Radiologic and Clinical Evaluation 12 Months after Anterior Cervical Diskectomy and Dynamic Stabilization of the Segment with Dynamic Cervical Implant

Abstract

Background Anterior cervical diskectomy (ACD) is an established therapy for degenerative cervical radiculopathy and myelopathy. Controversy remains regarding the dynamic or rigid stabilization of the segment.

Methods We studied our first 31 patients treated with ACD plus the Dynamic Cervical Implant (DCI) as an alternative to fusion or to arthroplasty, treated between February 2009 and 2011. Radiologic data were collected before and 12 months after surgery. Clinical results were documented 12 months after surgery. The radiologic analysis focused on the mobility of the segment, position of the implant, amount of preoperative osteochondrosis, and the development of heterotopic ossifications (HOs) after 1 year.

Results At the 1-year follow-up after DCI implantation, there was quite a high fusion rate (23%); however, the formation of HOs was comparable with that of arthroplasty. Fusion could not be predicted by viewing the degree of disk degeneration on preoperative magnetic resonance imaging studies and had no negative impact on the clinical outcome.

Conclusion As an alternative to arthroplasty, DCI does maintain some flexion-extension mobility after 1 year in 77% of our cases.

Keywords

cervical diskectomy - dynamic stabilization - fusion rates

• References

• 1 Boselie TF, Willems PC, van Mameren H, de Bie RA, Benzel EC, van Santbrink H. Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine 2013; 38 (17) E1096-E1107
• 2 Walraevens J, Liu B, Meersschaert J , et al. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints. Eur Spine J 2009; 18 (3) 358-369
• 3 Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166 (1 Pt 1) 193-199
• 4 Mann E, Peterson CK, Hodler J. Degenerative marrow (Modic) changes on cervical spine magnetic resonance imaging scans: prevalence, inter- and intra-examiner reliability and link to disc herniation. Spine 2011; 36 (14) 1081-1085
• 5 Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE. Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine 2003; 28 (1) 46-51
• 6 McAfee PC, Cunningham BW, Devine J, Williams E, Yu-Yahiro J. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech 2003; 16 (4) 384-389
• 7 Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958; 15 (6) 602-617
• 8 Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958; 40-A (3) 607-624
• 9 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 (3) 198-209
• 10 Sasso RC, Smucker JD, Hacker RJ, Heller JG. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007; 32 (26) 2933-2940 ; discussion 2941–2942
• 11 Sasso RC, Best NM. Cervical kinematics after fusion and Bryan disc arthroplasty. J Spinal Disord Tech 2008; 21 (1) 19-22
• 12 Cheng JS, Liu F, Komistek RD, Mahfouz MR, Sharma A, Glaser D. Comparison of cervical spine kinematics using a fluoroscopic model for adjacent segment degeneration. Invited submission from the Joint Section on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine 2007; 7 (5) 509-513
• 13 Liu F, Cheng J, Komistek RD, Mahfouz MR, Sharma A. In vivo evaluation of dynamic characteristics of the normal, fused, and disc replacement cervical spines. Spine 2007; 32 (23) 2578-2584
• 14 Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine 2005; 30 (10) 1165-1172
• 15 Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 2005; 3 (6) 417-423
• 16 Cardoso MJ, Mendelsohn BA, Rosner MK. Cervical hybrid arthoplasty with 2 unique fusion techniques. J Neurosurg Spine 2011; 15: 28-54
• 17 Nabhan A, Ishak B, Steudel WI, Ramadhan S, Steimer O. Assessment of adjacent-segment mobility after cervical disc replacement versus fusion: RCT with 1 year's results. Eur Spine J 2011; 20 (6) 934-941
• 18 Nabhan A, Ahlhelm F, Pitzen T , et al. Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study. Eur Spine J 2007; 16 (3) 423-430
• 19 Kim SW, Limson MA, Kim SB , et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 2009; 18 (2) 218-231
• 20 Anderson PA, Sasso RC, Hipp J , et al. Kinematics of the cervical adjacent segments following disc arthroplasty and anterior discectomy and fusion: a systematic review and meta analysis. Spine 2012; 37: 85-95
• 21 Harrod CC, Hilibrand AS, Fischer DJ, Skelly AC. Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine 2012; 37 (22, Suppl): S96-S112
• 22 Si W, Zhang H, Wang A, Sun Y, Bai Y. Clinical research of dynamic cervical implant and cage fusion in two-level cervical disc protrusion [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28 (1) 60-63
• 23 Matgé G, Berthold C, Gunness VR, Hana A, Hertel F. Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression. J Neurosurg Spine 2015; 22 (3) 237-245
• 24 Wang L, Song YM, Liu LM, Liu H, Li T. Clinical and radiographic outcomes of dynamic cervical implant replacement for treatment of single-level degenerative cervical disc disease: a 24-month follow-up. Eur Spine J 2014; 23 (8) 1680-1687
• 25 Li Z, Yu S, Zhao Y , et al. Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease. J Clin Neurosci 2014; 21 (6) 942-948
• 26 Mehren C, Suchomel P, Grochulla F , et al. Heterotopic ossification in total cervical artificial disc replacement. Spine 2006; 31 (24) 2802-2806
• 27 Brenke C, Scharf J, Schmieder K, Barth M. High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses. J Neurosurg Spine 2012; 17 (2) 141-146
• 28 Tu TH, Wu JC, Huang WC , et al. Heterotopic ossification after cervical total disc replacement: determination by CT and effects on clinical outcomes. J Neurosurg Spine 2011; 14 (4) 457-465
• 29 Tu TH, Wu JC, Fay LY, Ko CC, Huang WC, Cheng H. Vertebral body split fracture after a single-level cervical total disc replacement. J Neurosurg Spine 2012; 16 (3) 231-235
• 30 Fan H, Wu S, Wu Z, Wang Z, Guo Z. Implant failure of Bryan cervical disc due to broken polyurethane sheath: a case report. Spine 2012; 37 (13) E814-E816
• 31 Wu JC, Huang WC, Tu TH , et al. Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up. J Neurosurg Spine 2012; 16 (2) 163-171