Long-term clinical efficacy of cervical artificial disc replacement for cervical spondylotic radiculopathy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Qingpeng ,  TIAN Wei , HE Da , HAN Xiao , ZHANG Ning , WANG Jinchao , LI Zuchang

Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;

Corresponding author：

TIAN Wei, Email: tianweijst@vip.163.com

Keywords：

Cervical artificial disc replacement; cervical spondylotic radiculopathy; long-term follow-up

DOI：

10.7507/1002-1892.201712045

Video：

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ObjectiveTo evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR).MethodsThe data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C_{3, 4} in 2 cases, C_{4, 5} in 6 cases, C_{5, 6} in 18 cases, C_{6, 7} in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups (P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification (PO) grading. The clinical evaluation indexes included neck disability index (NDI) and overall efficacy (Odom’s score).ResultsAll patients were followed up 121-153 months (mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased (P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up (P>0.05). Except that the loss of ROM (ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A (P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups (P>0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups (P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom’s score between 2 groups (P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups.ConclusionCADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.

Citation： SONG Qingpeng, TIAN Wei, HE Da, HAN Xiao, ZHANG Ning, WANG Jinchao, LI Zuchang. Long-term clinical efficacy of cervical artificial disc replacement for cervical spondylotic radiculopathy. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 668-672. doi: 10.7507/1002-1892.201712045 Copy

1.	Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
2.	Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
3.	van Eck CF, Regan C, Donaldson WF, et al. The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients. Spine (Phila Pa 1976), 2014, 39(26): 2143-2147.
4.	Verma K, Gandhi SD, Maltenfort M, et al. Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine (Phila Pa 1976), 2013, 38(26): 2253-2257.
5.	Sasso WR, Smucker JD, Sasso MP, et al. Long-term clinical outcomes of cervical disc arthroplasty: a prospective, randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(4): 209-216.
6.	Liu GM, Wang YJ, Wang DS, et al. Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study. J Orthop Surg Res, 2013, 8: 48.
7.	Skeppholm M, Lindgren L, Henriques T, et al. The Discover artificial disc replacement versus fusion in cervical radiculopathy—a randomized controlled outcome trial with 2-year follow-up. Spine J, 2015, 15(6): 1284-1294.
8.	Tu TH, Wu JC, Huang WC, et al. The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty: determination by computed tomography with a minimum 2-year follow-up: Clinical article. J Neurosurg Spine, 2012, 16(6): 601-609.
9.	Tian W, Fan MX, Liu YJ, et al. An analysis of paravertebral ossification in cervical artificial disc replacement: a novel classification based on computed tomography. Orthop Surg, 2016, 8(4): 440-446.
10.	伍少玲, 马超, 伍时玲, 等. 颈椎功能障碍指数量表的效度与信度研究. 中国康复医学杂志, 2008, 23(7): 625-628.
11.	Polston DW. Cervical radiculopathy. Neurol Clin, 2007, 25(2): 373-385.
12.	Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016, 30(2): 145-155.
13.	Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med, 2015, 163(5): 373-381.
14.	Gutman G, Rosenzweig DH, Golan JD. The surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine (Phila Pa 1976), 2018, 43(6): E365-E372.
15.	韩骁, 田伟, 刘波, 等. 不同影像学及症状学诊断颈椎退行性疾病患者行人工颈椎间盘置换术的中长期随访研究. 中华骨与关节外科杂志, 2015, 8(1): 15-20.
16.	Khong P, Bogduk N, Ghahreman A, et al. Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy. J Clin Neurosci, 2013, 20(10): 1411-1416.
17.	Fong SY, Duplessis SJ, Casha S, et al. Design limitations of Bryan disc arthroplasty. Spine J, 2006, 6(3): 233-241.

1. Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
2. Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
3. van Eck CF, Regan C, Donaldson WF, et al. The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients. Spine (Phila Pa 1976), 2014, 39(26): 2143-2147.
4. Verma K, Gandhi SD, Maltenfort M, et al. Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine (Phila Pa 1976), 2013, 38(26): 2253-2257.
5. Sasso WR, Smucker JD, Sasso MP, et al. Long-term clinical outcomes of cervical disc arthroplasty: a prospective, randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(4): 209-216.
6. Liu GM, Wang YJ, Wang DS, et al. Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study. J Orthop Surg Res, 2013, 8: 48.
7. Skeppholm M, Lindgren L, Henriques T, et al. The Discover artificial disc replacement versus fusion in cervical radiculopathy—a randomized controlled outcome trial with 2-year follow-up. Spine J, 2015, 15(6): 1284-1294.
8. Tu TH, Wu JC, Huang WC, et al. The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty: determination by computed tomography with a minimum 2-year follow-up: Clinical article. J Neurosurg Spine, 2012, 16(6): 601-609.
9. Tian W, Fan MX, Liu YJ, et al. An analysis of paravertebral ossification in cervical artificial disc replacement: a novel classification based on computed tomography. Orthop Surg, 2016, 8(4): 440-446.
10. 伍少玲, 马超, 伍时玲, 等. 颈椎功能障碍指数量表的效度与信度研究. 中国康复医学杂志, 2008, 23(7): 625-628.
11. Polston DW. Cervical radiculopathy. Neurol Clin, 2007, 25(2): 373-385.
12. Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016, 30(2): 145-155.
13. Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med, 2015, 163(5): 373-381.
14. Gutman G, Rosenzweig DH, Golan JD. The surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine (Phila Pa 1976), 2018, 43(6): E365-E372.
15. 韩骁, 田伟, 刘波, 等. 不同影像学及症状学诊断颈椎退行性疾病患者行人工颈椎间盘置换术的中长期随访研究. 中华骨与关节外科杂志, 2015, 8(1): 15-20.
16. Khong P, Bogduk N, Ghahreman A, et al. Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy. J Clin Neurosci, 2013, 20(10): 1411-1416.
17. Fong SY, Duplessis SJ, Casha S, et al. Design limitations of Bryan disc arthroplasty. Spine J, 2006, 6(3): 233-241.

Chinese Journal of Reparative and Reconstructive Surgery

Long-term clinical efficacy of cervical artificial disc replacement for cervical spondylotic radiculopathy

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