Mid-term follow-up of dynamic cervical implant replacement for the treatment of single-segmental degenerative cervical disc disease_West China Medical Journal

Authors：

WANG Linnan , WANG Lei ,  SONG Yueming , LIU Limin , YANG Xi , FENG Ganjun , ZHOU Chunguang

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SONG Yueming, Email: hx_sym@163.com

Keywords：

Cervical vertebrae; Dynamic cervical implant; Treatment outcome; Subsidence; Heterotopic ossification

DOI：

10.7507/1002-0179.201802008

Video：

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ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C_2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C_2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.

Citation： WANG Linnan, WANG Lei, SONG Yueming, LIU Limin, YANG Xi, FENG Ganjun, ZHOU Chunguang. Mid-term follow-up of dynamic cervical implant replacement for the treatment of single-segmental degenerative cervical disc disease. West China Medical Journal, 2018, 33(9): 1073-1078. doi: 10.7507/1002-0179.201802008 Copy

1.	Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol, 1998, 49(1): 25-31.
2.	Kulkarni V, Rajshekhar V, Raghuram L. Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurg, 2004, 100(1 Suppl Spine): 2-6.
3.	Hilibrand AS, Carlson GD, Palumbo MA, et al. 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.
4.	安春厚, 郭金明, 原泉. 颈椎椎间融合术后邻近节段病变的临床观察. 中国修复重建外科杂志, 2008(4): 390-393.
5.	孙宇, 赵衍斌, 周非非, 等. Bryan 颈椎人工椎间盘置换术后 5 年随访结果. 中国脊柱脊髓杂志, 2012(1): 1-7.
6.	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.
7.	Zhu R, Yang H, Wang Z, et al. Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy. BMC Musculoskelet Disord, 2014, 15(233): 1-6.
8.	Matgé G, Buddenberg P, Eif M, et al. Dynamic cervical stabilization: a multicenter study. Eur Spine J, 2015, 24(12): 2841-2847.
9.	Wang L, Song YM, Liu LM, et al. 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.
10.	Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc, 1958, 166(1): 23-28.
11.	van Jonbergen HP, Spruit M, Anderson PG, et al. Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. Spine J, 2005, 5(6): 645-649.
12.	Mcafee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
13.	侯振扬, 徐耀增, 顾叶, 等. 颈椎动态稳定器置入非融合颈椎的生物力学分析. 中国组织工程研究与临床康复, 2011, 15(26): 4821-4824.
14.	Matgé G, Berthold C, Gunness VR, et al. Stabilization with the dynamic cervical implant: a novel treatment approach following cervical discectomy and decompression. J Neurosurg Spine, 2015, 22(3): 237-245.
15.	周非非, 赵衍斌, 孙宇, 等. Bryan 人工颈椎间盘置换术后异位骨化形成的临床因素分析. 中国脊柱脊髓杂志, 2009, 19(1): 39-43.
16.	Wu WJ, Jiang LS, Liang Y, et al. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J, 2012, 21(7): 1374-1382.
17.	Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. J Bone Joint Surg, 2003, 85(7): 1019-1025.
18.	马永刚, 刘世清, 李亚明, 等. 颈椎前路减压融合术后钛笼下沉临床分析. 中国脊柱脊髓杂志, 2011, 21(1): 21-23.
19.	Mckenna PJ, Freeman BJ, Mulholland RC, et al. A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J, 2005, 14(8): 727-737.
20.	李忠海, 侯树勋, 李利, 等. 颈椎动态稳定器植入术治疗颈椎病的临床疗效观察. 中国骨伤, 2014(12): 1050-1055.
21.	Yang HS, Lu XH, Yuan W, et al. Artificial disk replacement in the treatment of degenerative cervical disk disorder. Spine (Phila Pa 1976), 2014, 39(19): 1564-1571.
22.	Wang MY, Leung CH, Casey AT. Cervical arthroplasty with the Bryan disc. Neurosurgery, 2005, 56(1 Suppl): 58-65; discussion 58-65.

1. Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol, 1998, 49(1): 25-31.
2. Kulkarni V, Rajshekhar V, Raghuram L. Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurg, 2004, 100(1 Suppl Spine): 2-6.
3. Hilibrand AS, Carlson GD, Palumbo MA, et al. 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.
4. 安春厚, 郭金明, 原泉. 颈椎椎间融合术后邻近节段病变的临床观察. 中国修复重建外科杂志, 2008(4): 390-393.
5. 孙宇, 赵衍斌, 周非非, 等. Bryan 颈椎人工椎间盘置换术后 5 年随访结果. 中国脊柱脊髓杂志, 2012(1): 1-7.
6. 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.
7. Zhu R, Yang H, Wang Z, et al. Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy. BMC Musculoskelet Disord, 2014, 15(233): 1-6.
8. Matgé G, Buddenberg P, Eif M, et al. Dynamic cervical stabilization: a multicenter study. Eur Spine J, 2015, 24(12): 2841-2847.
9. Wang L, Song YM, Liu LM, et al. 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.
10. Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc, 1958, 166(1): 23-28.
11. van Jonbergen HP, Spruit M, Anderson PG, et al. Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. Spine J, 2005, 5(6): 645-649.
12. Mcafee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
13. 侯振扬, 徐耀增, 顾叶, 等. 颈椎动态稳定器置入非融合颈椎的生物力学分析. 中国组织工程研究与临床康复, 2011, 15(26): 4821-4824.
14. Matgé G, Berthold C, Gunness VR, et al. Stabilization with the dynamic cervical implant: a novel treatment approach following cervical discectomy and decompression. J Neurosurg Spine, 2015, 22(3): 237-245.
15. 周非非, 赵衍斌, 孙宇, 等. Bryan 人工颈椎间盘置换术后异位骨化形成的临床因素分析. 中国脊柱脊髓杂志, 2009, 19(1): 39-43.
16. Wu WJ, Jiang LS, Liang Y, et al. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J, 2012, 21(7): 1374-1382.
17. Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. J Bone Joint Surg, 2003, 85(7): 1019-1025.
18. 马永刚, 刘世清, 李亚明, 等. 颈椎前路减压融合术后钛笼下沉临床分析. 中国脊柱脊髓杂志, 2011, 21(1): 21-23.
19. Mckenna PJ, Freeman BJ, Mulholland RC, et al. A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J, 2005, 14(8): 727-737.
20. 李忠海, 侯树勋, 李利, 等. 颈椎动态稳定器植入术治疗颈椎病的临床疗效观察. 中国骨伤, 2014(12): 1050-1055.
21. Yang HS, Lu XH, Yuan W, et al. Artificial disk replacement in the treatment of degenerative cervical disk disorder. Spine (Phila Pa 1976), 2014, 39(19): 1564-1571.
22. Wang MY, Leung CH, Casey AT. Cervical arthroplasty with the Bryan disc. Neurosurgery, 2005, 56(1 Suppl): 58-65; discussion 58-65.

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