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J Neurol Surg A Cent Eur Neurosurg 2016; 77(04): 300-307
DOI: 10.1055/s-0035-1567861
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Dynamic Cervical Implant versus Anterior Cervical Diskectomy and Fusion: A Prospective Study of Clinical and Radiologic Outcome

Heiko Richter
1   Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
Martin Seule
1   Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
Gerhard Hildebrandt
1   Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
Jean-Yves Fournier
1   Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
› Author Affiliations
Further Information

Publication History

20 May 2014

14 September 2015

Publication Date:
18 April 2016 (online)

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Abstract

Objective To evaluate clinical and radiologic outcome in patients treated with a dynamic cervical implant (DCI) or anterior cervical diskectomy and fusion (ACDF).

Study Design A prospective comparative cohort study.

Methods The study included 60 patients with one- or two-level cervical degenerative disk disease (DDD) undergoing treatment with either DCI (n = 30) or ACDF (n = 30). Clinical and radiologic outcomes were assessed 3 and 12 months after surgery. Clinical scoring systems included the Visual Analog Scale for Neck (VAS-N) and Arm pain (VAS-A), the Neck Pain and Disability Scale (NPAD), and the European Quality of Life Scale (EQ-5D).

Results Both the DCI and ACDF group showed significant clinical improvement 12 months after surgery using the VAS-N (p = 0.034 and p < 0.001, respectively), VAS-A (p < 0.001 and p < 0.001, respectively), NPAD (p < 0.001 and p < 0.001, respectively), and EQ-5D (p < 0.001 and p < 0.001, respectively). There were no significant differences in clinical outcome comparing both groups at the 3- and 12-month follow-up. The fusion rate at 12 months after surgery was 39.4% and 80.0% in the DCI and ACDF groups, respectively. Radiolucency was found in 90.9% in the DCI group at 12-month follow-up.

Conclusion The clinical results for DCI treatment are equivalent to those for ACDF in the treatment of one- and two-level cervical DDD at 12 months after surgery. Further studies are necessary to investigate the high rates of radiolucency and fusion associated with DCI treatment.

Keywords

dynamic cervical implant - anterior cervical diskectomy and fusion - cervical spine - adjacent segment disease - cervical disk arthroplasty
 

