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Twenty-Year Radiographic Outcomes Following Single-Level Cervical Disc Arthroplasty: Results From a Prospective
David P Foley1, Willa R Sasso2, Jason Y Ye3
1Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
Spine
|November 29, 2023
Summary
Cervical disc arthroplasty (CDA) preserves cervical range of motion and shows significantly lower adjacent segment degeneration compared to anterior cervical discectomy and fusion (ACDF) after 20 years. CDA also demonstrated reduced adjacent-level ossification development.
Area of Science:
- Spine surgery outcomes
- Orthopedic biomechanics
- Degenerative disc disease research
Background:
- Anterior cervical discectomy and fusion (ACDF) is the standard surgical treatment for cervical radiculopathy due to disc degeneration.
- Cervical disc arthroplasty (CDA) is proposed to reduce shear strain, potentially mitigating adjacent segment degeneration (ASD) linked to ACDF's altered range of motion (ROM).
Purpose of the Study:
- To compare long-term (20-year) range of motion (ROM) and adjacent segment degeneration (ASD) between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF).
- Evaluate the impact of CDA versus ACDF on cervical spine biomechanics and degeneration over two decades.
Main Methods:
- A prospective randomized controlled trial involving 47 patients undergoing either ACDF or CDA.
- Lateral cervical spine radiographs were analyzed preoperatively, postoperatively, and at the 20-year follow-up.
- Key outcome measures included cervical alignment, ROM, ASD, and heterotopic ossification.
Main Results:
- At 20 years, total cervical ROM was significantly higher in the CDA group (47.8°) compared to the ACDF group (33.4°).
- Adjacent segment degeneration (ASD) grading was significantly lower in the CDA group versus the ACDF group.
- Twenty-year adjacent-level ossification development was significantly increased following ACDF compared to CDA.
Conclusions:
- Cervical disc arthroplasty (CDA) effectively maintains index-level and total cervical range of motion with very long-term follow-up.
- CDA demonstrates superior outcomes over anterior cervical discectomy and fusion (ACDF) by resulting in lower rates of adjacent segment degeneration and ossification.
