Abstract
We reviewed charts and radiologic studies of 30 patients operated upon by ADR with Mobi-C® in single level since 2006. All patients had healthy cervical facet joints (less than or equal to grade 1 according to grading systems for cervical facet joint degeneration) preoperatively. We assessed clinical outcomes with NDI and VAS on neck and arm over follow-up and also measured ROM at implanted segment on dynamic radiographs during follow-up. The mean follow-up period was 42.4 ± 15.9 months. We then assessed the linearity of changes in ROM at implanted segment through linear mixed model. All patients showed significantly improved clinical outcomes. ROMs at implanted segment were maintained at slightly increased levels until 24 months postoperatively (P = 0.529). However, after 24 months, ROMs at implanted segment decreased significantly until last follow-up (P = 0.001). In addition, the decreasing pattern after 24 months showed a regular regression (P = 0.001). This decline was correlated with decline of extension angle at implanted segment. Based on this regular regression, we estimated that ROMs at implanted segments would be less than 2 degrees at 10.24 years postoperatively. Even though implanted segment maintains its motion for some length of time, we could assume that an artificial disc would have limited life expectancy correlated with the decline of extension angle.
Highlights
Anterior cervical discectomy and fusion (ACDF) is the gold standard for the treatment of degenerative cervical spine disease [1]
There are numerous studies that have revealed the preservation of segmental range of motion (ROM) over follow–up without the development of adjacent segment disease after artificial disc replacement (ADR) [6, 7]
Since we found that segmental ROMs decreased after 24 months, we analyzed how many of the implanted segments maintained their motion during the follow-up period compared to the normal segmental ROMs by using a Kaplan–Meier curve analysis
Summary
Anterior cervical discectomy and fusion (ACDF) is the gold standard for the treatment of degenerative cervical spine disease [1]. The long term results of ACDF have shown development of adjacent segment disease because of the loss of range of motion (ROM) at fused segments [2,3,4,5]. Cervical artificial disc replacement (ADR) has been suggested as an alternative to ACDF due to the preservation of mobility of implanted segments. There are numerous studies that have revealed the preservation of segmental ROM over follow–up without the development of adjacent segment disease after ADR [6, 7]. Cervical artificial disc replacement offers several theoretical and obvious advantages compared with ACDF.
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