  • References

  • 1 Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa Jr FP. Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine 2006; 31 (8) 897-902
    CrossrefPubMedSearch in Google Scholar
  • 2 Lee CH, Hyun SJ, Kim MJ , et al. Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech 2013; 26 (2) 112-118
    CrossrefPubMedSearch in Google Scholar
  • 3 Delamarter RB, Zigler J. Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine 2013; 38 (9) 711-717
    CrossrefPubMedSearch in Google Scholar
  • 4 McAfee PC, Reah C, Gilder K, Eisermann L, Cunningham B. A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from 4 prospective multicenter randomized clinical trials and up to 1226 patients. Spine 2012; 37 (11) 943-952
    CrossrefPubMedSearch in Google Scholar
  • 5 Seo M, Choi D. Adjacent segment disease after fusion for cervical spondylosis; myth or reality?. Br J Neurosurg 2008; 22 (2) 195-199
    CrossrefPubMedSearch in Google Scholar
  • 6 Lee SH, Im YJ, Kim KT, Kim YH, Park WM, Kim K. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine 2011; 36 (9) 700-708
    CrossrefPubMedSearch in Google Scholar
  • 7 Chang UK, Kim DH, Lee MC, Willenberg R, Kim SH, Lim J. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 2007; 7 (1) 33-39
    CrossrefPubMedSearch in Google Scholar
  • 8 Welke B, Hurschler C, Packheiser A , et al. Biomechanical concept of a novel dynamic cervical implant: first biomechanical comparison among fusion, TDR and dynamic stabilization. Eur Spine J 2010; 19: 1963-2073
    CrossrefPubMedSearch in Google Scholar
  • 9 Welke B, Hurschler C, Schwarze M , et al. Biomechanical comparison between fusion, TDR and dynamic stabilization. Eur Spine J 2011; 20: 1979-2066
    CrossrefPubMedSearch in Google Scholar
  • 10 Mo ZJ, Zhao YB, Wang LZ, Sun Y, Zhang M, Fan YB. Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue. Eur Spine J 2014; 23 (3) 613-621
    CrossrefPubMedSearch in Google Scholar
  • 11 Li Z, Yu S, Zhao Y , et al. Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease. J Clin Neurosci 2014; 21 (6) 942-948
    CrossrefPubMedSearch in Google Scholar
  • 12 Wang L, Song YM, Liu LM, Liu H, Li T. Clinical and radiographic outcomes of dynamic cervical implant replacement for treatment of single-level degenerative cervical disc disease: a 24-month follow-up. Eur Spine J 2014; 23 (8) 1680-1687
    CrossrefPubMedSearch in Google Scholar
  • 13 Phillips FM, Carlson G, Emery SE, Bohlman HH. Anterior cervical pseudarthrosis. Natural history and treatment. Spine 1997; 22 (14) 1585-1589
    CrossrefPubMedSearch in Google Scholar
  • 14 Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999; 81 (4) 519-528
    CrossrefPubMedSearch in Google Scholar
  • 15 Bremerich FH, Grob D, Dvorak J, Mannion AF. The Neck Pain and Disability Scale: cross-cultural adaptation into German and evaluation of its psychometric properties in chronic neck pain and C1-2 fusion patients. Spine 2008; 33 (9) 1018-1027
    CrossrefPubMedSearch in Google Scholar
  • 16 Greiner W, Claes C, Busschbach JJV, von der Schulenburg JM. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 2005; 6 (2) 124-130
    CrossrefPubMedSearch in Google Scholar
  • 17 EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (3) 199-208
    CrossrefPubMedSearch in Google Scholar
  • 18 Schluessmann E, Aghayev E, Staub L, Moulin P, Zweig T, Röder C ; SWISSspine Registry Group. SWISSspine: the case of a governmentally required HTA-registry for total disc arthroplasty: results of cervical disc prostheses. Spine 2010; 35 (24) E1397-E1405
    CrossrefPubMedSearch in Google Scholar
  • 19 Herdmann J, Buddenberg P, Rhee S , et al. A dynamic cervical disc replacement--in between fusion and prosthesis. Eur Spine J 2009; 18: 1713-1826
    CrossrefPubMedSearch in Google Scholar
  • 20 Herdmann J, Buddenberg P, Pilz A , et al. Can dynamic cervical disc replacement compete with to ACDF?. Eur Spine J 2010; 19: 1963-2073
    CrossrefPubMedSearch in Google Scholar
  • 21 Matgé G, Eif M, Herdmann J. Dynamic cervical implant (DCITM): clinical results from an international multicenter prospective study. Paradigm Spine 2015; 1: 1-3
    PubMedSearch in Google Scholar
  • 22 Auerbach JD, Anakwenze OA, Milby AH, Lonner BS, Balderston RA. Segmental contribution toward total cervical range of motion: a comparison of cervical disc arthroplasty and fusion. Spine 2011; 36 (25) E1593-E1599
    CrossrefPubMedSearch in Google Scholar
  • 23 Jaumard NV, Bauman JA, Guarino BB , et al. ProDisc cervical arthroplasty does not alter facet joint contact pressure during lateral bending or axial torsion. Spine 2013; 38 (2) E84-E93
    CrossrefPubMedSearch in Google Scholar
  • 24 Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T. Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects. Eur Spine J 2012; 21 (8) 1492-1498
    CrossrefPubMedSearch in Google Scholar
  • 25 Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up. J Spinal Disord Tech 2010; 23 (6) 367-371
    CrossrefPubMedSearch in Google Scholar
  • 26 Cunningham BW, Hu N, Zorn CM, McAfee PC. Comparative fixation methods of cervical disc arthroplasty versus conventional methods of anterior cervical arthrodesis: serration, teeth, keels, or screws?. J Neurosurg Spine 2010; 12 (2) 214-220
    CrossrefPubMedSearch in Google Scholar
  • 27 Herdmann J, Buddenberg P, Pilz A , et al. Life quality after cervical reconstruction with dynamic cervical implant. Eur Spine J 2011; 20: 1979-2066
    CrossrefPubMedSearch in Google Scholar