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Tsung-Hsi Tu, Jau-Ching Wu, Li-Yu Fay, Chin-Chu Ko, Wen-Cheng Huang and Henrich Cheng

C ervical TDR has recently been regarded as an alternative surgical treatment for degenerative disc disease. Compared with the standard ACDF, cervical TDR preserves segmental motion, and the theoretical potential to decrease adjacent-segment disease is thus anticipated. Randomized controlled clinical trials of a number of cervical TDR devices, with a maximum follow-up duration of 5 years, have been published. 2–4 , 6 , 8–11 , 13 These trials all concluded that cervical TDR is a safe and effective alternative to ACDF for single-level cervical spondylosis

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Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang, Ching-Lan Wu, Chin-Chu Ko and Henrich Cheng

cervical arthroplasty. Interestingly, the reported incidence rates of HO development are substantially inconsistent in different series, ranging from none to more than two-thirds of the treated levels. 2 , 3 , 6 , 8 , 12 , 15 , 17 , 18 , 29 , 34 The true cause of these widely variable incidences of HO in the literature remains elusive. This disparity can be attributed to the design and the material of devices, timing and method of evaluation, the use of NSAIDs, or idiosyncrasy. Furthermore, the long-term effects of HO on clinical outcomes are still uncertain and require

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Jau-Ching Wu, Wen-Cheng Huang, Tsung-Hsi Tu, Hsiao-Wen Tsai, Chin-Chu Ko, Ching-Lan Wu and Henrich Cheng

F or decades, ACDF has been the gold standard in surgical treatment for various cervical disc diseases. Several degenerative cervical spine problems, including single- or multilevel disc diseases, spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and kyphotic deformity, can be managed with ACDF. 2 , 8 , 16 , 17 , 29 In the last decade, there emerged the option of cervical arthroplasty, which replaces the pathological disc with a mechanical device to preserve joint function. Several of these artificial discs have

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Tsung-Hsi Tu, Chao-Hung Kuo, Wen-Cheng Huang, Li-Yu Fay, Henrich Cheng and Jau-Ching Wu

after anterior cervical discectomy and thus ameliorate the development of ASD. During the past decade, data from US Food and Drug Administration (FDA) clinical trials comparing 1- and 2-level CDA to ACDF have demonstrated equal or superior results for CDA in terms of improvement in neurological function and in the reduction of secondary surgery. 14 , 15 , 18 Much of the literature agrees that these CDA devices can successfully maintain segmental mobility at an average of about 7°–8° during flexion and extension. However, it remains questionable if the CDA can

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Chao-Hung Kuo, Wen-Cheng Huang, Jau-Ching Wu, Tsung-Hsi Tu, Li-Yu Fay, Ching-Lan Wu and Henrich Cheng

MI-TLIF, supporting the theoretical effects of DDS on the deceleration of degeneration. However, because of the low incidence of ASD shortly after the operations, a long enough follow-up—for example, 10 to 15 years—may be necessary to differentiate the true effects of these two treatment modalities. Whether the ASD was device related or a natural course remains undetermined since the study did not have a control group that did not undergo surgery. Results of the current study obviously suggest the need for greater case numbers and a longer duration (at least 5

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Jau-Ching Wu, Wen-Cheng Huang, Hsiao-Wen Tsai, Chin-Chu Ko, Ching-Lan Wu, Tsung-Hsi Tu and Henrich Cheng

dynamic stabilization device. Future studies with stratification of each specific indication for the dynamic stabilization device are necessary to clarify its optimal application. There are limitations to this study. This cohort was composed of patients with lumbar spondylosis of various kinds, including unstable stenosis, degenerative disc disease, mild spondylolisthesis, recurrent disc herniation, and iatrogenic instability. The surgical indications for dynamic stabilization in the study were not uniform, which might contribute differently to screw loosening. The

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Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang, Wan-Yuo Guo, Ching-Lan Wu, Yang-Hsin Shih and Henrich Cheng

, data from the 2-year follow-up of the Bryan FDA investigational device exemption trial showed no spontaneous fusion at 2 years. 12 The authors attributed the excellent mobility of the artificial discs to the prescription of NSAIDs for 2 weeks postoperatively, as well as patient selection to exclude those with severe spondylosis, in whom fusion was more likely. In the current study, 1-week postoperative NSAID treatment was chosen as a balance between HO prevention and NSAID side effects. However, to date, there is still no solid evidence regarding the effect of

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Chin-Chu Ko, Hsiao-Wen Tsai, Wen-Cheng Huang, Jau-Ching Wu, Yu-Chun Chen, Yang-Hsin Shih, Hung-Chieh Chen, Ching-Lan Wu and Henrich Cheng

facilitated by instrumentation has been regarded as the standard treatment for severe degenerative lumbar spondylosis. However, a considerable amount of associated morbidity and complications have been reported, 3 , 8 and adjacent segment degeneration is one that has drawn the most attention. The transition syndrome theoretically occurs from an overloading of adjacent segments, 1 , 15 thereby challenging the long-accepted choice of fusion as standard surgical treatment. Numerous devices have since been developed to overcome the shortcomings of spinal fusion. Dubois and

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Jau-Ching Wu, Wen-Cheng Huang, Hsiao-Wen Tsai, Chin-Chu Ko, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu and Henrich Cheng

of HO formation. Overall, HO was found in 38 patients (54.3%). The 1-level group had 17 patients (40.5%) in whom HO was identified around the arthroplasty device. Moreover, it must be noted that the incidence of HO was significantly higher in the 2-level group (21 patients) than in the 1-level group (75.0% vs 40.5%, respectively; p = 0.009). Despite HO formation in many of these patients, most (94.3%) of the artificial discs in this series remained mobile. Significantly more mobile artificial discs were found in the 1-level group than the 2-level group (100% vs

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Li-Yu Fay, Peng-Yuan Chang, Jau-Ching Wu, Wen-Cheng Huang, Chun-Hao Wang, Tzu-Yun Tsai, Tsung-Hsi Tu, Hsuan-Kan Chang, Ching-Lan Wu and Henrich Cheng

, 17 , 18 , 30 , 31 Although there are still issues with this fusion surgery, spinal arthrodesis has been a popular choice of strategy of surgical management for lumbar spondylosis. 1 , 9 , 11 , 25 , 29 In recent decades, there has been an emerging option of dynamic stabilization for lumbar spondylosis with preservation of spinal segmental motion. The Dynesys dynamic stabilization (DDS) system (Zimmer Spine), a spinal motion preservation system, consists of a pedicle screw–based stabilization device for the lumbar spine. The DDS was designed to unload the