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Radiographic ALD progression linked to long-term CADR implant motion

Severe progression of radiographic adjacent level degeneration occurred in 47% of patients who had an artificial disc that moved 0° to 3°.

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Patients who underwent cervical artificial disc replacement tended to have less radiographic adjacent level degeneration at long-term follow-up than patients who underwent anterior cervical discectomy and fusion, according the results of a prospective randomized study.

The rate of progressive radiographic adjacent level degeneration (R-ALD) that investigators Jeffrey M. Spivak, MD, and colleagues observed was significantly lower in patients who underwent cervical artificial disc replacement (CADR) compared with patients who underwent anterior cervical discectomy and fusion (ACDF).

When he presented the results of the study at the Cervical Spine Research Society Annual Meeting, Spivak noted 53% of CADR patients and 77% of ACDF patients exhibited progression of R-ALD through 7-year follow-up.

“The rate of progressive radiographic degeneration is significantly lower at final follow-up of 7 years following disc arthroplasty compared to ACDF. In addition, that decreased difference seen in arthroplasty is seen mainly at the superior adjacent level,” Spivak said.

Superior ALD

Spivak and colleagues included 160 patients with one-level symptomatic cervical disc disease in their study. All the patients had available radiographic data at final follow-up through 7 years. In total, 73 patients underwent ACDF and 87 patients underwent CADR. The latter were treated with the ProDisc-C Total Disc Replacement (DePuy Synthes Spine) prosthesis. The demographics for the two groups of patients were similar.

All of the radiographs used in the study to assess R-ALD were evaluated by an independent radiologist.

Evaluation of the radiographs showed the rate of R-ALD was significantly lower in the superior adjacent level for the CADR group, as 36% of CADR patients exhibited R-ALD at that level vs. 59% of the ACDF group.

“Looking at any progression for radiographic degeneration at adjacent levels, we found a statistically significant difference in the arthroplasty patients as compared to the fusion patients. If we tried to parse this out for superior and inferior adjacent levels, we found the difference was only present when looking at the superior adjacent level,” Spivak said.

R-ALD, index level studied

Spivak and colleagues found at final follow-up that R-ALD was significantly inversely correlated with range of motion at the treatment level in the patients who underwent CADR.

Artificial discs with a range of motion between 0° and 3° had a 68% rate of progressive R-ALD, based on the study results. The rate of progressive R-ALD was 53% in discs that moved 4° to 6° postoperatively, and there was less progression of R-ALD (43%) in patients whose disc prostheses moved 7° or more.

In the CADR patients, severe progression of R-ALD (grade 0 to 1 initially, and grade 3 to 4 at final follow-up), was seen in 47% of the patients whose discs moved 0° to 3°. No patients who had discs that moved 4° to 6° exhibited severe progression of R-ALD, and 9.5% of patients who had discs that moved 7° or more exhibited severe progression of R-ALD.

“Looking at that small sub-population of the normal discs at the start that progress to severe degeneration, we found a much higher percentage of those in the stiffer arthroplasty patients compared to those with more mobility at final follow-up,” Spivak said.

Spivak and colleagues concluded the overall rate of R-ALD at long-term follow-up was significantly lower in patients who underwent CADR compared to patients who underwent ACDF. Also, the CADR patients with more mobile discs had significantly less progression and severity of R-ALD compared to the patients with stiffer artificial discs. – by Robert Linnehan

• Reference:
• Spivak JM, et al. Paper #14. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 3-5, 2015; San Diego.

• For more information:
• Jeffrey M. Spivak, MD, can be reached at NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003; email: jeffrey.spivak@nyumc.org.

Disclosure: Spivak reports he has stock or stock options with Paradigm Spine and Titan Spine, he is a paid consultant to DePuy Synthes Spine and Titan Spine, he receives research support from Synthes and receives IP royalties and other financial/material support from Titan Spine.