Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion.

Yuxiang Chen,Qingjun Su,Peng Yin,Yong Hai,Yuzeng Liu,Jincai Yang,Yue Li,Sidong Yang

doi:10.1155/2022/3353810

Yuxiang Chen, Qingjun Su + Show 6 more

Open Access

https://doi.org/10.1155/2022/3353810

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Journal: Pain research & management	Publication Date: Jan 24, 2022
Citations: 3	License type: CC BY 4.0

Affiliation: Beijing Chao-Yang Hospital

Abstract

Background The surgical management of cervical degenerative disc degeneration (CDDD) has not reached a consensus. Artificial cervical disc replacement (ACDR) has been shown to be efficient in reducing symptoms after CDDD, although the topic remains highly controversial in this field. This study aimed to evaluate the effectiveness of ACDR on the treatment of CDDD on the aspect of radiographic reconstruction and clinical improvement compared with anterior cervical discectomy and fusion (ACDF). Methods This was a retrospective comparative study with 47 patients who underwent single-level ACDR and 46 patients who underwent single-level ACDF. The radiographic reconstruction was assessed by the cervical sagittal alignment parameters, consisting of two aspects, distance and angle, such as cervical sagittal vertical axis (cSVA), cervical lordosis (CL), T1 slope (T1s), and intervertebral space height (ISH). The clinical improvement was assessed by patient-related outcomes (PROs), consisting of two aspects, relief of axial neck pain and recovery of cervical dysfunction, measured through the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA). Results Significant variations were achieved on aspects of radiographic reconstruction and clinical improvement after ACDR (P < 0.05), which were similar to that of the ACDF group (P < 0.05). A significantly larger postoperative range of motion (ROM) was found in patients less than 45 years of age in the ACDR group (P < 0.05). In addition, a significantly better postoperative JOA was found in patients with a preoperative ISH less than 4 mm in the ACDF group than that in the ACDR group (P < 0.05). Other than that mentioned above, no significant variations in radiographic and clinical outcomes were found between the two groups (P > 0.05). Conclusions Overall, this study showed that a similar capability in terms of radiographic reconstruction and clinical improvement was found between the two methods. Specific concerns should be analyzed while choosing between an ACDR and an ACDF. It should be pointed out that, based on our experience, if the patient is younger, ACDR is recommended; for patients with preoperative ISH less than 4 mm, ACDF is more recommended.

Highlights

Myelopathy, radiculopathy, or both can be caused by cervical degenerative disc disease (CDDD) which can induce severe axial neck pain [1]
Study Design. e patients diagnosed with CDDD who underwent artificial cervical disc replacement (ACDR) or ACDF performed by a single surgeon team from February 2016 to February 2019 in our center were screened for enrollment
Radiographic Measurement. e radiographic reconstruction was assessed by the cervical sagittal alignment parameters, consisting of two aspects, distance and angle, such as cervical sagittal vertical axis, cervical lordosis (CL), T1 slope (T1s), and intervertebral space height (ISH) (Figure 1)

Summary

Introduction

Myelopathy, radiculopathy, or both can be caused by cervical degenerative disc disease (CDDD) which can induce severe axial neck pain [1]. It has been decades since anterior cervical discectomy and fusion (ACDF) was first introduced and has been regarded as the gold standard procedure to treat CDDD [2,3,4,5]. ACDF was used as a control group to explore the efficacy of ACDR Even on this premise, the optimum treatment remains in dispute [16,17,18,19,20,21,22,23,24]

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