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Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels.
Matthew F Gornet1, Francine W Schranck2, Katrine M Sorensen2
1The Orthopedic Center of St Louis, St Louis, Missouri.
International Journal of Spine Surgery
|September 30, 2020
Summary
Cervical disc arthroplasty (CDA) for 3- and 4-level degenerative disc disease shows significant long-term improvements in patient outcomes and satisfaction. This study demonstrates the safety and effectiveness of multi-level CDA in appropriately selected patients.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Spinal Surgery
Background:
- Multilevel cervical degenerative disc disease presents treatment challenges.
- Anterior cervical discectomy and fusion has high rates of adjacent segment disease.
- Cervical disc arthroplasty (CDA) is FDA-approved for 1- and 2-level pathology, with limited evidence for more levels.
Purpose of the Study:
- To investigate the long-term outcomes of 3- and 4-level cervical disc arthroplasty (CDA).
- To evaluate the safety and effectiveness of multi-level CDA up to 7 years postoperatively.
Main Methods:
- Retrospective review of prospectively collected data from 139 patients (116 three-level, 23 four-level CDA).
- Collection of patient-reported outcomes (PROs) including Neck Disability Index (NDI), pain scores, Veterans Rand 12-item Health Survey (PCS/MCS), and satisfaction.
- Analysis using mixed-effects regression models to assess outcomes up to 7 years.
Main Results:
- All PRO scores showed statistically significant improvement at all postoperative intervals (P < .001).
- Mean NDI improved by 45.9%, neck pain by 49.4%, arm pain by 54.1%, PCS by 41.8%, and MCS by 19.9% from preoperatively to 7 years.
- Only 3.6% of three-level CDA patients required secondary surgery, with over 88% patient satisfaction at 7 years.
Conclusions:
- Three- and four-level CDA demonstrate statistically significant improvements in PROs.
- Low rates of secondary surgery and high patient satisfaction indicate safety and effectiveness.
- Multi-level CDA is a viable option for appropriately selected patients with cervical degenerative disc disease.
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