Cervical disc replacement may yield better clinical outcomes vs. discectomy, fusion
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CHICAGO — Results presented here showed a significantly greater overall clinical success rate with cervical disc replacement in patients with cervical disc disease compared with anterior cervical discectomy and fusion.
“These results add to the growing body of literature supporting disc replacement for treating two-level cervical disc disease with radiculopathy and/or myelopathy,” Richard D. Guyer, MD, said in his presentation at the North American Spine Society Annual Meeting.
Guyer and colleagues compared patients with two-level cervical disc disease who underwent cervical total disc replacement with a PEEK-on-ceramic artificial disc (n=182; Simplify Cervical Artificial Disc, NuVasive Inc.) with a historical, propensity score-matched control group who underwent anterior cervical discectomy and fusion (ACDF; n=170). Primary outcome measures included at least a 15-point improvement in Neck Disability Index (NDI) scores, maintenance or improvement in neurological status, no serious adverse events and no additional index level surgery, while secondary outcomes included NDI scores, numeric rating scales assessing neck and arm pain intensity and frequency, and patient satisfaction.
“Safety was assessed by adverse events, and the patients were followed by 6 weeks, 3 months, 6 months, 12 months and 24 months postop,” Guyer said.
Guyer noted patients who underwent cervical disc replacement had statistically better composite success scores compared with the ACDF group.
“If we look at the individual scores, we can see that all patients, both fusion and disc replacement patients, were improved compared to preop [and this was similar] with the neck pain, intensity scores and arm pain, as well,” Guyer said.
He added patients in both groups reported being happy with their surgery. Secondary surgical interventions, including revisions, removals, reoperations and supplemental fixation, occurred in 2.2% of patients in the cervical disc replacement group and in 8.8% of patients in the ACDF group.
“We can see that there was one vertebral body fracture, subsidence, radiculopathy and a painful herniated disc at an adjacent segment [in the disc replacement group], whereas the fusion group, there were 10 repairs,” Guyer said.
Perspective
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Richard D. Guyer, MD, presented an interesting paper looking at the results of two-level cervical arthroplasty compared with anterior cervical discectomy and fusion. They studied an artificial disc made of PEEK on ceramic, and there were a few important findings from this study. One of which is that it’s yet another paper that adds to the literature in showing superior results at long-term follow-up with motion preservation surgery, like disc arthroplasty, compared with fusion. Second, this is an interesting device. Because of the materials, it allows for postoperative MRI and that may be a desirable option for many surgeons. Finally, when arthroplasty first came online many years ago, it was primarily a one-level procedure, so it’s also promising to see further data showing that we can safely do this at two consecutive levels and that it’s effective at both.
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Coric D, et al. Paper 11. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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