Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months -Pfirrmann Grade and Cervical Arthroplasty-

오창현,윤승환,김도연,지규열,김여주,현동근,김은영,박현선,박형천 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.4

Purpose: Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. Materials and Methods: Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmannclassification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analoguescale (VAS) scores of neck and arm pain, modified Oswestry Disability Index(mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. Results: VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. Conclusion:Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patientswith mild degenerative cervical disc disease after 18 months of follow-up.

Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty

하윤,신준재,김광렬,손동욱,신동아,이성,김긍년,윤도흠 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.1

Purpose: The purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty. Materials and Methods: A total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up. Results: The mean follow-up period was 38 months (range, 25–114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis. Conclusion: CDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.

Comparative Analysis of Cervical Disc Arthroplasty Using Two Types of Artificial Cervical Discs: BryanⓇ versus Mobi-CⓇ

최대한,이상구,박찬우,김우경 대한척추신경외과학회 2011 Neurospine Vol.8 No.3

Objective: Since the 1990s, due to postoperative loss of mobility and adjacent segmental disease after anterior cervical fusion, many different types of cervical artificial discs have been developed as alternative implants. The purposes of this study are investigation and comparison of radiographic and clinical outcomes between two different types of prostheses, BryanⓇ and Mobi-CⓇ. Methods: We retrospectively evaluated 33 patients who were treated for cervical degenerative disc disease that resulted in radiculopathy and/or myelopathy between May 2004 and April 2009. Seventeen patients underwent BryanⓇ cervical disc arthroplasty and sixteen patients underwent Mobi-CⓇ arthroplasty. The radiographic outcomes were assessed by measuring the cervical lordosis, segmental lordosis, range-of-motion (ROM) of the cervical spine (C2-7), functional segmental unit (FSU), prosthesis’ shell and the upper adjacent segment. The clinical results were evaluated according to the Visual Analogue Scale (VAS) for axial pain and radiculopathy, Odom’s criteria, and the modified Prolo’s economic and functional outcome rating scale. Results: The age of the study population ranged from 24 to 69 years with a mean age of 48 years vs. 46 years in the BryanⓇ and Mobi-CⓇ groups, respectively. The mean duration of follow-up was 23.7 months in the BryanⓇ group and 11.3 months in the Mobi-CⓇ group. The changes of overall cervical sagittal angle were not significantly different between two groups,but the increase of segmental sagittal angle (0.85° in BryanⓇ, 8.04° in Mobi-CⓇ), ROM of the FSU(-0.51° in BryanⓇ, 2.47° in Mobi-CⓇ) and ROM of the shell (1.77° in BryanⓇ, 5.28° in Mobi-CⓇ) were significantly higher in Mobi-CⓇ group than in BryanⓇ group (p<0.05). The clinical results were not significantly different between two groups. Conclusion: The Mobi-CⓇ prosthesis showed more favorable radiographic results than that of the BryanⓇ prosthesis, however, the clinical outcomes were similar in both groups. Large-scale and long-term follow-up studies are needed to confirm our results.

Motion Preserving Surgery in Two Cases of Brown-Sequard Syndrome Caused by Herniated Cervical Discs

양진서,허동화,조성민,조용준 대한척추신경외과학회 2011 Neurospine Vol.8 No.1

We described two cases of Brown-Sequard syndrome caused by cervical disc herniation that were treated by cervical artificial disc replacement. Two patients presented Brown-Sequard syndrome. Computed tomography scanning and magnetic resonance imaging showed a massive soft disc herniation compressing the spinal cord. We performed a total discectomy to remove the ruptured disc particle and replace it with an artificial disc. The neurologic symptoms of two patients were resolved after the surgery. We suggest that cervical arthroplasty can also be used to treat more severe forms of cervical myelopathy such as Brown-Sequard syndrome.

Comparative Analysis of Cervical Arthroplasty Using Mobi-$C^{(R)}$ and Anterior Cervical Discectomy and Husion Using the $Solis^{(R)}$-Cage

Park, Jin-Hoon,Roh, Kwang-Ho,Cho, Ji-Young,Ra, Young-Shin,Rhim, Seung-Chul,Noh, Sung-Woo The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.44 No.4

Objective : Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. Methods : We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. Results : Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. Conclusion : Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.

