Abstract
BackgroundTo evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease.MethodsFrom April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging.ResultsThe mean follow-up period was 72.3 months (range 68–78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively.ConclusionsThe clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.
Highlights
To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease
Compare with total disc replacement (TDR), DCI arthroplasty has several reported advantages: 1) DCI arthroplasty has a wider range of indications and is a relatively simple surgical technique [18], 2) DCI functions as a shock absorber that limits axial rotation and lateral bending, exacerbating facet joint stress [17], 3) DCI allows for axial compression in flexion and limited extension, with motion at the index level relatively close to the intact value [22], and 4) there is no grinding of the metal when the DCI functions, and so there is no local or systemic reaction to debris [18]
Matgé et al reported that all 47 patients who underwent DCI arthroplasty achieved satisfactory or somewhat satisfactory clinical outcomes during 2 years of follow-up; three of the 47 patients experienced implant subsidence, and 12 patients had major heterotopic ossification (HO) that resulted in less range of motion (ROM) [17]
Summary
To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. The standard anterior surgical procedure for degenerative cervical disc disease is currently anterior cervical discectomy and fusion (ACDF). ACDF achieves a satisfactory clinical outcome and fusion rate; it increases the motion and intradiscal pressure of the adjacent segments [1, 2], resulting in adjacent segment degeneration (ASD) [3, 4]. This complication led to the search for motion-preserving alternative procedures that could provide sufficient stability and simultaneously decrease the rate of ASD [5,6,7]. Some studies reported that TDR has limitations such as a high rate of heterotopic ossification (HO) and spontaneous fusion [11,12,13]
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