Combination of Fusion and Motion Preservation in the Surgical Treatment of Degenerative Cervical Disc Disease

Abstract

Introduction Our clinical study design was prospective, concurrently enrolled, and single-center trial of the combination of fusion (intervertebral cage with or without ventrofixation) and cervical disc prosthesis implantation in the treatment of patients with multiple level degenerative disc disease. The cervical disc arthroplasty become more and more popular in the surgical treatment of the degenerative cervical disc disease. The goals of the cervical disc arthroplasty are to maintain or restore intervertebral height, spinal balance and mobility, and to avoid adjacent segment degeneration. However, in most of the patients with multisegmental degenerative disc disease, the certain segments show different stage of degeneration and instability. The study was designed to investigate the clinical effects of the combination of cervical fusion and arthroplasty and to observe the stability, range of motion, and the cervical spine sagittal balance in the follow-up period. Patients and Methods Since December 2007 to September 2012, 36 patients with symptomatic cervical radiculopathy and/or myelopathy underwent surgery with this combined method. In 14 cases, the surgery involved two level, in 16 cases was three level, and 6 cases was four level. At the follow-up period, the patients' pain, neurologic function, and the radiographic parameters (range of motion at the level of prosthesis and the adjacent segments, the intervertebral disc height of the adjacent segments, lordosis of the whole cervical spine, and heterotopic ossification) were evaluated. Results Early clinical experiences are promising. The segment of the prosthesis ultimately showed preservation of motion when compared with preoperative levels. The pre-op average ROM was 8.2 degrees (flexion/extension), the post-op average ROM 7.6 degrees. The whole cervical spine lordosis was pre-op 1.7 degrees the post-op 16.2 degrees. We have no implant-related failure. Conclusion The most important potential advantages of this method is that we can treat the multisegmental degeneration in each segment with the proper method including motion preservation and fusion, and restore the sagittal balance of the cervical spine. Although early results are promising, long-term follow-up studies required to prove its efficacy in the surgical treatment of the multisegmental degenerative cases.