경추 추간판 전치환술과 단독 Cage를 이용한 경추 전방고정술의 임상적, 방사선학적 비교 분석

김범준,서중근,조태형,태현석 대한척추신경외과학회 2009 Neurospine Vol.6 No.1

Objective: Total intervertebral disc replacement is designed to preserve motion and avoid limitations of fusion after removing local pathology. The authors report the results of a signle-center study to determine functional and radiologic outcomes associated with cervical total disc replacement versus those of cervical fusion. Methods: We retrospectively reviewed the charts and radiographs of patients who underwent a total intervertebral disc replacement (TDR) or a single-level anterior cervical fusion (ACDF) between January 1, 2004, and September 31, 2007. Clinical symptom was assessed using the Visual Analog Scale (VAS) of the neck and of the arm pain. Range of motion was determined by radiologic assessment of flexion-extension radiographs. Data were collected before surgery and at 6 weeks, 3, 6, 12, and 24 months after surgery. Result: A total of 125 patients were identified with 63 having TDR (43 males and 20 females) and 62 having fusion (42 males and 20 females). The average age was 49.1 years (TDR) and 51.7 years (ACDF) (p=0.229). The mean neck pain VAS before surgery was 6.52 (TDR) and 6.61 (ACDF)(p=0.732). At 2-year follow-up, the average neck pain VAS for the TDR group was 1.59 and ACDF 1.85(p=0.168). The mean arm pain VAS before surgery was 6.37 (TDR) and 6.60 (ACDF)(p=0.335). At 2 years: 1.41 (TDR) and 1.65 (ACDF)(P = 0.148). More motion (an average of 9.00° at 24 months) was retained after surgery in the TDR group than the fusion group at the treatment level. There was no significant difference in motion at adjacent levels. Conclusion: Total disc replacement maintained physiological segmental motion at the 2-year follow-up. The finding that there was no statistically significant difference between the groups in motion at adjacent levels must be verified on further studies. Objective: Total intervertebral disc replacement is designed to preserve motion and avoid limitations of fusion after removing local pathology. The authors report the results of a signle-center study to determine functional and radiologic outcomes associated with cervical total disc replacement versus those of cervical fusion. Methods: We retrospectively reviewed the charts and radiographs of patients who underwent a total intervertebral disc replacement (TDR) or a single-level anterior cervical fusion (ACDF) between January 1, 2004, and September 31, 2007. Clinical symptom was assessed using the Visual Analog Scale (VAS) of the neck and of the arm pain. Range of motion was determined by radiologic assessment of flexion-extension radiographs. Data were collected before surgery and at 6 weeks, 3, 6, 12, and 24 months after surgery. Result: A total of 125 patients were identified with 63 having TDR (43 males and 20 females) and 62 having fusion (42 males and 20 females). The average age was 49.1 years (TDR) and 51.7 years (ACDF) (p=0.229). The mean neck pain VAS before surgery was 6.52 (TDR) and 6.61 (ACDF)(p=0.732). At 2-year follow-up, the average neck pain VAS for the TDR group was 1.59 and ACDF 1.85(p=0.168). The mean arm pain VAS before surgery was 6.37 (TDR) and 6.60 (ACDF)(p=0.335). At 2 years: 1.41 (TDR) and 1.65 (ACDF)(P = 0.148). More motion (an average of 9.00° at 24 months) was retained after surgery in the TDR group than the fusion group at the treatment level. There was no significant difference in motion at adjacent levels. Conclusion: Total disc replacement maintained physiological segmental motion at the 2-year follow-up. The finding that there was no statistically significant difference between the groups in motion at adjacent levels must be verified on further studies.

