Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level

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OBJECTIVE

Food and Drug Administration–approved investigational device exemption (IDE) studies have provided level I evidence supporting cervical disc arthroplasty (CDA) as a safe and effective alternative to anterior cervical discectomy and fusion (ACDF). Long-term CDA outcomes continue to be evaluated. Here, the authors present outcomes at 10 years postoperatively for the single-level CDA arm of an IDE study (postapproval study).

METHODS

The primary endpoint was overall success, a composite variable composed of five criteria: 1) Neck Disability Index score improvement ≥ 15 points; 2) maintenance or improvement in neurological status; 3) no decline in anterior or posterior functional spinal unit (FSU) height of more than 2 mm compared to 6 weeks postoperatively; 4) no serious adverse event (AE) caused by the implant or the implant and the surgical procedure; and 5) no additional surgery classified as a failure. Additional safety and effectiveness measures included numeric rating scales for neck pain and arm pain, SF-36 quality-of-life physical and mental components, patient satisfaction, range of motion, and AEs.

RESULTS

From the reported assessments at 7 years postoperatively to the 10-year postoperative follow-up, the scores for all patient-reported outcomes, rate of overall success (without FSU), and proportion of patients at least maintaining their neurological function remained stable for the CDA group. Nine patients had secondary surgery at the index level, increasing the secondary surgery cumulative rate from 6.6% to 10.3%. In that same time frame, four patients experienced a serious implant or implant/surgical procedure–related AE, for a 10-year cumulative rate of 7.8%. Seven patients had any second surgery at adjacent levels, for a 10-year cumulative rate of 13.8%. Average angular motion at both the index and adjacent levels was well maintained without creating hypermobility. Class IV heterotopic ossification increased from 1.2% at 2 years to 4.6% at 7 years and 9.0% at 10 years. Patient satisfaction was > 90% at 10 years.

CONCLUSIONS

CDA remained safe and effective out to 10 years postoperatively, with results comparable to 7-year outcomes and with high patient satisfaction.

Clinical trial registration no.: NCT00667459 (clinicaltrials.gov)

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; AE = adverse event; ASD = adjacent segment disease; CDA = cervical disc arthroplasty; FDA = Food and Drug Administration; FSU = functional spinal unit; HO = heterotopic ossification; IDE = investigational device exemption; MCS = Mental Component Summary; NDI = Neck Disability Index; PCS = Physical Component Summary.
Article Information

Contributor Notes

Correspondence Matthew F. Gornet: The Orthopedic Center of St. Louis, St. Louis, MO. mfgspine@gmail.com.INCLUDE WHEN CITING Published online May 10, 2019; DOI: 10.3171/2019.2.SPINE1956.Disclosures The investigational device exemption study was sponsored by Medtronic (Memphis, TN). The authors report the following potential or perceived conflicts: Dr. Gornet: consulting: Aesculap and Medtronic; stock ownership: Bonovo, International Spine & Orthopedic Institute, LLC, Nocimed, OuroBoros, and Paradigm Spine; royalties: Medtronic and RTI. Dr. Burkus: consulting: NuVasive; royalties: Zimmer-Biomet. Ms. Schranck: stock ownership: Nocimed.
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