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One-level ACDF and arthroplasty relieve radiculopathy, myelopathy symptoms
Following cervical disc arthroplasty, 93% of patients returned to full activity compared to 88% of patients who underwent ACDF.
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NEW ORLEANS — Investigators found that both single-level anterior cervical arthroplasty and anterior cervical discectomy and fusion yielded a high rate of complete symptom relief in about 90% of patients who underwent either procedure for cervical radiculopathy and myelopathy. However, they determined the arthroplasty group had a higher rate of persistent posterior axial neck pain, while the discectomy and fusion group showed a higher rate of symptomatic pseudoarthrosis.
“To our knowledge, this study represents the largest nonfunded single-center review comparing arthroplasty to [anterior cervical discectomy and fusion] ACDF,” Daniel G. Kang, MD, said at the North American Spine Society Annual Meeting, here.
Daniel G. Kang
Kang told Spine Surgery Today the take-home message of the study was as follows: “Our study represents the largest, non-funded single-center review, and found cervical disc arthroplasty is a safe alternative to anterior cervical discectomy and fusion at short-term follow-up.”
Single institution comparative trial
At the meeting, Kang said, “We found approximately 90% complete relief of preoperative symptoms in both groups. However, the arthroplasty group did have a significantly greater return to preoperative level of activity. Both groups had a low rate of complication and reoperation. However, the ACDF group did have a slightly higher reoperation rate. But, more interestingly, is that the arthroplasty group had a higher rate of posterior axial neck pain that was persistent beyond greater than 3 months.”
Figure A (far left): Single-level cervical disc arthroplasty with metal-on-polymer articulation (ProDisc-C, DePuy Synthes Spine, Raynham, Mass.). Figure B (middle): Single-level cervical disc arthroplasty with metal-on-metal articulation (Prestige ST, Medtronic Sofamor Danek, Memphis, Tenn.). Figure C (far right): Single level anterior cervical discectomy and fusion using an allograft interbody spacer and anterior cervical plate. Images were prepared as part of Dr. Kang’s official duties as an employee of the United States government and as such, are exempt from U.S. copyright.
Images: Kang DG
In their retrospective analysis, Kang and colleagues compared 171 patients who underwent cervical disc arthroplasty (CDA) and 88 patients who underwent ACDF performed at a single institution during the 4-year period from August 2008 to August 2012.
The investigators found some differences among the patients in both treatment groups.
“The average age was significantly greater in the ACDF group. We also found that patients undergoing ACDF were more commonly referred for revision compared to arthroplasty,” Kang said in his presentation.
Activity after CDA
Among the findings from the study was a significantly greater return to full activity in the CDA group compared to the ACDF cohort (93% vs. 88%). In addition the study revealed significantly more patients in the CDA group had persistent posterior axial neck pain compared to the ACDF group (16% vs. 12%).
The investigators discovered a lower reoperation rate in the CDA group compared to the ACDF cohort (3.5% vs. 5.7%), “with the ACDF group having a rate of symptomatic pseudoarthrosis of 3.4%,” Kang said during his presentation.
Although Kang and colleagues noted in the abstract that there was a relatively low complication rate across both groups of patients they studied, recurrent laryngeal nerve (RLN) injury rates were 3.6% in the CDA cohort, but they found no cases of RLN injury associated with the ACDF group. Patient-reported dysphagia rates were 5.5% and 3.4% in the CDA and ACDF groups, respectively.
“Our short-term results demonstrate that arthroplasty is a safe and viable alternative to ACDF. However, further investigations are necessary to determine outcomes at long-term follow-up,” Kang said. – by Gina Brockenbrough, MA, and Susan M. Rapp
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Disclosure: Kang has no relevant financial disclosures. The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government. All authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.