Clinical and Radiological Analysis of Cervical Arthroplasty Compared to Anterior Cervical Discectomy and Fusion in Cervical Disc Disease

Abstract

Objective: Although anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative cervical disc disease, concerns about adjacent level degeneration and loss of motion have led to suggestions that total disc replacement may be a better alternative. Methods: Since April 2006, 35 cases of cervical arthroplasty have been performed at our institute. Here we compare clinical and radiological results in patients who have cervical disc herniations treated with arthroplasty or with ACDF. We evaluated 67 patients treated for cervical disc herniations with radiculopathy and neck pain, of whom 35 underwent cervical arthroplasty using the Mobi-C (LDR medical, Troyes, France) implant and 32 underwent ACDF using the Solis cage (Stryker Spine, Allendale, NJ). Clinical measurements of outcome included the numeric rating scale (NRS) score for radiculopathy and neck pain, neck disability index (NDI) score, duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring overall cervical lordosis (Cobb’s angle), segmental lordosis and segmental range-of-movement (ROM) of operated disc levels and adjacent disc levels. Results: Mean hospital stay (5.52 vs. 6.26 days, p 0.05). In addition, segmental motion of operated level in the arthroplasty group were maintained at the last follow-up assessment. In two cases of arthroplasty group, new bony growth at the treated level, indicating heterotrophic ossification, was suspected based on radiographic (film) results. Conclusion: Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Postoperative overall cervical and segmental lordosis were reduced in the ACDF group compared with preoperative levels, but not in the arthroplasty group. (J Kor Neurotraumatol Soc 2009;5:83-88)