General Session: Cervical Motion Preservation

Presented by: P. Karpe - View Audio/Video Presentation (Members Only)

Author(s):

P. Karpe(1), S. Khan(1), G. Reddy(1), C. Bhatia(1), T. Friesem(1)

(1) North Tees and Hartlepool NHS, Stockton, United Kingdom

Abstract

Introduction/

Aim: Disc arthroplasty for surgical treatment in myelopathy as motion preservation raises a concern of ongoing microtrauma to an already compromised cervical cord while being beneficial of increasing CSF flow by motion preservation. Few studies in literature have analyzed the outcomes of cervical disc arthroplasty for of cervical myelopathy. The purpose of this prospective study is to evaluate safety of cervical disc arthroplasty in management of cervical myelopathy.

Materials and Methods: From September 2005 to July 2011, 26 patients (Mean age 58.2years [45-81], with cervical myelopathy associated with spinal stenosis and neural compression due to disc herniation/osteophyte complex were enrolled. Patients had cervical disc arthroplasty at single, two or three levels from C3 to T1.Patients with fusion at adjacent level were excluded. Outcome measures used included Neck Disability Index (NDI), Bodily pain component of Short Form-36 scores and VAS scores for arm and neck. Secondary outcome measures were hospital anxiety and depression scores, neurological status and gait improvement. Average duration of symptoms was 57.54 months (3-300months). Mean follow-up was 58.04 months [12-117 ]. All patents underwent anterior cervical discectomy and disc arthroplasty using either the Prestige (Medtronics), Discoserv (Alphatec-scient'x) or Nunec(Pioneer Medical) disc replacement.

Results: All patients had primary surgeries with 46 operated levels. Single level disc arthroplasty was performed in eleven, two levels in ten and three levels in five patients. 2 patients were lost to follow-up. There were no implant related problems. Statistical analysis was done using SPSS 19.There was statistically significant improvement in clinical outcomes. The mean NDI difference was 12.00, p< 0.01. The mean SF36 difference was 9.54 ,p< 0.01. The VAS (Neck) mean difference was 2.54,p< 0.01.The VAS (Arm) data was not normally distributed, Wilcoxon Signed Ranks test was used and p< 0.01.

Conclusions: We find disc arthroplasty a safe and reliable option for patients with cervical myelopathy. It has an added advantage over fusion by way of preserving motion and preventing adjacent segment degeneration.