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Cervical disc prosthesis: 2-year follow-up

Prótese de disco cervical: 2 anos de seguimento

Prótesis de disco cervical: 2 años de seguimiento

Abstracts

OBJECTIVE:

To review the medical records of patients who underwent surgery for placement of cervical disc prosthesis after two years of postoperative follow-up, showing the basic epidemiological data, the technical aspects and the incidence of complications.

METHODS:

Medical records of seven patients who underwent surgery for placement of cervical disc prosthesis were reviewed after two years of follow-up, at the Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo.

RESULTS:

The average age of patients participating in this study was 43.86 years. Six patients (85.7%) had one level approached while one patient (14.3%) had two levels addressed. The level C5-C6 has been approached in one patient (14.3%) while the C6-C7 level was addressed in five patients (71.4%). One patient (14.3%) had these two levels being addressed, C5-C6 and C6-C7. The mean operative time was 164.29±40 minutes. Three patients were hospitalized for 2 days and four for 3 days making an average of 2.57±0.535 days. Two patients (28.6%) underwent a new surgical intervention due to loosening of the prosthesis. The mean follow-up was 28.14±5.178 months (23-35 months).

CONCLUSIONS:

Although cervical arthroplasty appears to be a safe procedure and present promising results in our study as well as in many other studies, it requires long-term studies.

Intervertebral disc degeneration; Arthroplasty; Joint prosthesis; Spine


OBJETIVO:

Revisar las historias clínicas de los pacientes que se sometieron a cirugía para colocación de prótesis de disco cervical después de dos años de seguimiento postoperatorio, que muestran los datos epidemiológicos básicos, los aspectos técnicos y la incidencia de complicaciones.

MÉTODOS:

Fueron revisados los registros médicos de siete pacientes que se sometieron a cirugía para colocación de prótesis de disco cervical después de dos años de seguimiento en el Instituto de Ortopedia y Traumatología de la Facultad de Medicina de la Universidad de São Paulo.

RESULTADOS:

La edad media de los pacientes que participaron en este estudio fue de 43,86 años. Seis pacientes (85,7%) tuvieron un nivel a ser abordado mientras que un paciente (14,3%) tuvo dos niveles abordados. El nivel C5-C6 ha sido tratado por separado en un paciente (14,3%), mientras que el nivel de C6-C7 fue tratado en cinco pacientes (71,4%). Un paciente (14,3%) tuvo dos niveles abordados, C5-C6 y C6-C7. El tiempo quirúrgico promedio fue de 164,29 ± 40 minutos. Tres pacientes fueron hospitalizados por 2 días y cuatro por 3 días, lo que hace una media de 2,57 ± 0,535 días. Dos pacientes (28,6%) fueron sometidos a una nueva intervención quirúrgica debido al aflojamiento de la prótesis. El promedio de seguimiento fue de 28,14 ± 5,178 meses (23-35 meses).

CONCLUSIONES:

Aunque la artroplastia cervical parezca un ser procedimiento seguro y que presente resultados prometedores en nuestro estudio, así como en muchos otros estudios, necesita estudios a largo plazo.

Degeneración del disco intervertebral; Artroplastia; Prótesis articulares; Columna vertebral


OBJETIVO:

Revisar os prontuários de pacientes que foram submetidos à cirurgia para colocação de prótese de disco cervical, após dois anos de seguimento pós-operatório, evidenciando os dados epidemiológicos básicos, os aspectos da técnica e a incidência de complicações.

MÉTODO:

Foram revisados os prontuários de sete pacientes submetidos à cirurgia para colocação de prótese de disco cervical após dois anos de seguimento no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo.

RESULTADO:

A média de idade dos pacientes participantes no presente estudo foi 43,86 anos. Seis pacientes (85,7%) tiveram um nível abordado enquanto um paciente (14,3%) teve dois níveis abordados. O nível C5-C6 foi abordado isoladamente em um paciente (14,3%) enquanto o nível C6-C7 em cinco pacientes (71,4%). Um paciente (14,3%) teve dois níveis abordados sendo estes C5-C6 e C6-C7. A média de tempo cirúrgico foi de 164,29 ± 40 minutos. Três pacientes ficaram internados por 2 dias e quatro por 3 dias, perfazendo uma média de 2,57 ± 0,535 dias. Dois pacientes (28,6%) foram submetidos a reintervenção cirúrgica devido à soltura da prótese. O acompanhamento médio foi de 28,14 ± 5,178 meses (23-35 meses).