Surgical Outcome of Cervical Arthroplasty Using $Bryan^{(R)}$

Kim, Hong-Ki,Kim, Myung-Hyun,Cho, Do-Sang,Kim, Sung-Hak The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.6

Objective : Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of $Bryan^{(R)}$ cervical disc prosthesis. Methods : The authors retrospectively reviewed radiographic and clinical outcomes in 52 patients who received the $Bryan^{(R)}$ Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of functional spine unit (FSU), and the C2-7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom's criteria, visual analogue pain scale (VAS) and neck disability index (NDI). Results : A total of 71 $Bryan^{(R)}$ disc were placed in 52 patients. A single-level procedure was performed in 36 patients, a two-level procedure in 13 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made preoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom's criteria, and showed significant improvement by VAS and NDI score (p < 0.05). The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level (p < 0.05). 97% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 88.5% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 70% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 66.6% of the patients postoperatively. Conclusion : Arthroplasty using the $Bryan^{(R)}$ disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although the early results are promising, this is a relatively new approach, therefore long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

경추부 인공관절 수술의 조기 방사선학적 결과

김명현,조도상 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.2

전방 경유 골유합술은 50여년 전부터 시술이 시작되어 최근까지 경추부 퇴행성 질환에 대한 대표적인 수술로 알려져 왔다3-5)18). 그 수술 결과는 이미 많은 저자들에 의해 비교적 좋은 결과를 보인다고 발표되어 왔는데, 한편으로는 수술 후 장기간의 보조구 착용으로 인한 사회 경제적인 손실, 골유합으로 인한 경추부 운동 장애, 인접한 추체와 추간판의 심한 퇴행성 변화와 이차적인 병적 상태 발생 등이 문제점으로 거론되어 왔다2)6)9)10)12)13). 특히 여러 분절에 걸친 다발성 경추부 퇴행성 질환인 경우에는 수술 후 매우 심각한 지경의 후유증이 발생한다. 어떤 보고에 의하면 인접한 분절에 발생한 병변으로 골유합술을 시행 받은 환자들 중에서 1년에 2.9%의 환자들이 재수술을 받으며, 10년 내에 25.6%의 환자가 재발된 증상에 대해 추가적인 수술을 받을 수 있다고 보고한 바 있다13). 최근 이러한 단점을 보완하기 위해 경추부의 운동 분절을 유지하며 병적 상태를 제거할 수 있는 수술법들이 시도되고 있는데 대표적인 것이 신경공 확장술(Anterior microforaminotomy)과 다양한 종류의 인공디스크 수술이다. 신경공 확장술은 추간판의 대부분을 보존하면서 비교적 경추 운동에 영향을 미치지 않는 구상돌기의 일부를 제거하여 이를 통해 신경공을 감압하는 방법이며14), 인공디스크 수술은 추간판을 모두 제거하고 이를 통해 병적인 상태를 제거한 후 운동성을 가진 인공디스크로 대체하는 일종의 인공관절 수술이다1)8)11). 인공디스크 수술은 관절 운동을 유지하고, 골유합술의 단점을 피하며, 빠른 회복을 통해 환자로 하여금 일상생활이나 직업생활로 빠르게 복귀하도록 하기 위해 고안되었다. 이 수술의 목표는 디스크의 높이를 유지하고, 신경을 압박하는 모든 병적 상태를 제거한 후 운동 관절을 유지하기 위한 것이며, 아울러서 인접한 관절의 정상적인 상태를 유지하도록 하는 것이다. 저자는 다양한 경추부 퇴행성 질환에 대해 널리 사용되는 인공디스크 중 주로 Bryan을 사용한 수술을 시행하여 그 결과를 알아보고자 하였다. Object:Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of Bryan cervical disc prosthesis. Method:The authors retrospectively reviewed radiographic and clinical outcomes in 49 patients who received the Bryan Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of the FSU, and the C2-7 Cobb angle. The range of motion(ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom’s criteria. Result:A total of 66 Bryan disc were placed in 49 patients. A single-level procedure was performed in 35 patients, a two-level procedure in 14 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made reoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom’s criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. 90% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 89.4% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 57.7% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 62.5% of the patients postoperatively. Conclusion:Arthroplasty using the Bryan disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although early and intermediate results are promising, this is also a relatively new approach, long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Andre M. Samuel,Harold G. Moore,Avani S. Vaishnav,Steven McAnany,Todd Albert,Sravisht Iyer,Yoshihiro Katsuura,Catherine Himo Gang,Sheeraz A. Qureshi 대한척추신경외과학회 2019 Neurospine Vol.16 No.3

