P54. Cervical disc arthroplasty versus anterior cervical discectomy with fusion for cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging

Abstract

BACKGROUND CONTEXT The clinical outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF) for cervical spondylotic myelopathy (CSM) with with increased signal intensity (ISI) on T2-weighted images (T2WI) is still not clear. PURPOSE The purpose of this study was to compare the clinical outcomes and complications between the two methods for CSM with ISI on T2WI. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A total of 64 patients. OUTCOME MEASURES The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index(NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. The indicators and complications of the two groups were compared. METHODS We analyzed 32 patients with CSM with ISI on T2WI who underwent CDA from January 2015 to January 2017 (CDA Group). The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index (NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. Propensity score matching identified 32 patients (ACDF Group) as controls, who underwent ACDF, from January 2010 to January 2015 using 6 independent variables (pre-operation): age, sex, m-JOA, SF36 PCS, SF36 MCS and tobacco use. RESULTS There were no statistical difference in the baseline of the two groups. At the last follow-up, the m-JOA, VAS, NDI and SF-36 (PCS and MCS) scores of the two groups were all significantly improved. But NDI and SF-36 PCS and SF-36 MCS were better in CDA Group at the final follow-up. The the height of adjacent intervertebral disc, extension and flexion ROM were lost in ACDF group. The complication rate was higher in the ACDF group. CONCLUSIONS Our results showed that both ACDF and CDA could achieve satisfactory neurological recovery for CSM with ISI on T2WI. But CDA had better clinical outcomes and lower complication rate at the final follow up. However, these results require further validation and investigation in high evidence researches. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.