A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

Abstract

To present a long-term clinical and radiographic comparison between the Prestige LP cervical disc replacement and the Zero-P spacer cervical disc fusion in the treatment of patients with symptomatic 2-level cervical degenerative disease. In total, 36 patients in the anterior cervical discectomy and fusion (ACDF) group and 24 patients in the cervical disc arthroplasty (CDA) group were analyzed before surgery and at 1 week and 3, 6, 12, 24, and 60 months after surgery. Clinical assessments included the Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index scores. Radiographic assessments included cervical lordosis, range of motion (ROM) of the total cervical spine, functional spinal unit (FSU), and superior and inferior adjacent segments. Complications including heterotopic ossification and adjacent-segment degeneration (ASD) at 5-year follow-up were collected as well. Mean follow-up period was 65.6 months. Both the ACDF and CDA groups showed significant clinical improvements in terms of Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index (P<0.05), but there was no significant difference between groups at the last follow-up period. A significant increase of cervical lordosis was observed in the CDA group after surgery whereas a significant difference was not observed between groups. ROM of the total cervical spine and FSU were maintained during the follow-up, and a significant decrease was observed in the ACDF group after surgery (P< 0.05). The ROM of the superior adjacent segment did not show any difference whereas the ROM of the inferior adjacent segment in the ACDF group presented a significant increase at 6 months and 1 year after surgery and a significant decrease at the last follow-up period. A total of 8 (33.3%) patients in the CDA group had an occurrence of heterotopic ossification. ASD was observed in 2 (8.3%) patients who underwent CDA surgery and 8 (22.2%) patients who underwent ACDF surgery. The use of the Prestige-LP and ZERO-P Spacer implantations is safe and effective. At 5 years after surgery, CDA with Prestige-LP is superior in terms of ROM of the total cervical spine, FSU, and inferior adjacent segment. It also has a relatively low occurrence rate of ASD. This procedure may be a suitable choice for the treatment of contiguous 2-level CDDD.