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Cervical disc arthroplasty as a safe and effective procedure for obese patients
Daniel Zeitouni1,2, Landon M Burton3, Trent VanHorn1,2
11Atrium Health Neurological Surgery, Charlotte.
Objective:
Cervical disc arthroplasty (CDA) is an effective motion-sparing procedure for patients with cervical radiculopathy or myelopathy. Obese patients undergoing anterior cervical discectomy and fusion have higher complication rates, but the procedure remains effective in this population. The aim of this study was to determine the safety and efficacy of CDA in appropriately selected obese patients.
Methods:
This single-institution retrospective cohort study included adult patients who underwent CDA from July 2015 to December 2020. Patients were included if they had baseline and at least 4-year postoperative patient-reported outcome measures (PROMs), including the Neck Disability Index (NDI), numeric rating scale (NRS) for neck pain and arm pain, EQ-5D, and North American Spine Society patient satisfaction questionnaire. Demographic, intraoperative, and postoperative characteristics were collected. Patients were divided into nonobesity (BMI < 30) and obesity (BMI ≥ 30) groups.
Results:
There were 83 patients included in this study, with 49 in the nonobesity group and 34 in the obesity group. Obese patients were more likely to have diabetes mellitus and a higher American Society of Anesthesiologists class. There were no significant differences in the operative duration, hospital length of stay, estimated blood loss, 90-day readmission rate, 90-day return to the operating room rate, or time to return to work. The mean follow-up duration was 5.6 years in the nonobesity group and 5.1 years in the obesity group. Both groups significantly improved across all PROMs postoperatively (p < 0.001). There were no significant differences in preoperative or postoperative NDI, NRS neck pain, NRS arm pain, or EQ-5D scores. There were no significant differences in patient satisfaction with surgery (89.8% satisfied in nonobesity group and 85.3% satisfied in obesity group; OR 1.52, 95% CI 0.40-5.71).
Conclusions:
CDA is a safe and effective motion-sparing procedure for cervical radiculopathy and myelopathy in appropriately selected obese patients.
