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Adjacent segment disease and C-ADR: promises fulfilled?
K Daniel Riew1, Jeannette M Schenk-Kisser, Andrea C Skelly
1Washington University Orthopedics, St Louis, MO, USA.
Evidence-Based Spine-Care Journal
|December 14, 2012
Summary
Cervical disc arthroplasty (C-ADR) does not show evidence of decreasing adjacent segment disease (ASD) compared to anterior cervical discectomy and fusion (ACDF). Current research indicates no significant difference in ASD rates or timing between these surgical treatments.
Area of Science:
- Spine surgery
- Degenerative disc disease
- Biomechanical engineering
Background:
- Adjacent segment disease (ASD) is a potential complication following cervical spine surgery.
- Cervical disc arthroplasty (C-ADR) was proposed as an alternative to anterior cervical discectomy and fusion (ACDF) to potentially reduce ASD.
- Long-term comparative data on ASD rates between C-ADR and ACDF are crucial for clinical decision-making.
Purpose of the Study:
- To compare the rates and timing of adjacent segment disease (ASD) between cervical disc arthroplasty (C-ADR) and anterior cervical discectomy and fusion (ACDF).
- To evaluate the efficacy of C-ADR in preventing or delaying ASD compared to ACDF in patients with cervical degenerative disc disease.
Main Methods:
- Systematic review of MEDLINE/PubMed and article bibliographies.
- Inclusion of studies with long-term follow-up (48-60 months) of primary FDA-approved C-ADR devices (Prestige ST, Prodisc-C, Bryan) and other discs (≥24 months follow-up).
- Exclusion of studies on lordosis/angle changes and case series; focus on symptomatic and/or radiographic ASD.
Main Results:
- Analysis of four reports from three randomized controlled trials and four nonrandomized studies.
- No significant difference in symptomatic ASD rates (1.5%-2.3% risk difference) between C-ADR and ACDF.
- No significant difference in the time to ASD development; variable radiographic ASD rates; no significant differences in adjacent segment range of motion.
Conclusions:
- Current evidence does not support the hypothesis that cervical disc arthroplasty decreases adjacent segment disease compared to anterior cervical discectomy and fusion.
- The anticipated benefit of arthroplasty in reducing ASD has not been demonstrated in available long-term studies.
- Further research may be needed to clarify the long-term impact of C-ADR on adjacent segment health.
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