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Similar improvement seen with one- and two-level vs three- and four-level cTDA
The procedures were done using prostheses from three different manufacturers.
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LAS VEGAS — Results presented at the International Society for the Advancement of Spine Surgery Annual Meeting showed patients with one- and two-level cervical disc arthroplasty had improvements similar to those of patients who underwent the procedure at three and four levels and there were no significant differences between the two groups at a minimum follow-up of 2 years.
“When we have done a grouped analysis of the one- and two-level and three and four-level cervical disc arthroplasty, we have not seen a statistically significant difference between the groups,” Andrew Berg, specialty trainee in trauma and orthopaedics at Health Education North West, United Kingdom, said in his presentation. “Our study, we feel, further supports the utilization of cervical disc arthroplasty at multiple levels.”
Cervical disc arthroplasty
Images: Berg A
Berg and colleagues prospectively collected Neck Disability Index (NDI), VAS for neck and VAS for arm scores preoperatively and at 3 months, 6 months, 1 year postoperatively and yearly thereafter for 42 patients who underwent one-level cervical total disc arthroplasty (cTDA), 50 patients who underwent two-level cTDA and 51 patients who underwent three-level or four-level cTDA. The procedures were done with either the NuNec (RTI Surgical), Discocerv (Alphatec) or Prestige (Medtronic) cervical prostheses.
Patients’ symptoms in the one- and two-level group had a duration of 51.24 months and patients’ symptoms in the three- and four-level 4 group had a duration of 62 months prior to treatment. Berg noted NDI scores improved in the one- and two-level groups from about 47 to about 35, whereas the NDI scores improved in the three- and four-level groups from around 52 to around 37. There was no statistically significant difference between the two groups for NDI scores.
Results based on VAS scores
“With the VAS neck score, there was similar improvement seen in both the groups,” Berg said. “Comparing the two groups, [there] was not a statistically significant difference.”
He also noted the VAS arm pain scores were similar preoperatively and postoperatively in all the groups.
Although Berg said the researchers were not surprised by the improvements they saw in both groups, he told Orthopaedics Today Europe that seeing improvements among patients with three- and four-level cTDA, who may have had symptoms longer and experienced more disability from their condition, that were similar to patients with one- and two-level cTDA may be viewed by some as surprising.
A direction of future research should be to identify the behavior of different arthroplasty implants, as well as the potential risks of implantation of certain implant designs at multiple levels.
“[We] know that at different levels in the cervical spine, the biomechanics of each level, are different,” Berg said. “[If] you put the same implant into multiple levels, does it have enough flexibility in its biomechanical design to be able to [restore] normal motion at all levels?” – by Casey Tingle
- Reference:
- Friesem S, et al. Paper #530. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting; April 6-8, 2016; Las Vegas.
- For more information:
- Andrew Berg can be reached at The Spinal Unit, University Hospital of North Tees, North Tees and Hartlepool NHS Foundation Trust, Hardwick Rd., Stockton on Tees, TS19 8PE, United Kingdom; email: a.j.berg@doctors.org.uk.
Disclosure: Berg reports no relevant financial disclosures.