Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yi , HE Junbo , WU Tingkui , DING Chen , WANG Beiyu ,  LIU Hao

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

Corresponding author：

LIU Hao, Email: liuhao6304@126.com

Keywords：

Preoperative symptom duration; cervical spondylotic radiculopathy; cervical disc arthroplasty; cervical lordosis

DOI：

10.7507/1002-1892.202310071

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Objective To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. Methods The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups (P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C₂-C₇ range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group (P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C₂-C₇ ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Results Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups (P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group (P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation (P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up (P>0.05). Imaging evaluation showed that there was no significant difference in CL, C₂-C₇ ROM, DA, DROM, and DIH between the two groups at each time point before and after operation (P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C₂-C₇ ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up.Conclusion Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

Citation： LI Yi, HE Junbo, WU Tingkui, DING Chen, WANG Beiyu, LIU Hao. Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(2): 176-182. doi: 10.7507/1002-1892.202310071 Copy

1.	Mayfield FH. Cervical spondylotic radiculopathy and myelopathy. Adv Neurol, 1979, 22: 307-321.
2.	Huo LY, Yang XX, Feng TX, et al. Management of cervical spondylotic radiculopathy: A systematic review. Global Spine J, 2022, 12(8): 1912-1924.
3.	Nikolaidis I, Fouyas IP, Sandercock PA, et al. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev, 2010, 2010(1): CD001466.
4.	Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J, 2011, 11(1): 64-72.
5.	Pandey PK, Pawar I, Gupta J, et al. Comparison of outcomes of single-level anterior cervical discectomy with fusion and single-level artificial cervical disc replacement for single-level cervical degenerative disc disease. Spine (Phila Pa 1976), 2017, 42(1): E41-E49.
6.	Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
7.	Findlay C, Ayis S, Demetriades AK. Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes. Bone Joint J, 2018, 100-B(8): 991-1001.
8.	Hu X, Liu H, Wang B, et al. Cervical disc arthroplasty versus anterior cervical discectomy and fusion for the treatment of single-level disc degenerative disease with preoperative reversible kyphosis. Clin Neurol Neurosurg, 2021, 202: 106493.
9.	Tetreault L, Wilson JR, Kotter MRN, et al. Is preoperative duration of symptoms a significant predictor of functional outcomes in patients undergoing surgery for the treatment of degenerative cervical myelopathy? Neurosurgery, 2019, 85(5): 642-647.
10.	Shenoy K, Patel PD, Henstenburg JM, et al. Impact of preoperative weakness and duration of symptoms on health-related quality-of-life outcomes following anterior cervical discectomy and fusion. Spine J, 2020, 20(11): 1744-1751.
11.	Levy HA, Karamian BA, Adams AJ, et al. The impact of preoperative symptom duration on patient outcomes after posterior cervical decompression and fusion. Global Spine J, 2023, 13(8): 2463-2470.
12.	Matsukura Y, Egawa S, Inose H, et al. Preoperative symptom duration influences neurological recovery and patient-reported outcome measures after surgical treatment of cervical ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976), 2023, 48(18): 1259-1265.
13.	Radcliff KE, Rihn J, Hilibrand A, et al. Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes?: analysis of the spine outcomes research trial. Spine (Phila Pa 1976), 2011, 36(25): 2197-2210.
14.	Omidi-Kashani F, Ghayem Hasankhani E, Ghandehari R. Impact of age and duration of symptoms on surgical outcome of single-level microscopic anterior cervical discectomy and fusion in the patients with cervical spondylotic radiculopathy. Neurosci J, 2014, 2014: 808596.
15.	Basques BA, Ahn J, Markowitz J, et al. Does the duration of cervical radicular symptoms impact outcomes after anterior cervical discectomy and fusion? Clin Spine Surg, 2019, 32(9): 387-391.
16.	Burneikiene S, Nelson EL, Mason A, et al. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J, 2015, 15(3): 427-432.
17.	Tarazona D, Boody B, Hilibrand AS, et al. Longer preoperative duration of symptoms negatively affects health-related quality of life after surgery for cervical radiculopathy. Spine (Phila Pa 1976), 2019, 44(10): 685-690.
18.	Wong JJ, Côté P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J, 2014, 14(8): 1781-1789.
19.	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.
20.	Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. Br Med J, 1963, 2(5373): 1607-1610.
21.	Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain, 2013, 29(12): 1073-1086.
22.	Salt E, Wright C, Kelly S, et al. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther, 2011, 16(1): 53-65.
23.	Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp, 1955, 96(5): 223-224.
24.	Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 Suppl): 190S-194S.
25.	Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg, 1998, 88(6): 943-948.
26.	Zeidan M, Goz V, Lakomkin N, et al. Predictors of readmission and prolonged length of stay after cervical disc arthroplasty. Spine (Phila Pa 1976), 2021, 46(8): 487-491.
27.	Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976), 2001, 26(17): 1890-1894.
28.	Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One, 2015, 10(4): e0123022.
29.	Morningstar MW, Strauchman MN, Weeks DA. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study. J Chiropr Med, 2003, Spring,2(2): 51-54.
30.	Tan LA, Straus DC, Traynelis VC. Cervical interfacet spacers and maintenance of cervical lordosis. J Neurosurg Spine, 2015, 22(5): 466-469.
31.	McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005, 28(3): 187-193.
32.	Panjabi MM, Cholewicki J, Nibu K, et al. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon), 1998, 13(1): 11-17.
33.	Alpayci M, Şenköy E, Delen V, et al. Decreased neck muscle strength in patients with the loss of cervical lordosis. Clin Biomech (Bristol, Avon), 2016, 33: 98-102.
34.	Mehren C, Heider F, Siepe CJ, et al. Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement. Eur Spine J, 2017, 26(9): 2441-2449.
35.	Chen TY, Chen WH, Tzeng CY, et al. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J, 2020, 20(8): 1211-1218.
36.	Huang CW, Tsou HK, Chen WH, et al. The residual exposed endplate ratio is predictive of posterior heterotopic ossification after cervical Bryan disc arthroplasty. J Clin Neurosci, 2023, 114: 97-103.