Objective: Cervical disc replacement (CDR) is an effective long-term treatment for both cervical radiculopathy and myelopathy. However, there may be unique differences in the early postoperative clinical improvement for patients with and without myelopathy. In addition, previous studies using CDR to treat cervical myelopathy were underpowered to determine risk factors for relatively postoperative medical complications. Methods: Two different cohorts were studied. A local cohort of patients undergoing CDR by a single surgeon was utilized to study the early postoperative course of clinical improvement. In addition, a national cohort of patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program database was utilized to study differences in postoperative medical complications after CDR. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohorts, and perioperative outcomes and complications were compared to patients without myelopathy. Results: A total of 43 patients undergoing CDR were included in the institutional cohort, of those 16 patients (37% of cohort) had a preoperative diagnosis of cervical myelopathy. A total of 3,023 patients undergoing CDR were included in the national cohort, of those 411 (13% of cohort) had a preoperative diagnosis of cervical myelopathy. In the institutional cohort, the nonmyelopathy group had a lower initial Neck Disability Index (NDI) and saw a faster improvement in NDI by 2 weeks postoperative. However, at 24 weeks there was no significant difference between groups in terms of NDI. Interestingly, only the nonmyelopathy cohort had a significant improvement in modified Japanese Orthopaedic Association score by 6 weeks (p<0.05). In the national cohort, myelopathy was associated with longer operative time and length of stay (p<0.05). However, there was no significant difference in perioperative complications (p>0.05) between myelopathy and nonmyelopathy patients. Conclusion: Significant improvements in NDI, visual analogue scale (VAS)-arm pain, and VAS-neck pain are seen in both myelopathy and nonmyelopathy populations undergoing CDR by 6 weeks postoperatively. However, nonmyelopathy populations improve faster by 2 weeks postoperatively. In the national cohort analysis, medical complications were similarly low in both myelopathy and nonmyelopathy groups.

Anterior Bone Loss in Cervical Disc Arthroplasty

David Christopher Kieser,Derek Thomas Cawley,Takashi Fujishiro,Celeste Tavolaro,Simon Mazas,Louis Boissiere,Ibrahim Obeid,Vincent Pointillart,Jean Marc Vital,Olivier Gille 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Study Design: Retrospective, longitudinal observational study. Purpose: To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. Overview of Literature: ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown. Methods: Patients with non-keeled CDA (146) were retrospectively reviewed. X-rays were examined at 6 weeks, 3, 6, 9, 12, 18, and 24 months, and annually thereafter for a minimum of 5 years. These were compared with the initial postoperative X-rays to determine the ABL. Visual Analog Scale pain scores were recorded at 3 months and 5 years. Neck Disability Index was recorded at postoperative 5 years. The natural history was determined and a classification system was introduced. Results: Complete radiological assessment was available for 114 patients with 156 cervical disc replacements (CDRs) and 309 endplates (average age, 45.3 years; minimum, 28 years; maximum, 65 years; 57% females). ABL occurred in 57.1% of CDRs (45.5% mild, 8.3% moderate, and 3.2% severe) and commenced within 3 months of the operation and followed a benign course, with improvement in the bone stock after initial bone resorption. There was no relationship between ABL degree and pain or functional outcome, and no implants were revised. Conclusions: ABL is common (57.1%). It occurs at an early stage (within 3 months) and typically follows a non-progressive natural history with stable radiographic features after the first year. Most ABL cases are mild, but severe ABL occurs in approximately 3% of CDAs. ABL does not affect the patients’ clinical outcome or the requirement for revision surgery. Surgeons should thus treat patients undergoing CDA considering ABL.