Abstract
Objective: Cervical Total Disc Replacement (CTDR) has recently been developed as an alternative to Anterior Cervical Discectomy and Fusion (ACDF) in cervical degenerative disease to preserve the motion at the treated level. The aim of this study is to investigate the safety and efficacy of CTDR by comparing it with ACDF in the treatment of single-level cervical degenerative disease, retrospectively. Methods: This study included 61 patients, who underwent either stand-alone single-level ACDF (n = 33) or singlelevel CTDR (Bryan cervical artificial disc, n = 28) at C3 to C7 for degenerative cervical disease between June 2007 and December 2009. Cervical radiographs were obtained to measure overall and regional cervical angle and Range of Motion (ROM). For evaluation for patient’s pain, visual analogue scale and Japanese Orthopedic Association score was measured. Results: The changes of the overall Cervical Sagittal Angle (CSA) were not significantly different between the two groups. The Segmental Angle (SA) was maintained at a significantly higher in the CTDR group compared to the ACDF group during the follow-up period (p < 0.05). The ROM of the upper adjacent segment was significantly increased in the ACDF group compared to the CTDR group. Conclusions: Clinically, CTDR is at least as efficient as ACDF. CTDR using a Bryan artificial disc provided a significant maintenance of the SA and the ROM at the treated level, and prevented the hyper-mobility at the upper adjacent segment compared to the ACDF. In the Future, prospective, randomized, long-term follow-up study with large-number will be required to clarify the efficacy of CTDR.
Highlights
Since Anterior Cervical Discectomy and Fusion (ACDF) was first introduced by Smith and Robinson, since it has been considered the standard surgical procedure for treatment of degenerative cervical disease [1,2]
The cervical spine is a mobile complex, ACDF results in a loss of mobility at the treated level, and it may eventually lead to kinematic strain on adjacent spinal levels and consequent disc degeneration and mechanical instability
The ACDF and Cervical Total Disc Replacement (CTDR) groups were similar in terms of age, sex, overall Cervical Sagittal Angle (CSA), Segmental Angle (SA) of treated level, Range of Motion (ROM) of the cervical spine and treated level, and ROM of upper and lower adjacent segments
Summary
Since Anterior Cervical Discectomy and Fusion (ACDF) was first introduced by Smith and Robinson, since it has been considered the standard surgical procedure for treatment of degenerative cervical disease [1,2]. The cervical spine is a mobile complex, ACDF results in a loss of mobility at the treated level, and it may eventually lead to kinematic strain on adjacent spinal levels and consequent disc degeneration and mechanical instability. Long term follow-up on ACDF has revealed that up to 25% of patients may develop recurrent axial or radicular symptoms for Adjacent Segment Degeneration (ASD) [3]. Complications of ACDF, such as graft collapse, expulsion, pseudoarthrosis and instrumentation failure, have been frequently reported during the follow-up period [4]. These problems have encouraged the development of new technology as an alternative to ACDF in cervical degenerative disease; Cervical Total Disc Replacement (CTDR) has been devised and used
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