CONCLUSÕES:

A artroplastia cervical, apesar de parecer ser um procedimento seguro e apresentar resultados promissores em nosso estudo, bem como em diversos estudos da literatura, necessita de estudos a longo prazo.

Degeneração de disco intervertebral; Artroplastia; Prótese articular; Coluna vertebral


INTRODUCTION

The primary cause of chronic neck pain is degeneration of cervical intervertebral discs due to aging.1Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004. Disc degeneration may result in rupture or herniation, spinal instability, facet joint syndrome, or radiculopathy affecting the upper ends, due to compression of spinal nerves.2Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg. 1998;88(6):943-8. , 3Bryan VE Jr. Cervical motion segment replacement. Eur Spine J. 2002;11(Suppl 2):S92-7. The resulting pain can lead to significant disability.1Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004. Existing treatments for cervical disc degeneration include surgery or conservative methods such as rest, heat, electrotherapy, physiotherapy and analgesics.3Bryan VE Jr. Cervical motion segment replacement. Eur Spine J. 2002;11(Suppl 2):S92-7. Currently there are two main surgical techniques for the treatment of disc degeneration: the removal of the disc (discectomy or nucleotomy) i.e., removal of the nucleus, anterior and posterior components, and ring, followed by spinal fusion, which consists of grafting bone between the adjacent vertebrae to the degenerated disc to remove the damaged segment of the joint, which is typically performed for treating degeneration associated with instability and reduce inter-vertebral space.2Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg. 1998;88(6):943-8. , 4Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13 Frontal cervical plate or rigid internal fixation may also be used to promote fusion.4Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13 However, there is significant evidence confirming that biomechanical stress increases between the discs above and below the fusion, resulting in symptomatic degenerative disc disease in the adjacent levels.4Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13

McAfee PC, Cunningham B, Dmitriev A, Hu N, Woo Kim S, Cappuccino A, Pimenta L. Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2003;28(20):S176-85.

Pickett GE, Duggal N. Artificial disc insertion following anterior cervical discectomy. Can J Neurol Sci. 2003;30(3):278-83.

Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg. 2002;96(Suppl 1):17-21.

Wigfield CC, Gill SS, Nelson RJ, Metcalf NH, Robertson JT. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine (Phila Pa 1976). 2002;27(22):2446-52.

DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23.
- 1010 Guyer RD, Ohnmeiss DD. Intervertebral disc prostheses. Spine (Phila Pa 1976). 2003;28(Suppl 15):S15-23.

Discectomy involves excision of part or the whole degenerated disc and it is typically performed in root syndrome treatment, in cases of disc herniation. Half of surgical discectomy procedures involve removal of disc material that is invading the spinal nerve.1Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004. Although discectomy often eases symptoms by removing the compression of spinal nerves, it does not treat degeneration of the nucleus pulposus, nor restores the integrity of the damaged disc. Therefore, although the discectomy alone can succeed in alleviating the symptoms of disc degeneration, natural mobility is reduced as a result thereof. Although complications are relatively rare, they include infection, dural injury, nerve injury, and segmental instability (which may require reoperation).1Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004.

Spinal fusion effectively eliminates motion segment between two vertebrae through bone graft or similar material, thereby providing improved stability, and pain reduction.1Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004. , 7Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg. 2002;96(Suppl 1):17-21. However, the spinal fusion success rate proved to be highly variable.9DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23. Therefore, in recent years, spinal fusion has been completed by various fixing methods to increase the fusion rate. Interbody fusion cages can yield high fusion rates, but internal fixation increases the rigidity of the welded area, resulting in additional strain on the adjacent non-welded segments.9DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23. Fixation methods have also included both dorsal and frontal plates, which are intended to increase the fusion rate and provide stability until the fusion occurs.4Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13 , 7Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg. 2002;96(Suppl 1):17-21.

Wigfield CC, Gill SS, Nelson RJ, Metcalf NH, Robertson JT. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine (Phila Pa 1976). 2002;27(22):2446-52.
- 9DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23. Although these devices may facilitate fusion, there is a growing concern about the disease of adjacent levels after the well succeeded fusion.6Pickett GE, Duggal N. Artificial disc insertion following anterior cervical discectomy. Can J Neurol Sci. 2003;30(3):278-83.

Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg. 2002;96(Suppl 1):17-21.

