Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

Yoon-Suk Hyun; Jun-Sik Park; Kyung-Won Song; Gab-Lae Kim; Jin-Young Lee; Jae-Hyuk Shin

doi:10.4184/jkss.2017.24.4.211

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Hyun, Park, Song, Kim, Lee, and Shin: Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

Original Article

Journal of Korean Spine Surg 2017;24(4):211-220.

Published online: 31 December 2017

DOI: https://doi.org/10.4184/jkss.2017.24.4.211

Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

Yoon-Suk Hyun, M.D., Jun-Sik Park, M.D., Kyung-Won Song, M.D., Ph.D., Gab-Lae Kim, M.D., Jin-Young Lee, M.D., Ph.D., Jae-Hyuk Shin, M.D., Ph.D.

Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital Kangdong Sacred Heart Hospital-affiliated to Hallym University College of Medicine, Seoul, Korea

Corresponding author: Jae-Hyuk Shin, M.D., Ph.D. ORCID ID: Yoon-Suk Hyun: https://orcid.org/0000-0003-3826-2527 Jun-Sik Park: https://orcid.org/0000-0003-3466-350X Kyung-Won Song: https://orcid.org/0000-0003-2433-1587 Gab-Lae Kim: https://orcid.org/0000-0002-0282-1721 Jin-Young Lee: https://orcid.org/0000-0003-1947-2588 Jae-Hyuk Shin: https://orcid.org/0000-0001-6344-0714 Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, 445 Gil-dong, Kangdong-gu, Seoul, 134-701, Korea TEL: +82-2-2224-2230, FAX: +82-2-489-4391 E-mail: jshin2100@gmail.com

Received 16 August 201729 August 2017 Accepted 24 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective case-control study.

Objectives

To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease.

Summary of Literature Review

ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified.

Materials and Methods

Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured.

Results

Group I showed a superior NDI at 18 months postoperatively (p�0.05). The mean C2-7 ROM of both groups recovered to the preoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p�0.05). The superior adjacent segment ROM was higher in group II (p�0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05).

Conclusions

The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.

Keywords: Cervical vertebrae, Intervertebral disc disease, Spinal fusion, Total disc replacement

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Fig. 1.

A 51-year-old man in group I with radiculopathy and myelopathy. Preoperative (A) anteroposterior view and (B) lateral view of cervical radiographs show degenerative changes of the cervical vertebrae. (C) Preoperative sagittal T2-weighted magnetic resonance imaging shows C5-6 and C6-7 disc bulging and a focal high-signal-intensity lesion of the spinal cord at C6-7 (arrow). (D) A lateral cervical radiograph 18 months after cervical artificial disc replacement at C5-6 and anterior cervical discectomy and fusion at C6-7 with flexion and (E) extension.

Fig. 2.

A 58-year-old woman in group II with radiculopathy. Preoperative (A) anteroposterior view and (B) lateral view of cervical radiographs show degenerative changes of the cervical vertebrae. (C) Preoperative sagittal T2-weighted magnetic resonance imaging shows C5-6 and C6-7 disc bulging and degeneration (arrow). (D) A lateral cervical radiograph 18 months after anterior cervical discectomy and fusion at C5-6 and C6-7 with flexion and (E) extension.

Fig. 3.

The Cobb angle between the inferior endplates of C2 and C7 was measured. The overall cervical (C2-7) range of motion was calculated by the difference of the Cobb angles between cervical lateral full flexion (A) and extension (B) radiographs.

Fig. 4.

The Cobb angle between the inferior endplate of the superior adjacent vertebra and the superior endplate of the inferior adjacent vertebra was measured. Adjacent segment range of motion was calculated by the difference of the Cobb angles between cervical lateral full flexion (A) and extension (B) radiographs.

Fig. 5.

Group I showed a superior neck disability index (NDI) at 18 months postoperatively (p�0.05).

Fig. 6.

Graphs show visual analogue scale (VAS) score improvements for the neck (A) and arm (B) between groups I and II, but there was no significant difference (p>0.05).

Fig. 7.

At 18 months postoperatively, the hybrid construct (HC) group showed an overall cervical range of motion (ROM) greater than that of the 2-level anterior cervical discectomy and fusion (ACDF) group (p�0.05).

Fig. 8.

(A) Starting at 6 months postoperatively, there was a significant difference in the upper adjacent segment motion range between the 2 groups (p�0.05). (B) However, in the lower adjacent segment, there was no significant difference between the 2 groups (p>0.05). Group I was subdivided into I-1 (C4-5 ACDF+C5-6 CADR) and I-2 (C5-6 CADR+C6-7 ACDF), but there was no significant difference between these subgroups in the upper (C) and lower adjacent segment (D) motion range (p>0.05). ACDF, anterior cervical discectomy and fusion; CADR, cervical artificial disc replacement.

Table 1.

Patient demographics

	HC (n=14)	2-level ACDF (n=12)
Mean age (Mean±SD)	40.5±6.9	47.2±6.0
Gender	Male:6	Male:6
	Female:8	Female:6
Level
C4-5 ACDF+C5-6 CADR	5
C4-6 ACDF		5
C5-6 CADR+C6-7 ACDF	9
C5-7 ACDF		7
Radiculopathy	12	10
Myelopathy & radiculopathy	2	2

HC: Hybrid construct, ACDF: Anterior cervical discectomy and fusion, CADR: Cervical artificial disc replacement.

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