Cervical disc arthroplasty versus anterior cervical discectomy and fusion for the treatment of single-level disc degenerative disease with preoperative reversible kyphosis
Introduction
Anterior cervical discectomy and fusion (ACDF) is traditionally the standard procedure to manage cervical degenerative disease that involves less than 3 levels. It could be indicated for various cervical disc pathology like segmental instability, severe facet joint degeneration and kyphosis [1]. For patients with preoperative kyphosis, short segment fusion operation could remarkably increase cervical lordosis by appropriate placement of interbody spacer [2]. Moreover, current studies [[3], [4], [5], [6]] indicated the stand-alone cage with integrated screw fixation had the similar capacity for maintaining segmental and overall alignment in comparison to the interbody cage plus anterior plate.
In recent years, cervical disc arthroplasty (CDA) provides a viable motion-preserving option for cervical degenerative disease. By maintaining the motion of the surgical level, CDA has the potential to decrease the biomechanical stress on adjacent levels, theoretically slowing down adjacent segment degeneration. Several randomized controlled studies reported that CDA achieved equivalent or superior outcomes compared with fusion [[7], [8], [9]]. However, it remained controversial whether CDA could be indicated for patient with kyphosis. On the one hand, most surgeons took a cautious and suspicious attitude towards the application of CDA in the spine with malalignment because of its lack of anterior column support and specific considerations to the segmental kyphosis after insertion with BRYAN® Cervical Disc (Medtronic, Sofamor Danek, Memphis) [10,11]. One the other hand, some authors found CDA could restore the cervical alignment to some extent [[12], [13], [14], [15], [16]]. Our previous study [16] found the cervical alignment of patients with preoperative reversible kyphosis experienced significant improvements after single-level CDA, although it was still significantly inferior to that of matched patients with preoperative lordosis.
The purpose of this study was to evaluate and compare the clinical and radiological outcomes of single-level CDA with Prestige-LP Disc (Medtronic Sofamor Danek, Memphis, TN) and single-level ACDF with Zero-P Spacer (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the patient with preoperative reversible kyphosis. In this study, special attention was paid to the radiological outcome of cervical alignment.
Section snippets
Implants introduction
The Prestige-LP Disc, the fifth generation of Prestige family, is manufactured from a titanium ceramic composite. It is a 2-piece disc consisting of a metal-on-metal device with a ball-and-trough articulation design. The radius of curvature of the ball on the upper plate is smaller than that of the trough on the lower plate. This semi-constraint design allows the flexion-extension motion to be coupled with the anterior-posterior translation in the sagittal plane [17].
The Zero-P Spacer consists
Results
Eighty-two patients were enrolled in the study, 2 of which were excluded for poor imaging quality or incomplete data. In the final analysis, there were 38 patients in CDA group (mean follow-up of 39.8 months, ranging from 20 to 64 months) and 42 patients (37.6 months, ranging from 18 to 61 months) in ACDF group. There was no significant difference in baseline data like age, gender, symptoms, index level and follow-up time between 2 groups (Table 1).
Discussion
Cervical disk arthroplasty has proven to be effective in the treatment of cervical disk degenerative for a certain population [[7], [8], [9], [10]]. Due to strict indications and reasonable prudence towards this new surgical technique, most studies reported the application of CDA in lordotic or straight cervical spine. Whether and when CDA could be indicated for preoperative cervical spine kyphosis is unclear. In this study, we reported the clinical and radiological outcomes of single-level CDA
Conclusion
For the patients with single-level disc degenerative disease and preoperative reversible kyphosis, both CDA and ACDF achieved satisfactory and comparable clinical results. CDA was non-inferior to ACDF regarding the radiological outcomes of cervical alignment. Patients in CDA group had a relatively high incidence of HO formation.
Funding
This study was supported by the National Natural Science Foundation of China (NO.31700839), Chengdu Science and Technology Program Projects (2017-CY02-00025-GX), Sichuan Province Science and Technology Program (NO.2019YFS0357) and 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH040).
CRediT authorship contribution statement
Xu Hu: Conceptualization, Methodology, Writing - original draft. Hao Liu: Data curation, Resources. Beiyu Wang: Conceptualization, Supervision, Writing - review & editing. Ying Hong: Data curation, Resources. Xin Rong: Investigation, Validation, Software. Dan Pu: Data curation, Resources. Kangkang Huang: Investigation, Validation, Software.
Declaration of Competing Interest
The authors declare that they have no conflict of interest.
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