Cervical disc arthroplasty for less-mobile discs

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OBJECTIVE

The published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°–9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.

METHODS

A series of consecutive patients who underwent CDA at the level of C5–6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5–6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5–6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.

RESULTS

A total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.

CONCLUSIONS

Preoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment degeneration; CDA = cervical disc arthroplasty; HO = heterotopic ossification; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; PLL = posterior longitudinal ligament; ROM = range of motion; VAS = visual analog scale.

Article Information

Correspondence Jau-Ching Wu: Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. jauching@gmail.com.

INCLUDE WHEN CITING Published online May 10, 2019; DOI: 10.3171/2019.2.SPINE181472.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Radiographs of a patient in the preoperatively less-mobile group who underwent CDA with a Bryan cervical disc replacement for cervical spondylosis with myeloradiculopathy at the C5–6 level. The segmental ROM was 4° preoperatively and 21° postoperatively. Preoperative (A) and 28-month postoperative (B) lateral flexion-extension radiographs demonstrated marked restoration of C5–6 segmental motion (*flexion curve; @extension curve). C and D: Measurement of angular mobility in the postoperative flexion-extension radiographs.

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    Radiographs of a patient in the preoperatively more-mobile group who underwent CDA with a Prestige LP artificial disc for cervical spondylosis with myeloradiculopathy at the C5–6 level. The segmental ROM was 11° preoperatively and 12° postoperatively. The preoperative (A and B) and 25-month postoperative (C and D) lateral flexion-extension radiographs demonstrated clear maintenance of the C5–6 segmental motion postoperatively.

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