EFFECT OF CERVICAL DISC ARTHROPLASTY AND ANTERIOR CERVICAL DECOMPRESSION AND FUSION ON ADJACENT SEGMENT DEGENERATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUANTao ¹ , HUZhifu ¹ , XIULei ¹ , LINan ¹ ,  JINQunhua ²

1. Clinical College, Ningxia Medical University, Yinchuan Ningxia, 750004, P. R. China;
2. Third Department of Orthopedics, General Hospital of Ningxia Medical University;

Corresponding author：

JINQunhua, Email: jinqunhua@sina.com

Keywords：

Anterior cervical decompression and fusion; Cervical disc arthroplasty; Adjacent segment degeneration

DOI：

10.7507/1002-1892.20140240

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Objective To compare the effect on adjacent segment degeneration after cervical disc arthroplasty (CDA) and anterior cervical decompression and fusion (ACDF) for treatment of cervical spondylosis. Methods Between August 2009 and February 2012, 60 cases of single segmental cervical spondylosis accorded with the inclusion criteria were included. Of 60 patients, 28 patients underwent CDA (CDA group) and 32 patients underwent ACDF (ACDF group). There was no significant difference in gender, age, disease duration, pathological type, pathological segment, the time of conservation treatment, preoperative neck disability index (NDI), preoperative Japanese Orthopaedic Association (JOA) score, and degeneration of the adjacent segment and disc between 2 groups (P > 0.05). The NDI and JOA score were used to evaluate effectiveness. The range of motion (ROM) of adjacent segment was measured, and degeneration of the adjacent segment and disc was evaluated according to Kellgren grading system based on X-ray and Miyazaki grading system based on T2-weighted MRI, respectively. Results The follow-up time was 24-50 months (mean, 34 months) in 2 groups. All patients had no complication of prosthesis loosening, dislocation, or fracture of plate. The NDI and JOA scores from 12 months after operation were significantly improved compared with preoperative scores in 2 groups (P < 0.05), but no significant difference was found at each time point between 2 groups (P > 0.05). The improvement rate of JOA was 80.68%±4.01% in ACDF group and was 79.44%±3.76% in CDA group at last follow-up, showing no significant difference (t=1.237, P=0.221). And the improvement rate of JOA in 2 groups were excellent. There was no significant difference in ROM and degeneration grading of adjacent segments between at last follow-up and at pre-operation in 2 groups (P > 0.05), and between 2 groups at pre-operation and at last follow-up (P > 0.05). The degeneration grading of disc at last follow-up showed significant difference in 2 groups compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (Z=0.132, P=0.895). Conclusion Both CDA and ACDF can achieve good effectiveness in treating cervical spondylosis, but CDA can not significantly slow down the degeneration of adjacent segment disc.

Citation： GUANTao, HUZhifu, XIULei, LINan, JINQunhua. EFFECT OF CERVICAL DISC ARTHROPLASTY AND ANTERIOR CERVICAL DECOMPRESSION AND FUSION ON ADJACENT SEGMENT DEGENERATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1100-1105. doi: 10.7507/1002-1892.20140240 Copy

1.	Garringer SM, Sasso RC.Safety of anterior cervical discectomy and fusion performed as outpatient surgery.J Spinal Disord Tech, 2010, 23(7):439-443.
2.	Eck JC, Humphreys SC, Lim TH, et al.Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion.Spine (Phila Pa 1976), 2002, 27(22):2431-2434.
3.	Burkus JK, Haid RW, Traynelis VC, et al.Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc:results from a prospective randomized controlled clinical trial.J Neurosurg Spine, 2010, 13(3):308-318.
4.	Garrido BJ, Taha TA, Sasso RC.Clinical outcomes of Bryan cervical disc arthroplasty:a prospective, randomized, controlled, single site trial with 48-month follow-up. Spinal Disord Tech, 2010, 23(6):367-371.
5.	Goffin J, van Loon J, Van Calenbergh F, et al.A clinical analysis of 4-and 6-year follow-up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis.J Neurosurg Spine, 2010, 12(3):261-269.
6.	Yang B, Li H, Zhang T, et al.The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA):a meta analysis of randomized controlled trials.PLoS One, 2012, 7(4):e35032.
7.	Kellgren JH, Jefrey MR, Ball J.The epidemiology of chronic rheumatism.vol Ⅱ:Atlas of standard radiographs of arthritis.Oxford:Blackwell Scientiic Publications, 1963:14-19.
8.	Miyazaki M, Hong SW, Yoon SH, et al.Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine.Spine (Phila Pa 1976), 2008, 33(2):187-193.
9.	Lin Q, Zhou X, Wang X, et al.A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy.Eur Spine J, 2012, 21(3):474-481.
10.	Sasso RC, Anderson PA, Riew KD, et al. Results of cervical arthroplasty compared with anterior discectomy and fusion:four-year clinical outcomes in a prospective, randomized controlled trial.J Bone Joint Surg (Am), 2011, 93(18):1684-1692.
11.	Hilibrand AS, Carlson GD, Palumbo MA, et al.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis.J Bone Joint Surg (Am), 1999, 81(4):519-528.
12.	Heller JG, Sasso RC, Papadopoulos SM, et al.Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion:clinical and radiographic results of a randomized, controlled clinical trial. Spine (Phila Pa 1976), 2009, 34(16):101-107.
13.	Kelly MP, Mok JM, Frisch RF, et al.Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty:analysis from a randomized, controlled trial.Spine (Phila Pa 1976), 2011, 36(15):1171-1179.
14.	Yi S, Lim JH, Choi KS, et al.Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy.Surg Neurol, 2009, 71(6):677-680.
15.	Kim SW, Limson MA, Kim SB, et al.Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases.Eur Spine, 2009, 18(2):218-231.
16.	Pfirrmann CW, Metzdorf A, Zanetti M, et al.Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine (Phila Pa 1976), 2001, 26(17):1873-1878.
17.	Jawahar A, Cavanaugh DA, Kerr EJ, et al.Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine:results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12):1043-1048.
18.	Maldonado CV, Paz RD, Martin CB.Adjacent-level degeneration after cervical disc arthroplasty versus fusion. Eur Spine J, 2011, 3:403-407.
19.	Mummaneni PV, Burkus JK, Haid RW, et al.Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion:a randomized controlled clinical trial.J Neurosurg Spine, 2007, 6(3):198-209.
20.	McCormick PC.The adjacent segment.J Neurosurg Spine, 2007, 6(1):1-4.
21.	Sugawara T, Itoh Y, Hirano Y, et al.Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages.Acta Neurochir (Wien), 2009, 151(4):303-309.

