Results of Total Cervical Disc Replacement with a Minimum Follow-up of 10 Years

Retrospective study of patients undergoing single-level total cervical disc replacement (TCDR). Clinical results included the neck disability index (NDI) and the visual analogue scale (VAS) in the preoperative period, one year postoperatively, and a minimum of 10 years of follow-up. The radiographic parameters included cervical mobility, segmental lordosis, C2-C7 angle, heterotopic ossification (HO), facet and joint degeneration (FJD) and adjacent segment disease (ASD).

Results

We identified 22 patients, 16 women and 6 men with mean age of 39.7 years old (26–51 years old), of which fifteen completed a minimum follow-up of 10 years. There was a statistically significant improvement of NDI and VAS (p < 0.001) between the preoperative and the postoperative periods (1 year or > 10 years). At the end of 10 years, HO was observed in 59% of the cases. The mobility of the implant was preserved in 80% of the patients. Radiological evidence of ASD was recorded in 6 patients (40%). There was no correlation between the clinical parameters evaluated and the presence of ASD or the different classes of HO.

Conclusion

Clinical improvement in all evaluated parameters, which persists over time. Most implants maintained mobility, as has already been demonstrated in other studies with shorter follow-ups. In a significant percentage of cases, ASD was observed, questioning the concept of motion preserving technology. However, we did not have any surgical intervention for this reason, since there was no correlation with worse clinical results.

Keywords
total disc replacement; arthroplasty; cervical vertebrae

Inclusion Criteria
Symptomatic degenerative cervical disc disease at one level with cervicalgia and/or brachialgia and/or neurological deficits confirmed by magnetic resonance imaging
Surgery at one cervical level and between C5-C7
Age between 18-65 years old during the period of surgery
Bad results with conservative treatment
Informed consent of the patient

	Prosthesis				NDI (%)			VAS (Cervical)			VAS (Upper Arm)
Patient		Gender	Age	Level	Preoperative	Postoperative (1 year)	≥ 10 years	Preoperative	Postoperative (1 year)	≥ 10 years	Preoperative	Postoperative (1 year)	≥ 10 years
1	Bryan	♂	44	C5C6	68	32	36	9	4	4	5	0	2
2	Bryan	♀	45	C5C6	62	40	16	7	4	1	6	2	0
3	Bryan	♀	46	C5C6	38	42	10	9	6	2	6	1	2
4	Bryan	♂	44	C5C6	48	2	2	8	0	0	6	0	0
5	Bryan	♂	48	C5C6	60	6	4	10	3	2	10	0	0
6	Prestige	♂	40	C6C7	80	14	14	9	2	0	8	4	2
7	Prestige	♀	33	C5C6	98	14	24	8	1	1	8	2	0
8	Prestige	♀	35	C6C7	82	10	18	10	4	3	10	1	2
9	Prestige	♀	26	C5C6	98	8	22	8	1	0	8	1	1
10	Prestige	♀	42	C6C7	92	8	10	8	3	0	8	3	0
11	Prestige	♀	51	C5C6	68	60	46	8	8	6	10	5	0
12	Prestige	♂	35	C6C7	68	2	4	8	0	0	10	1	0
13	Prestige	♀	36	C6C7	82	8	18	8	0	0	10	4	0
14	Prestige	♀	30	C5C6	72	14	14	7	4	0	9	1	0
15	Prestige	♂	41	C5C6	60	14	12	7	5	1	7	0	0
16	Prestige^* * Complication with conversion to anterior arthrodesis in the 24-48h post op period .	♀	47	C5C6	70	-	-	7	-	-	8	-	-

	McAffee					Cervical Lordosis			Segmental Lordosis			ASD
Patient	0	I	II	III	IV	Preoperative	Postoperative (1 year)	≥ 10 years	Preoperative	Postoperative (1 year)	≥ 10 years
1	X					15	23	15	3	12	3.7	X
2	X					10	11.0	10.0	4	3	6.0	X
3	X					8	13.0	12	3	3.2	3.2	X
4					X	14	13.0	11	12	13	10	√
5		X				5	10.0	7	4	9	5	X
6					X	9	22.0	10	3	3	3	X
7	X					2	20.0	12	2.1	2	2	X
8	X					20	15.0	13.1	11	10	10	√
9		X				12	25.0	18	3	5	5	X
10		X				10	18.0	12	5	3	3	X
11	X					10	19.0	15	0	5	5	√
12				X		9	17.0	17	4	7.7	6	X
13				X		-17	-5.0	-5	6	9	9	√
14		X				-20	-9.0	-9	2	2	2	√
15					X	8	10.0	9.3	0	0	0	√
16^* * Complication with conversion to anterior arthrodesis in the 24-48h post op period.						-	-	-	-	-	-	-

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence João Pedro Ferraz Montenegro Lobo, MD, Department of Orthopedics of Centro Hospitalar São João Hospital, Avenida Prof. Hernâni Monteiro, 4202–451 Porto, Portugal (e-mail: joao_2523@hotmail.com).

Brasil

Brasil

Results of Total Cervical Disc Replacement with a Minimum Follow-up of 10 Years* * Study conducted at the Department of Orthopedics, Hospital São João, Porto, Portugal.

Abstract

Objective

Methods

Results

Conclusion

Results of Total Cervical Disc Replacement with a Minimum Follow-up of 10 Years^* * Study conducted at the Department of Orthopedics, Hospital São João, Porto, Portugal.