Wigfield CC, Gill SS, Nelson RJ, Metcalf NH, Robertson JT. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine (Phila Pa 1976). 2002;27(22):2446-52.
- 9DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23. Moreover, complications with plate devices reported in the literature describe migrating or breaking pins or its housing into the esofagus.9DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23.

Patients whose charts were reviewed in this study were treated with a cervical disc prosthesis brand Porous Coated Motion (PCM-VTM) (Implamed, USA), designed to provide a new modality of treatment as an alternative to fusion with or without internal fixation. The device is a modular system designed to stabilize the spine after discectomy without fusion, thus preserving the flexibility of the operated level(s) of the cervical spine.2Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg. 1998;88(6):943-8. , 4Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13 It is indicated for use in the treatment of disc degenerative disease in one or two levels of the cervical spine (C3-C4 to C6-C7), in patients with skeletal maturity with associated radicular pain aiming to provide an additional therapeutic option to maintain the position of the drive segment and the spacing while preserving the flexibility of the adjacent cervical vertebral levels.

The objective of this paper is to review the medical records of patients who underwent surgery for placement of cervical disc prosthesis, after two years of postoperative follow-up, showing the basic epidemiological data (gender and age), aspects of the surgical technique (surgical time, volume of intraoperative bleeding and length of hospital stay), as well as the incidence of complications or reoperation estimating, therefore, the safety of the procedure.

METHODS

This is a retrospective cross-sectional study in which records of seven patients undergoing surgery for placement of cervical disc prosthesis after two years of follow-up were reviewed. The study was conducted at the Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, an institution linked to the Unified Health System (SUS) which conducts medium and high complexity medical activities, becoming a reference in teaching, research and medical assistance. Data were statistically analyzed and as it is a descriptive work, the intention was to build tables and graphs on absolute and relative values (percentages) for comparison with the data from the literature.

This study was approved by the Research Ethics Committee of the Institution and follows specific resolution of the National Health Council (Nº 466/2012) under protocol Nº 030/06.

RESULTS

The mean age of patients participating in this study was 43.86 years old (minimum 32, maximum 55) with a standard deviation of 9.082 years old. Regarding the levels operated, six patients (85.7%) had one level operated while one patient (14.3%) had two levels operated. C5-C6 level has been operated in one patient alone (14.3%), while the C6-C7 level in five patients (71.4%). One patient (14.3%) had two levels operated, C5-C6 and C6-C7. (Figure 1) Regarding surgical time, the average value was 164.29 ± 40 minutes (minimum 75 and maximum 190 minutes). Regarding hospitalization days, three patients were hospitalized for two days and four for three days, 2.57 ± 0.535 days on average. Two patients (28.6%) underwent reoperation, one of them seven months after surgery for placement of the prosthesis and the other after nine months, resulting 8 ± 1.414 months on average, both due to loosening of the prosthesis. No heterotopic ossification was seen in the cases studied. The average follow-up tome was 28.14 ± 5.178 months (23-35 months) (Table 1).

Figure 1
Number of patients distributed by neurological levels operated.

Table 1.
Epidemiological and surgical data of cases.

DISCUSSION

The current standard treatment for cervical myelopathy is anterior discectomy followed by arthrodesis. Since its introduction in the 50s, studies have shown excellent pain relief rates and a significant rate of fusion.1111 Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 1990;15(10):1023-5.

12 Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602-17.

13 Emery SE, Bolesta MJ, Banks MA, Jones PK. Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine (Phila Pa 1976). 1994;19(6):660-3.

14 Robinson RA, Smith GW. Antero-lateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223-224.
- 1515 Williams JL, Allen MB Jr, Harkess JW. Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg Am. 1968;50(2):277-86. The advent of cervical plates further improved fusion rates, especially in cases of operation of multiple levels.1616 Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229-36.

17 Wang JC, McDonough PW, Endow KK, Delamarter RB. Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2000;25(1):41-5.
- 1818 Wang JC, McDonough PW, Kanim LE, Endow KK, Delamarter RB. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2001;26(6):643-6. Although presenting good results in the short term, the literature has shown degeneration of adjacent levels due to segmental stiffness achieved with arthrodesis. Matsunaga et al.1919 Matsunaga S, Kabayama S, Yamamoto T, Yone K, Sakou T, Nakanishi K. Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976). 1999;24(7):670-5.analyzed the strength distribution on the intervertebral discs after cervical arthrodesis and confirmed an increase in immediately adjacent levels.

