Segmental Motion of the Cervical Spine After Total Disc Replacement Using ActivC Versus Discectomy and Fusion Using Stand-alone Cage

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Abstract

Objective: Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for the treatment of cervical disc diseases. However, due to several reports regarding postfusion exacerbation of adjacent segments, a motion-preserving prosthesis was developed. In the present retrospective analysis, total disc replacement (TDR) using ActivC (Aesculap AG, Tuttlingen, Germany) was compared with ACDF using a stand-alone cage. Methods: Among patients diagnosed with cervical disc diseases, those who received either ACDF or TDR at a single level between C3 and C7 from January 2010 to December 2015 were reviewed. Clinical outcomes were assessed using the visual analogue scale for arm and neck pain and the neck disability index. Clinical scales, lateral neutral, and flexion–extension radiographs were taken for all patients preoperatively and 2 months, 6 months, 1 year, and 2 years postoperatively. Global lordosis, C2–C7 Sagittal vertical axis, and T1 slope were measured on lateral neutral radiographs. The segmental range of motion (ROM) of the operated level, cranial adjacent level, and caudal adjacent level were defined as the difference between Cobb angles on flexion–extension lateral radiographs. Results: A total of 53 patients (mean age 48.5 years) were reviewed. Thirty patients were treated with ACDF and the remaining 23 patients received TDR. At the 2-year follow-up, the segmental ROM of operated level was significantly preserved in the TDR group compared with the ACDF group (P = 0.007). Conversely, no significant differences in the ROM at the adjacent segments were observed between the TDR and ACDF groups (P > 0.05). The clinical outcome was excellent in both ACDF and TDR groups and was maintained until the 2-year follow-up. Conclusions: In the present study, TDR using ActivC showed successful motion preservation at the operated level and equivalent results were observed with ACDF based on clinical and radiologic results.

Original languageEnglish
Pages (from-to)e1228-e1234
JournalWorld Neurosurgery
Volume126
DOIs
Publication statusPublished - 2019 Jun 1

Fingerprint

Total Disc Replacement
Diskectomy
Spine
Articular Range of Motion
Lordosis
Neck Pain
Visual Analog Scale
Prostheses and Implants
Germany
Arm
Neck

Keywords

  • Arthroplasty
  • Cervical vertebrae
  • Diskectomy
  • Intervertebral disc degeneration
  • Range of motion
  • Spinal fusion
  • Total disc replacement

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{716a12441a5a4a2eb7a983e36a6a6bca,
title = "Segmental Motion of the Cervical Spine After Total Disc Replacement Using ActivC Versus Discectomy and Fusion Using Stand-alone Cage",
abstract = "Objective: Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for the treatment of cervical disc diseases. However, due to several reports regarding postfusion exacerbation of adjacent segments, a motion-preserving prosthesis was developed. In the present retrospective analysis, total disc replacement (TDR) using ActivC (Aesculap AG, Tuttlingen, Germany) was compared with ACDF using a stand-alone cage. Methods: Among patients diagnosed with cervical disc diseases, those who received either ACDF or TDR at a single level between C3 and C7 from January 2010 to December 2015 were reviewed. Clinical outcomes were assessed using the visual analogue scale for arm and neck pain and the neck disability index. Clinical scales, lateral neutral, and flexion–extension radiographs were taken for all patients preoperatively and 2 months, 6 months, 1 year, and 2 years postoperatively. Global lordosis, C2–C7 Sagittal vertical axis, and T1 slope were measured on lateral neutral radiographs. The segmental range of motion (ROM) of the operated level, cranial adjacent level, and caudal adjacent level were defined as the difference between Cobb angles on flexion–extension lateral radiographs. Results: A total of 53 patients (mean age 48.5 years) were reviewed. Thirty patients were treated with ACDF and the remaining 23 patients received TDR. At the 2-year follow-up, the segmental ROM of operated level was significantly preserved in the TDR group compared with the ACDF group (P = 0.007). Conversely, no significant differences in the ROM at the adjacent segments were observed between the TDR and ACDF groups (P > 0.05). The clinical outcome was excellent in both ACDF and TDR groups and was maintained until the 2-year follow-up. Conclusions: In the present study, TDR using ActivC showed successful motion preservation at the operated level and equivalent results were observed with ACDF based on clinical and radiologic results.",
keywords = "Arthroplasty, Cervical vertebrae, Diskectomy, Intervertebral disc degeneration, Range of motion, Spinal fusion, Total disc replacement",
author = "Bum-Joon Kim and Se-Hoon Kim and Lee, {Seung Hwan} and Sung-Kon Ha and Sang-Dae Kim and Lim, {Dong Jun}",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.wneu.2019.02.233",
language = "English",
volume = "126",
pages = "e1228--e1234",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Segmental Motion of the Cervical Spine After Total Disc Replacement Using ActivC Versus Discectomy and Fusion Using Stand-alone Cage

