences between the 2 groups were observed in postoperative range of motion of C2–C7. C2–C7 cervical lordosis assessed preoperatively and at final follow-up differed significantly in patients who underwent single replacement combined with double fusion. This group showed a higher incidence of heterotopic ossification than patients who underwent double replacement combined with single fusion. Conclusions Both types of hybrid surgery are safe and effective in treating 3-level cervical degenerative disc diseases. Single replacement combined with double fusion showed greater accuracy in correcting cervical lordosis, but was associated with a higher incidence of heterotopic ossification. In contrast, single fusion combined with double replacement was superior in maintaining cervical range of motion.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Chen Ding
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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Wang H, Huang K, Liu H, Meng Y, Wang X, Ding C, Hong Y. Is Cervical Disc Replacement Valuable in 3-Level Hybrid Surgery Compared with 3-Level Anterior Cervical Discectomy and Fusion? World Neurosurg 2020; 146:e151-e160. [PMID: 33075576 DOI: 10.1016/j.wneu.2020.10.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cervical degenerative disc disease is common in clinical practice. Surgery is among the most effective treatments for patients with cervical radiculopathy, myelopathy, or stenosis. Which treatment is the best option for multilevel cervical degenerative disc disease is controversial. Hybrid surgery, combined cervical disc replacement and anterior cervical discectomy and fusion, may be an alternative treatment for multilevel cervical degenerative disc disease. METHODS Sixty-four patients with 3-level hybrid surgery and 37 patients with 3-level anterior cervical discectomy and fusion were reviewed retrospectively. Clinical outcomes were based on visual analog scale, Neck Disability Index, 36-Item Short Form Survey, and Japanese Orthopaedic Association scores and Japanese Orthopaedic Association recovery rate. Radiologic assessments included range of motion (ROM) of C2-C7 and adjacent level and cervical lordosis of C2-C7. Perioperative parameters, fusion condition, and complications were assessed. RESULTS There were no statistical differences observed between the 2 groups for Japanese Orthopaedic Association, Neck Disability Index, or visual analog scale scores. The hybrid surgery group had better physical and mental 36-Item Short Form Survey scores than the fusion group at 1-year follow-up (physical component summary: 49.34 vs. 46.70, P = 0.012; mental component summary: 45.67 vs. 43.95, P = 0.004). ROM of C2-C7 and adjacent levels was less compromised in the hybrid group compared with baseline (64.60% vs. 51.34%, P < 0.001). Cervical lordosis was decreased with time in both groups but was acceptable at final follow-up, and both groups showed solid fusion. CONCLUSIONS Normal ROM and solid fusion were achieved at both arthroplasty and arthrodesis levels. ROM of replacement levels in different locations of the 3-level construct was acceptable.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kangkang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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