Data from long-term studies (5-10 years) suggest that in patients undergoing discectomy and anterior arthrodesis significant radiographic changes in adjacent levels such as joint narrowing or development of new osteophytes translated clinically as emergence of a new radiculopathy or myelopathy arising from this new impaired level.2020 Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519-28. A retrospective study showed that ossification of the anterior longitudinal ligament occur in 59% of cephalic interdiscal space ad and 29% of caudal space (p <0.001).2121 Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005;87(3):558-63. Goffin et al.2222 Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, Van, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004;17(2):79-85.have shown in a follow-up of at least 60 months a ratio 6.11% of surgical re-intervention due to adjacent symptomatic degeneration. Seok et al.2323 Kim SW, Limson MA, Kim SB, Arbatin JJ, Chang KY, Park MS, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J. 2009;18(2):218-31. demonstrated in a comparative study of patients undergoing cervical arthroplasty and decompression followed by arthrodesis a higher average motion and height of the intervertebral space in the group submitted to cervical disc prosthesis placement, while radiographic changes were 3.5 times more frequent in the discectomy and arthrodesis group. Also in this study, the authors reported a higher rate of degenerative alterations of neighboring levels (about twice) comparing two levels operated (both in arthrodesis surgery as in arthroplasty) in relation to only one level.2424 Yoon DH, Yi S, Shin HC, Kim KN, Kim SH. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien). 2006;148(9):943-50.

In this context, the cervical disc prosthesis arises, where the preservation of some degree of motion in the affected joint has the advantage to lead to less stress on neighboring joints.2424 Yoon DH, Yi S, Shin HC, Kim KN, Kim SH. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien). 2006;148(9):943-50.

25 Cheng L, Nie L, Li M, Huo Y, Pan X. Superiority of the Bryan((r)) disc prosthesis for cervical myelopathy: a randomized study with 3-year followup. Clin Orthop Relat Res. 2011;469(12):3408-14.

26 Du J, Li M, Liu H, Meng H, He Q, Luo Z. Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis. Spine J. 2011;11(4):281-9.

27 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. J Spinal Disord Tech. 2010;23(6):367-71.

28 Boden SD, Balderston RA, Heller JG, Hanley EN Jr, Zigler JE. An AOA critical issue. Disc replacements: this time will we really cure low-back and neck pain? J Bone Joint Surg Am. 2004;86(2):411-22.

29 Lafuente J, Casey AT, Petzold A, Brew S. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases. J Bone Joint Surg Br. 2005;87(4):508-12.

30 Lin EL, Wang JC. Total disk arthroplasty. J Am Acad Orthop Surg. 2006;14(13):705-14.
- 3131 Shim CS, Lee SH, Park HJ, Kang HS, Hwang JH. Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech. 2006;19(7):465-70. Recovery of cervical kinematic is partial, in relation to physiological, but this recovery seems to prove superiority over the discectomy and arthrodesis with regard to adjacent joint wear.3232 Barrey C, Campana S, Persohn S, Perrin G, Skalli W. Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation. Eur Spine J. 2012;21(3):432-42. Nabhan et al.3333 Nabhan A, Ahlhelm F, Pitzen T, Steudel WI, Jung J, Shariat K, et al. Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study. Eur Spine J. 2007;16(3):423-30. used a radiostereometric analysis to quantify the intervertebral mobility and concluded that there is a significant difference between the group that underwent arthrodesis and the group submitted to arthroplasty after 3-24 weeks. In another study, the average mobility post- one level arthroplasty after 24 months was 7,95° (preoperative value was 6.43°) while the average mobility in arthrodesis is 1.11° and 0.87° in three and 24 months postoperative, respectively.3434 Goffin J, Pointillart V, Lind B, Casey A, Kehr P, Logroscino C, et al. Two-year clinical results from a multicenter study of the Bryan cervical disc system. Proceedings of the NASS 19th annual meeting. Spine J. 2004;4(Suppl 5):3-199. In the literature good results can be found, such as that reported by Goffin et al.3434 Goffin J, Pointillart V, Lind B, Casey A, Kehr P, Logroscino C, et al. Two-year clinical results from a multicenter study of the Bryan cervical disc system. Proceedings of the NASS 19th annual meeting. Spine J. 2004;4(Suppl 5):3-199. (90% good results with cervical disc prosthesis implants in one level and 88% and 86% of the cervical motion preservation in patients treated with one level and two levels arthroplasty, respectively, after one year).

