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Cervical total disc replacement yields lower reoperation risk vs ACDF
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Patients who underwent cervical total disc replacement had a similar reduction in patient reported outcome of pain and function as well as a lower risk for reoperation compared with patients who underwent anterior discectomy and fusion, according to results published in the International Journal of Spine Surgery.
“Compared to an anterior fusion alternative, [total disc replacement] TDR provided a similar reduction in patient-reported outcomes of pain and function,” Kris Radcliff, MD, co-author of the study, told Healio.com/Orthopedics. “The improved outcome of TDR over [anterior cervical discectomy and fusion] ACDF appears to be durable from the 2-year to the 7-year follow-up. The main driver of success in TDR patients was a lower rate of radiographic and clinical adjacent segment pathology in TDR patients.”
Radcliff and colleagues randomly assigned patients with degenerative disc disease to undergo either cervical total disc replacement with the Mobi-C Cervical Disc (Zimmer Biomet) or an anterior discectomy and fusion. Researchers collected overall success, Neck Disability Index, VAS neck and arm pain, segmental range of motion, patient satisfaction, SF-12 physical and mental health, major complications and subsequent surgery rate preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 12 months, 18 months, annually through 60 months and at 84 months.
Total disc replacement vs ACDF
Overall, 164 patients underwent one-level total disc replacement and 225 patients underwent two-level total disc replacement while 81 patients underwent one-level ACDF and 105 patients underwent two-level ACDF. Results showed an overall success rate of 60.8% for two-level total disc replacement, 34.2% for two-level ACDF, 55.2% for one-level total disc replacement and 50% for one-level ACDF. Researchers found Neck Disability Index scores, VAS neck and arm pain scores and SF-12 mental and physical scores significantly improved from baseline in both groups.
Patients who underwent single level total disc replacement had an increased percentage of being “very satisfied” with the outcomes postoperatively, as well as a lower rate of undergoing adjacent level secondary surgery vs. single level ACDF patients, according to study data.
Two-level results
Results showed a significantly greater Neck Disability Index success rate among patients in the two-level total disc replacement group, with a significant improvement in Neck Disability Index change score at 7 years compared with the two-level ACDF group. Researchers found a significantly higher rate of patients in the two-level total disc replacement group were “very satisfied” with their treatment. The two-level total disc replacement group also had a significantly lower rate of subsequent surgery at the index level, according to the data, as well as a significantly lower rate of adjacent level secondary surgery. Although patients in both the single- and two-level total disc replacement and ACDF groups had strikingly low percentages of worse Neck Disability Index or worse neck pain, researchers noted a lower trend among total disc replacement patients. – by Casey Tingle
Disclosures: Radcliff reports he is an unpaid consultant for 4 Web Medical, DePuy and Zimmer Biomet; is a board or committee member for the Association for Collaborative Spine Research; is a paid consultant for Altus Spine, DePuy, Globus Medical, Medtronic, Orthofix Inc. and Orthopedic Sciences Inc.; receives research support from DePuy, Globus Medical, Medtronic, Pacira Pharmaceuticals and Paradigm Spine; intellectual property royalties from Globus Medical and Orthopedic Sciences Inc.; and other financial or material support from NEXXY Spine, NuVasive and Stryker. Please see the full study for a list of all other authors’ relevant financial disclosures.
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