Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients With Myeloradiculopathy.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
01 Sep 2022
01 Sep 2022
Historique:
received:
30
12
2021
accepted:
28
04
2022
entrez:
19
8
2022
pubmed:
20
8
2022
medline:
23
8
2022
Statut:
ppublish
Résumé
This study compares perioperative and postoperative clinical outcomes in patients undergoing anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement (CDR) at C5-C6 in patients with myeloradiculopathy. Primary, elective, single-level CDR or ACDF procedures at C5-C6 for patients with myeloradiculopathy were included. Patient-reported outcome measures (PROMs) included visual analog scale (VAS) neck, VAS arm, Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Short-Form 12-Item Physical Composite Score (SF-12 PCS) collected at preoperative/6-week/12-week/6-month/1-year time points. Surgical cohorts were assessed for differences in demographics/perioperative characteristics using the chi square test and unpaired Student t-test for categorical and continuous variables, respectively. Achievement of minimum clinically important difference (MCID) was determined by comparing ΔPROMs with established thresholds. Outcome measures were compared at postoperative time points with the Student t-test, and improvement from preoperative baseline was assessed with a paired sample t-test. One hundred thirty-seven patients were included, 43 CDR and 94 ACDF. CDR patients demonstrated significantly reduced surgical times (46.3 versus 55.1 minutes), estimated blood loss (24.4 versus 43.6 mL), revision surgery rates (0.0% versus 5.3%), postoperative length of stay (8.9 versus 23.0 hours), and postoperative narcotic consumption (P < 0.017, all). Complication rates and mean PROMs did not differ between cohorts. The CDR cohort markedly improved from baseline for all PROMs postoperatively except SF-12 PCS/PROMIS-PF at 6 weeks. The ACDF cohort markedly improved at each time point except VAS arm at 1 year, NDI at 6 weeks/1 year, and SF-12 PCS/PROMIS-PF at 6 weeks. A majority of both cohorts achieved overall MCID for VAS neck/NDI/PROMIS-PF. MCID achievement rates did not differ except NDI at 12 weeks/1 year and SF-12 PCS at 6 months, both favoring CDR. Both procedural cohorts demonstrated similar long-term clinical outcomes for arm/neck pain and physical function; however, patients undergoing CDR at C5-C6 demonstrated an improved ability to maintain 1-year postoperative progress for neck disability with improved 1-year NDI MCID achievement. The CDR cohort, in addition, demonstrated an improved perioperative profile and reduced rate of revision surgery.
Identifiants
pubmed: 35984083
doi: 10.5435/JAAOS-D-21-01276
pii: 00124635-202209010-00011
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1137-e1147Informations de copyright
Copyright © 2022 by the American Academy of Orthopaedic Surgeons.
Références
Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG: Degenerative cervical myelopathy: Epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976) 2015;40:E675-E693.
Donnally CJ III, Hanna A, Odom CK: Cervical myelopathy, in StatPearls. Treasure Island, FL: StatPearls Publishing, 2021.
Heary RF, MacDowall A, Agarwal N: Cervical spondylotic myelopathy: A two decade experience. J Spinal Cord Med 2018;26:1-9.
Fehlings MG, Kwon BK, Tetreault LA: Guidelines for the management of degenerative cervical myelopathy and spinal cord injury: An introduction to a focus issue. Glob Spine J 2017;7(suppl 3):6S-7S.
Leven D, Meaike J, Radcliff K, Qureshi S: Cervical disc replacement surgery: Indications, technique, and technical pearls. Curr Rev Musculoskelet Med 2017;10:160-169.
Shiban E, Meyer B: Treatment considerations of cervical spondylotic myelopathy. Neurol Clin Pract 2014;4:296-303.
Kalsi-Ryan S, Karadimas SK, Fehlings MG: Cervical spondylotic myelopathy: The clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 2013;19:409-421.
Young WF: Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons. Am Fam Physician 2000;62:1064-1073.
Samuel AM, Moore HG, Vaishnav AS, et al.: Effect of myelopathy on early clinical improvement after cervical disc replacement: A study of a local patient cohort and a large national cohort. Neurospine 2019;16:563-573.
Miller J, Sasso R, Anderson P, Riew KD, McPhilamy A, Gianaris T: Adjacent level degeneration: Bryan total disc arthroplasty versus anterior cervical discectomy and fusion. Clin Spine Surg 2018;31:E98-E101.
Bono CM, Ghiselli G, Gilbert TJ, et al.: An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 2011;11:64-72.
Murrey D, Janssen M, Delamarter R, et al.: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 2009;9:275-286.
