Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up
Objective The long‐term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore,...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13900 |
| _version_ | 1797640295147372544 |
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| author | Ting‐kui Wu Jun‐bo He Kang‐kang Huang Xin Rong Chen Ding Bei‐yu Wang Hao Liu |
| author_facet | Ting‐kui Wu Jun‐bo He Kang‐kang Huang Xin Rong Chen Ding Bei‐yu Wang Hao Liu |
| author_sort | Ting‐kui Wu |
| collection | DOAJ |
| description | Objective The long‐term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid‐ to long‐term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non‐surgically treated adjacent segments. Methods We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2‐C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre‐ and postoperative values were compared using paired t‐tests or Wilcoxon rank‐sum tests. Independent Student t‐tests or Mann–Whitney U tests analyzed continuous data between CDA and HS groups, while chi‐square or Fisher exact tests assessed categorical data. Results Sixty‐four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow‐up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2‐C7 ROM (p < 0.05), but at the last follow‐up, the C2‐C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow‐up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%). Conclusion CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid‐to‐long‐term follow‐up. ASDeg is similar in non‐surgical segments after 70 months of follow‐up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration. |
| first_indexed | 2024-03-11T13:29:51Z |
| format | Article |
| id | doaj.art-d201124cbce248689a7c4cc4312fed35 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-11T13:29:51Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-d201124cbce248689a7c4cc4312fed352023-11-03T02:57:47ZengWileyOrthopaedic Surgery1757-78531757-78612023-11-0115112901291010.1111/os.13900Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐upTing‐kui Wu0Jun‐bo He1Kang‐kang Huang2Xin Rong3Chen Ding4Bei‐yu Wang5Hao Liu6Department of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaDepartment of Orthopaedic Surgery, West China Hospital Sichuan University Chengdu ChinaObjective The long‐term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid‐ to long‐term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non‐surgically treated adjacent segments. Methods We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2‐C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre‐ and postoperative values were compared using paired t‐tests or Wilcoxon rank‐sum tests. Independent Student t‐tests or Mann–Whitney U tests analyzed continuous data between CDA and HS groups, while chi‐square or Fisher exact tests assessed categorical data. Results Sixty‐four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow‐up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2‐C7 ROM (p < 0.05), but at the last follow‐up, the C2‐C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow‐up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%). Conclusion CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid‐to‐long‐term follow‐up. ASDeg is similar in non‐surgical segments after 70 months of follow‐up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.https://doi.org/10.1111/os.13900Adjacent segment degenerationCervical disc arthroplastyHybrid surgeryIntermediate segmentNoncontiguous cervical degenerative disc diseaseSkip level |
| spellingShingle | Ting‐kui Wu Jun‐bo He Kang‐kang Huang Xin Rong Chen Ding Bei‐yu Wang Hao Liu Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up Orthopaedic Surgery Adjacent segment degeneration Cervical disc arthroplasty Hybrid surgery Intermediate segment Noncontiguous cervical degenerative disc disease Skip level |
| title | Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up |
| title_full | Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up |
| title_fullStr | Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up |
| title_full_unstemmed | Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up |
| title_short | Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up |
| title_sort | cervical disc arthroplasty for the treatment of noncontiguous cervical degenerative disc disease results of mid to long term follow up |
| topic | Adjacent segment degeneration Cervical disc arthroplasty Hybrid surgery Intermediate segment Noncontiguous cervical degenerative disc disease Skip level |
| url | https://doi.org/10.1111/os.13900 |
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