Single-Level Cervical Arthroplasty with a Keel-less Prosthesis: Results in a Series of 35 Patients Operated on for Soft Disk Herniation with a Minimum of 3 Years of Follow-Up

Abstract

Background Cervical arthroplasty with artificial cervical disks has gained popularity as an alternative to anterior discectomy and fusion. The main advantages of disk arthroplasty include maintenance of the range of movement, restitution of disk height and spinal alignment, and reduction of adjacent segment degeneration (ASD). In this article, we aimed to assess the outcomes of the use of a keel-less prosthesis.

Material and Methods We included all the patients who underwent single-level cervical arthroplasties with the Discocerv Cervidisc Evolution for “soft” disk herniation. Clinical assessment included Neck Disability Index (NDI) and visual analog scale (VAS) for neck and arm pain. Radiologic studies investigated the occurrence of ASD and system failure or subsidence. The reoperation rate was also recorded.

Results The study included 35 patients (14 men and 21 women; mean age: 42.5 years; mean follow-up: 57.8 months). There was a significant decrease in VAS neck and VAS arm scores, which went from 7.2 and 6.9 preoperatively to 2.2 and 1.7 postoperatively, 2.2 and 1.6 at 6 months, 2.0 and 1.8 at 1 year, and 2.1 and 1.3 at the last follow-up, respectively. The mean NDI score was 58.0 preoperatively, 19.4 postoperatively, 17.0 at 6 months, 16.1 at 1 year, and 16.2 at the last follow-up. Radiologic studies revealed a preserved range of motion in 33 of 35 patients. No ASD occurred and no reoperation was required.

Conclusions Cervical disk arthroplasty with a keel-less prosthesis can be a safe and effective alternative to fusion for degenerative disk disease in selected patients, with a possible reduction of ASD.

Keywords

Discocerv - cervical arthroplasty - disk prosthesis - disk replacement - cervical herniation

Publication History

Received: 20 May 2020

Accepted: 22 September 2020

Article published online:
27 May 2021

• References

• 1 Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W. Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J 2012; 21 (08) 1648-1659
• 2 Tasiou A, Giannis T, Brotis AG. et al. Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg 2017; 3 (03) 444-459
• 3 Elsawaf A, Mastronardi L, Roperto R, Bozzao A, Caroli M, Ferrante L. Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages. Neurosurg Rev 2009; 32 (02) 215-224 , discussion 224
• 4 Yang JY, Song HS, Lee M, Bohlman HH, Riew KD. Adjacent level ossification development after anterior cervical fusion without plate fixation. Spine 2009; 34 (01) 30-33
• 5 Litrico S, Lonjon N, Riouallon G. et al; French Society of Spine Surgery (SFCR). Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up. Orthop Traumatol Surg Res 2014; 100 (6, Suppl): S305-S309
• 6 Hilibrand ASCG, 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 (04) 519-528
• 7 Butler JSMP, Morrissey PB, Wagner SC. et al. Surgical strategies to prevent adjacent segment disease in the cervical spine. Clin Spine Surg 2019; 32 (03) 91-97
• 8 Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 2002; 96 (1, Suppl): 17-21
• 9 Phillips FM, Geisler FH, Gilder KM, Reah C, Howell KM, McAfee PC. Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine 2015; 40 (10) 674-683
• 10 Hisey MS, Zigler JE, Jackson R. et al. Prospective, randomized comparison of one-level Mobi-C cervical total disc replacement vs. anterior cervical discectomy and fusion: results at 5-year follow-up. Int J Spine Surg 2016; 10 (10) 10
• 11 Sun Y, Zhao YB, Pan SF, Zhou FF, Chen ZQ, Liu ZJ. Comparison of adjacent segment degeneration five years after single level cervical fusion and cervical arthroplasty: a retrospective controlled study. Chin Med J (Engl) 2012; 125 (22) 3939-3941
• 12 Davis RJ, Nunley PD, Kim KD. et al. Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine 2015; 22 (01) 15-25
• 13 Coric D, Nunley PD, Guyer RD. et al. Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article. J Neurosurg Spine 2011; 15 (04) 348-358
• 14 Luo CA, Kaliya-Perumal AK, Lu ML, Chen LH, Chen WJ, Niu CC. Staged surgery for tandem cervical and lumbar spinal stenosis: which should be treated first?. Eur Spine J 2019; 28 (01) 61-68
• 15 Ramadan A, Mitulescu A, Champain S. Cervical arthroplasty with Discocerv™ “Cervidisc Evolution” surgical procedure and clinical experience 9 years after the first implantation of the first generation. Interact Surg 2008; 3: 187-200
• 16 Enan A, Abu-Hegazy M, Abo-Hegy M, Al-Kerdany A. Single level cervical arthroplasty with the Discocerv prosthesis: a preliminary report. Acta Orthop Belg 2011; 77 (02) 224-229
• 17 Ling JMTR, Tiruchelvarayan R. Early clinical and radiographical results of keel-less and shallow keel cervical disc replacement. Asian J Neurosurg 2015; 10 (01) 5-9
• 18 Tu TH, Kuo CH, Huang WC, Fay LY, Cheng H, Wu JC. Effects of smoking on cervical disc arthroplasty. J Neurosurg Spine 2019; 30 (02) 168-174
• 19 Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J 2018; 18 (09) 1678-1693
• 20 Yang X, Donk R, Arts MP, Bartels R, Vleggeert-Lankamp CLA. Prosthesis in anterior cervical herniated disc approach does not prevent radiologic adjacent segment degeneration. Spine 2020; 45 (15) 1024-1029