1. Mayfield FH. Cervical spondylotic radiculopathy and myelopathy. Adv Neurol, 1979, 22: 307-321.
2. Huo LY, Yang XX, Feng TX, et al. Management of cervical spondylotic radiculopathy: A systematic review. Global Spine J, 2022, 12(8): 1912-1924.
3. Nikolaidis I, Fouyas IP, Sandercock PA, et al. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev, 2010, 2010(1): CD001466.
4. Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J, 2011, 11(1): 64-72.
5. Pandey PK, Pawar I, Gupta J, et al. Comparison of outcomes of single-level anterior cervical discectomy with fusion and single-level artificial cervical disc replacement for single-level cervical degenerative disc disease. Spine (Phila Pa 1976), 2017, 42(1): E41-E49.
6. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
7. Findlay C, Ayis S, Demetriades AK. Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes. Bone Joint J, 2018, 100-B(8): 991-1001.
8. Hu X, Liu H, Wang B, et al. Cervical disc arthroplasty versus anterior cervical discectomy and fusion for the treatment of single-level disc degenerative disease with preoperative reversible kyphosis. Clin Neurol Neurosurg, 2021, 202: 106493.
9. Tetreault L, Wilson JR, Kotter MRN, et al. Is preoperative duration of symptoms a significant predictor of functional outcomes in patients undergoing surgery for the treatment of degenerative cervical myelopathy? Neurosurgery, 2019, 85(5): 642-647.
10. Shenoy K, Patel PD, Henstenburg JM, et al. Impact of preoperative weakness and duration of symptoms on health-related quality-of-life outcomes following anterior cervical discectomy and fusion. Spine J, 2020, 20(11): 1744-1751.
11. Levy HA, Karamian BA, Adams AJ, et al. The impact of preoperative symptom duration on patient outcomes after posterior cervical decompression and fusion. Global Spine J, 2023, 13(8): 2463-2470.
12. Matsukura Y, Egawa S, Inose H, et al. Preoperative symptom duration influences neurological recovery and patient-reported outcome measures after surgical treatment of cervical ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976), 2023, 48(18): 1259-1265.
13. Radcliff KE, Rihn J, Hilibrand A, et al. Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes?: analysis of the spine outcomes research trial. Spine (Phila Pa 1976), 2011, 36(25): 2197-2210.
14. Omidi-Kashani F, Ghayem Hasankhani E, Ghandehari R. Impact of age and duration of symptoms on surgical outcome of single-level microscopic anterior cervical discectomy and fusion in the patients with cervical spondylotic radiculopathy. Neurosci J, 2014, 2014: 808596.
15. Basques BA, Ahn J, Markowitz J, et al. Does the duration of cervical radicular symptoms impact outcomes after anterior cervical discectomy and fusion? Clin Spine Surg, 2019, 32(9): 387-391.
16. Burneikiene S, Nelson EL, Mason A, et al. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J, 2015, 15(3): 427-432.
17. Tarazona D, Boody B, Hilibrand AS, et al. Longer preoperative duration of symptoms negatively affects health-related quality of life after surgery for cervical radiculopathy. Spine (Phila Pa 1976), 2019, 44(10): 685-690.
18. Wong JJ, Côté P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J, 2014, 14(8): 1781-1789.
19. 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.
20. Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. Br Med J, 1963, 2(5373): 1607-1610.
21. Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain, 2013, 29(12): 1073-1086.
22. Salt E, Wright C, Kelly S, et al. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther, 2011, 16(1): 53-65.
23. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp, 1955, 96(5): 223-224.
24. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 Suppl): 190S-194S.
25. Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg, 1998, 88(6): 943-948.
26. Zeidan M, Goz V, Lakomkin N, et al. Predictors of readmission and prolonged length of stay after cervical disc arthroplasty. Spine (Phila Pa 1976), 2021, 46(8): 487-491.
27. Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976), 2001, 26(17): 1890-1894.
28. Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One, 2015, 10(4): e0123022.
29. Morningstar MW, Strauchman MN, Weeks DA. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study. J Chiropr Med, 2003, Spring,2(2): 51-54.
30. Tan LA, Straus DC, Traynelis VC. Cervical interfacet spacers and maintenance of cervical lordosis. J Neurosurg Spine, 2015, 22(5): 466-469.
31. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005, 28(3): 187-193.
32. Panjabi MM, Cholewicki J, Nibu K, et al. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon), 1998, 13(1): 11-17.
33. Alpayci M, Şenköy E, Delen V, et al. Decreased neck muscle strength in patients with the loss of cervical lordosis. Clin Biomech (Bristol, Avon), 2016, 33: 98-102.
34. Mehren C, Heider F, Siepe CJ, et al. Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement. Eur Spine J, 2017, 26(9): 2441-2449.
35. Chen TY, Chen WH, Tzeng CY, et al. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J, 2020, 20(8): 1211-1218.
36. Huang CW, Tsou HK, Chen WH, et al. The residual exposed endplate ratio is predictive of posterior heterotopic ossification after cervical Bryan disc arthroplasty. J Clin Neurosci, 2023, 114: 97-103.

Chinese Journal of Reparative and Reconstructive Surgery

Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients

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