Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study |
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| Affiliation: | 1. Hospital for Special Surgery, 541 East 71st St, New York, NY 10021, USA;2. Lenox Hill Hospital, 100 E 77th St, New York, NY 10075, USA;1. Clinic of Orthopedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Olimpiyat Bulvar? Yolu, 34480 Basaksehir, Istanbul, Turkey;2. Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey;3. Lycée Français Notre Dame de Sion, Cumhuriyet Cad 127, 34373 Sisli, Istanbul, Turkey;4. Department of Biostatistics, Ankara University School of Medicine, Adnan Saygun Cad., 06230 Altindag, Ankara, Turkey;5. Comprehensive Spine Center, Acibadem University Maslak Hospital, Buyukdere Cad 40, 34457 Sariyer, Istanbul, Turkey;6. Clinique du Dos, Elsan Jean Villar Private Hospital, 2 Av. de Terrefort, 33520 Bruges, Bordeaux, France;7. Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, 11564 Riyadh, Saudi Arabia;8. Spine Surgery Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain;9. Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland;10. Spine Surgery Unit, Hospital Universitari Vall d''Hebron, Passeig de la Vall d''Hebron, 119, 08035 Barcelona, Spain;1. Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea;2. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea;3. Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea;1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;2. Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands;1. Department of Orthopaedics, The Affiliated Changzhou No.2 People''s Hospital of Nanjing Medical University, Changzhou 213003, China;2. Graduate School of Dalian Medical University, Dalian 116000, China;1. Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan;2. Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan;3. Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan;4. Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan;5. Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan;6. Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan;7. Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan;8. Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan;9. Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan;10. Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan;11. Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan;12. Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan;13. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan;14. Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295;15. Department of Diagnostic Radiology, Centre for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan;p. Department of Biostatistics, M&D Data Science Centre, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan |
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| Abstract: | BACKGROUND CONTEXTThe theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial.PURPOSEThe present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center.STUDY DESIGNThis was a propensity-score matched cohort study.PATIENT SAMPLEThis study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups.OUTCOME MEASURESThe outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications.METHODSNDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method.RESULTSThe average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%).CONCLUSIONSThrough nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up. |
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