1. Garringer SM, Sasso RC.Safety of anterior cervical discectomy and fusion performed as outpatient surgery.J Spinal Disord Tech, 2010, 23(7):439-443.
2. Eck JC, Humphreys SC, Lim TH, et al.Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion.Spine (Phila Pa 1976), 2002, 27(22):2431-2434.
3. Burkus JK, Haid RW, Traynelis VC, et al.Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc:results from a prospective randomized controlled clinical trial.J Neurosurg Spine, 2010, 13(3):308-318.
4. Garrido BJ, Taha TA, Sasso RC.Clinical outcomes of Bryan cervical disc arthroplasty:a prospective, randomized, controlled, single site trial with 48-month follow-up. Spinal Disord Tech, 2010, 23(6):367-371.
5. Goffin J, van Loon J, Van Calenbergh F, et al.A clinical analysis of 4-and 6-year follow-up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis.J Neurosurg Spine, 2010, 12(3):261-269.
6. Yang B, Li H, Zhang T, et al.The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA):a meta analysis of randomized controlled trials.PLoS One, 2012, 7(4):e35032.
7. Kellgren JH, Jefrey MR, Ball J.The epidemiology of chronic rheumatism.vol Ⅱ:Atlas of standard radiographs of arthritis.Oxford:Blackwell Scientiic Publications, 1963:14-19.
8. Miyazaki M, Hong SW, Yoon SH, et al.Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine.Spine (Phila Pa 1976), 2008, 33(2):187-193.
9. Lin Q, Zhou X, Wang X, et al.A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy.Eur Spine J, 2012, 21(3):474-481.
10. Sasso RC, Anderson PA, Riew KD, et al. Results of cervical arthroplasty compared with anterior discectomy and fusion:four-year clinical outcomes in a prospective, randomized controlled trial.J Bone Joint Surg (Am), 2011, 93(18):1684-1692.
11. Hilibrand AS, Carlson GD, Palumbo MA, et al.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis.J Bone Joint Surg (Am), 1999, 81(4):519-528.
12. Heller JG, Sasso RC, Papadopoulos SM, et al.Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion:clinical and radiographic results of a randomized, controlled clinical trial. Spine (Phila Pa 1976), 2009, 34(16):101-107.
13. Kelly MP, Mok JM, Frisch RF, et al.Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty:analysis from a randomized, controlled trial.Spine (Phila Pa 1976), 2011, 36(15):1171-1179.
14. Yi S, Lim JH, Choi KS, et al.Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy.Surg Neurol, 2009, 71(6):677-680.
15. Kim SW, Limson MA, Kim SB, et al.Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases.Eur Spine, 2009, 18(2):218-231.
16. Pfirrmann CW, Metzdorf A, Zanetti M, et al.Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine (Phila Pa 1976), 2001, 26(17):1873-1878.
17. Jawahar A, Cavanaugh DA, Kerr EJ, et al.Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine:results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12):1043-1048.
18. Maldonado CV, Paz RD, Martin CB.Adjacent-level degeneration after cervical disc arthroplasty versus fusion. Eur Spine J, 2011, 3:403-407.
19. Mummaneni PV, Burkus JK, Haid RW, et al.Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion:a randomized controlled clinical trial.J Neurosurg Spine, 2007, 6(3):198-209.
20. McCormick PC.The adjacent segment.J Neurosurg Spine, 2007, 6(1):1-4.
21. Sugawara T, Itoh Y, Hirano Y, et al.Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages.Acta Neurochir (Wien), 2009, 151(4):303-309.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF CERVICAL DISC ARTHROPLASTY AND ANTERIOR CERVICAL DECOMPRESSION AND FUSION ON ADJACENT SEGMENT DEGENERATION

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