General Session: Cervical Motion Preservation

Presented by: M. Scott-Young - View Audio/Video Presentation (Members Only)

Author(s):

M. Scott-Young(1,2), L. McEntee(1,2), S.M. Lee(2), I.-M. Luukkonen(2)

(1) Bond University, Faculty of Health Sciences & Medicine, Gold Coast, QLD, Australia
(2) Gold Coast Spine, Southport, QLD, Australia

Abstract

Although several studies have established the potential benefits of motion preservation in the presence of single level disease when using cervical total disc replacement (CTDR) compared to anterior cervical decompression fusion (ACDF), there are few studies looking into the efficacy of multi-level CTDR when treating multi-level cervical degenerative disc disease (DDD). The optimal surgical intervention remains controversial for multi-level disease, with some studies having proposed a hybrid surgical technique involving a combination of both CTDR and ACDF. The cervical hybrid has been shown to be superior to multi-level ACDF in some clinical studies but outcomes compared to multi-level CTDR are less well described. The purpose of this paper is to compare the clinical outcomes and incidence of revision in multi-level CTDR compared to the hybrid technique for treating multi-level cervical DDD at 2 year follow-up.
A retrospective review of prospective data of 77 patients operated between 2004 and 2014, with 2 or 3 level cervical DDD was conducted. 37 patients underwent a cervical hybrid whilst 40 patients had a multi-level CTDR. The incidence of revision surgery was also documented at 2 years and the outcomes scores of these patients were excluded from the point of their revision surgery. Complications related to these surgeries was documented at 2 years and pre-operative diagnosis was compared between the two groups. Outcome measures including neck and arm pain Visual Analogue Scores (VAS) and Neck Disability Index (NDI) were collected pre-operatively and at 3, 6, 12 and 24 months post-operatively for both groups. Statistical analysis was conducted on the outcome measures using a two tailed paired T-test with an alpha level of 0.05 and a Chi-Square analysis was conducted to compare the incidence of revision rates, pre-operative diagnosis and complications.
There was no difference between the multi-level CTDR and hybrid groups in the presence of pre-operative cervical spondolytic radiculopathy (p=.075), myelopathy (p=.895) or combined radiculopathy and myelopathy (p=.883). Both groups had statistically significant improvements in clinical outcomes at all post-operative follow-ups compared to baseline. Further, when comparing the two groups, multi-level CTDR had statistically significant better VAS neck pain outcomes at 6 months (p=.025) and 24 months (p=.009) post-operative follow-up and VAS arm pain at 24 months (p=.023). In regards to revision rates, there was no statistically significant difference (p=.194) at 2 years between the cervical hybrid (3%) and multi-level CTDR (10%), although there was a trend towards a higher revision rate in the multi-level CTDR group. This lack of statistically significant difference and trend was also the case for surgical complications. With respect to revision, all hybrids were treated with a vertebrectomy whilst all multi-level CTDR had 1 or more of the CTDR levels converted to an ACDF.
This study shows that statistically significant pain reduction and functional improvement can be achieved with both multi-level CTDR and cervical hybrids when treating multi-level cervical DDD. Although the multi-level CTDR group showed superior neck pain reduction compared to the cervical hybrid group, the need for early revision surgery was higher. The complication and revision rate is low in the cervical hybrid group, which suggests cervical hybrids are safe and effective in treating multi-level cervical DDD.