Cheng et al.2525 Cheng L, Nie L, Li M, Huo Y, Pan X. Superiority of the Bryan((r)) disc prosthesis for cervical myelopathy: a randomized study with 3-year followup. Clin Orthop Relat Res. 2011;469(12):3408-14. reported few complications for this method over conventional discectomy followed by arthrodesis in a follow-up of 83 patients over three years, concluding that this method is safe and effective. Comparing these two methods, Zang et al.3535 Zhang X, Chen C, Zhang Y, Wang Z, Wang B, Yan W, et al. Randomized, controlled, multicenter, clinical triang comparing Bryan cervical disc arthroplasty with anterior cervical descompression and fusion in China. Spine (Phila Pa 1976). 2012;37(6):433-8. described a surgery time in patients undergoing cervical arthroplasty, but their conclusion was that it is a feasible procedure as an alternative to conventional anterior decompression.

The mean age of 40.86 ± 9.082 years old presents similar data in the literature.2323 Kim SW, Limson MA, Kim SB, Arbatin JJ, Chang KY, Park MS, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J. 2009;18(2):218-31. , 3636 Enan A, Abu-Hegazy M, Abo-Hegy M, Al-Kerdany A. Single level cervical arthroplasty with the Discocerv prosthesis: a preliminary report. Acta Orthop Belg. 2011;77(2):224-9.

CONCLUSION

Despite the good results, long-term studies are needed. Cervical arthroplasty appears to be a safe procedure and shows promising results in our study, as in many studies in the literature. However, this method is relatively new, and more studies, especially those with long term follow up are needed to confirm its effectiveness in preventing degenerative disease of the adjacent disc.

REFERENCES

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    Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002;76(6):998-1004.
  • 2
    Cummins BH, Robertson JT, Gill SS. Surgical experience with an implanted artificial cervical joint. J Neurosurg. 1998;88(6):943-8.
  • 3
    Bryan VE Jr. Cervical motion segment replacement. Eur Spine J. 2002;11(Suppl 2):S92-7.
  • 4
    Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307-13
  • 5
    McAfee PC, Cunningham B, Dmitriev A, Hu N, Woo Kim S, Cappuccino A, Pimenta L. Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2003;28(20):S176-85.
  • 6
    Pickett GE, Duggal N. Artificial disc insertion following anterior cervical discectomy. Can J Neurol Sci. 2003;30(3):278-83.
  • 7
    Wigfield C, Gill S, Nelson R, Langdon I, Metcalf N, Robertson J. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg. 2002;96(Suppl 1):17-21.
  • 8
    Wigfield CC, Gill SS, Nelson RJ, Metcalf NH, Robertson JT. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine (Phila Pa 1976). 2002;27(22):2446-52.
  • 9
    DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16(4):314-23.
  • 10
    Guyer RD, Ohnmeiss DD. Intervertebral disc prostheses. Spine (Phila Pa 1976). 2003;28(Suppl 15):S15-23.
  • 11
    Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 1990;15(10):1023-5.
  • 12
    Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602-17.
  • 13
    Emery SE, Bolesta MJ, Banks MA, Jones PK. Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine (Phila Pa 1976). 1994;19(6):660-3.
  • 14
    Robinson RA, Smith GW. Antero-lateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223-224.
  • 15
    Williams JL, Allen MB Jr, Harkess JW. Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg Am. 1968;50(2):277-86.
  • 16
    Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229-36.
  • 17
    Wang JC, McDonough PW, Endow KK, Delamarter RB. Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2000;25(1):41-5.
  • 18
    Wang JC, McDonough PW, Kanim LE, Endow KK, Delamarter RB. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2001;26(6):643-6.
  • 19
    Matsunaga S, Kabayama S, Yamamoto T, Yone K, Sakou T, Nakanishi K. Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976). 1999;24(7):670-5.
  • 20
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519-28.
  • 21
    Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005;87(3):558-63.
  • 22
    Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, Van, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004;17(2):79-85.
  • 23
    Kim SW, Limson MA, Kim SB, Arbatin JJ, Chang KY, Park MS, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J. 2009;18(2):218-31.
  • 24
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  • Work developed at Universidade de São Paulo, Faculdade de Medicina do Estado de São Paulo, Spine Group of the Institute of Orthopedics and Traumatology, Hospital das Clínicas da São Paulo, SP, Brazil.

Publication Dates

  • Publication in this collection
    June 2015

History

  • Received
    03 Nov 2013
  • Accepted
    08 Apr 2014
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