AU - Kim, Bum-Joon

AU - Kim, Se-Hoon

AU - Lee, Seung Hwan

AU - Ha, Sung-Kon

AU - Kim, Sang-Dae

AU - Lim, Dong Jun

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective: Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for the treatment of cervical disc diseases. However, due to several reports regarding postfusion exacerbation of adjacent segments, a motion-preserving prosthesis was developed. In the present retrospective analysis, total disc replacement (TDR) using ActivC (Aesculap AG, Tuttlingen, Germany) was compared with ACDF using a stand-alone cage. Methods: Among patients diagnosed with cervical disc diseases, those who received either ACDF or TDR at a single level between C3 and C7 from January 2010 to December 2015 were reviewed. Clinical outcomes were assessed using the visual analogue scale for arm and neck pain and the neck disability index. Clinical scales, lateral neutral, and flexion–extension radiographs were taken for all patients preoperatively and 2 months, 6 months, 1 year, and 2 years postoperatively. Global lordosis, C2–C7 Sagittal vertical axis, and T1 slope were measured on lateral neutral radiographs. The segmental range of motion (ROM) of the operated level, cranial adjacent level, and caudal adjacent level were defined as the difference between Cobb angles on flexion–extension lateral radiographs. Results: A total of 53 patients (mean age 48.5 years) were reviewed. Thirty patients were treated with ACDF and the remaining 23 patients received TDR. At the 2-year follow-up, the segmental ROM of operated level was significantly preserved in the TDR group compared with the ACDF group (P = 0.007). Conversely, no significant differences in the ROM at the adjacent segments were observed between the TDR and ACDF groups (P > 0.05). The clinical outcome was excellent in both ACDF and TDR groups and was maintained until the 2-year follow-up. Conclusions: In the present study, TDR using ActivC showed successful motion preservation at the operated level and equivalent results were observed with ACDF based on clinical and radiologic results.

AB - Objective: Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for the treatment of cervical disc diseases. However, due to several reports regarding postfusion exacerbation of adjacent segments, a motion-preserving prosthesis was developed. In the present retrospective analysis, total disc replacement (TDR) using ActivC (Aesculap AG, Tuttlingen, Germany) was compared with ACDF using a stand-alone cage. Methods: Among patients diagnosed with cervical disc diseases, those who received either ACDF or TDR at a single level between C3 and C7 from January 2010 to December 2015 were reviewed. Clinical outcomes were assessed using the visual analogue scale for arm and neck pain and the neck disability index. Clinical scales, lateral neutral, and flexion–extension radiographs were taken for all patients preoperatively and 2 months, 6 months, 1 year, and 2 years postoperatively. Global lordosis, C2–C7 Sagittal vertical axis, and T1 slope were measured on lateral neutral radiographs. The segmental range of motion (ROM) of the operated level, cranial adjacent level, and caudal adjacent level were defined as the difference between Cobb angles on flexion–extension lateral radiographs. Results: A total of 53 patients (mean age 48.5 years) were reviewed. Thirty patients were treated with ACDF and the remaining 23 patients received TDR. At the 2-year follow-up, the segmental ROM of operated level was significantly preserved in the TDR group compared with the ACDF group (P = 0.007). Conversely, no significant differences in the ROM at the adjacent segments were observed between the TDR and ACDF groups (P > 0.05). The clinical outcome was excellent in both ACDF and TDR groups and was maintained until the 2-year follow-up. Conclusions: In the present study, TDR using ActivC showed successful motion preservation at the operated level and equivalent results were observed with ACDF based on clinical and radiologic results.

KW - Arthroplasty

KW - Cervical vertebrae

KW - Diskectomy

KW - Intervertebral disc degeneration

KW - Range of motion

KW - Spinal fusion

KW - Total disc replacement

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