Wirth FP, Dowd GC, Sanders HF, Wirth C: Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol 2000;53:340-348, discussion 346-348.
Kim BD, Hsu WK, De Oliveira GS Jr, Saha S, Kim JY: Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: An analysis of 4588 surgical cases. Spine (Phila Pa 1976) 2014;39:510-520.
Cheng H, Clymer JW, Po-Han Chen B, et al.: Prolonged operative duration is associated with complications: A systematic review and meta-analysis. J Surg Res 2018;229:134-144.
Mikhail C, Pennington Z, Arnold PM, et al.: Minimizing blood loss in spine surgery. Glob Spine J 2020;10(1 suppl):71S-83S.
Hu SS: Blood loss in adult spinal surgery. Eur Spine J 2004;13(suppl 1):S3-S5.
van Eck CF, Regan CM, Donaldson WF, Kang JD, Lee JY: The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: A study of 672 consecutive patients. Spine J 2015;15:S165.
Bohlman HH, Emery SE, Goodfellow DB, Jones PK: Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 1993;75:1298-1307.
Yee TJ, Swong K, Park P: Complications of anterior cervical spine surgery: A systematic review of the literature. J Spine Surg 2020;6:302-322.
Tasiou A, Giannis T, Brotis AG, et al.: Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg 2017;3:444-459.
Veeravagu A, Cole T, Jiang B, Ratliff JK: Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: An administrative database study. Spine J 2014;14:1125-1131.
Moatz B, Tortolani PJ: Cervical disc arthroplasty: Pros and cons. Surg Neurol Int 2012;3(suppl 3):S216-S224.
Maiman DJ, Kumaresan S, Yoganandan N, Pintar FA: Biomechanical effect of anterior cervical spine fusion on adjacent segments. Biomed Mater Eng 1999;9:27-38.
Skovrlj B, Lee DH, Caridi JM, Cho SK: Reoperations following cervical disc replacement. Asian Spine J 2015;9:471-482.
Arnold PM, Rice LR, Anderson KK, McMahon JK, Connelly LM, Norvell DC: Factors affecting hospital length of stay following anterior cervical discectomy and fusion. Evid Based Spine Care J 2011;2:11-18.
Shields LB, Clark L, Glassman SD, Shields CB: Decreasing hospital length of stay following lumbar fusion utilizing multidisciplinary committee meetings involving surgeons and other caretakers. Surg Neurol Int 2017;8:5.
Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN: Factors affecting length of stay after elective posterior lumbar spine surgery: A multivariate analysis. Spine J 2015;15:1188-1195.
Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: A randomized controlled clinical trial. J Neurosurg Spine 2007;6:198-209.
Finkelstein JA, Schwartz CE: Patient-reported outcomes in spine surgery: Past, current, and future directions. J Neurosurg Spine 2019;31:155-164.
Jenkins NW, Parrish JM, Cha EDK, et al.: Validation of PROMIS physical function in MIS TLIF: 2-year follow-up. Spine (Phila Pa 1976) 2020;45:E1516-E1522.
Parrish JM, Jenkins NW, Cha EDK, et al.: Patient-reported outcomes measurement information system physical function validation for use in anterior cervical discectomy and fusion: A 2-year follow-up study. Neurospine 2021;18:155-162.
Andresen AK, Paulsen RT, Busch F, Isenberg-Jørgensen A, Carreon LY, Andersen MØ: Patient-reported outcomes and patient-reported satisfaction after surgical treatment for cervical radiculopathy. Glob Spine J 2018;8:703-708.
Schroeder GD, Coric D, Kim HJ, Albert TJ, Radcliff KE: Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery? Spine J 2017;17:943-952.
Heller JG, Sasso RC, Papadopoulos SM, et al.: Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: Clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 2009;34:101-107.
Coric D, Nunley PD, Guyer RD, et al.: Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: Clinical article. J Neurosurg Spine 2011;15:348-358.
Al-Ryalat NT, Saleh SA, Mahafza WS, Samara OA, Ryalat AT, Al-Hadidy AM: Myelopathy associated with age-related cervical disc herniation: A retrospective review of magnetic resonance images. Ann Saudi Med 2017;37:130-137.
Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ: Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: Clinical article. J Neurosurg Spine 2013;18:154-160.
Alluri RK, Vaishnav AS, Sivaganesan A, et al.: Anterior cervical discectomy and fusion vs cervical disc replacement for cervical spondylotic myelopathy: An MCID comparison. Spine J 1602(9 suppl):21S80.
Hadley MN: The real value of cervical arthroplasty? J Neurosurg Spine 2011;15:345-346, discussion 346-347.