Artificial Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion for the Treatment of Single-level Disc Degenerative Disease with Reversible Kyphosis
Department of Orthopedics,West China Hospital of Sichuan University
Abstract:Objective To compare the clinical and radiological outcomes of single-level artificial cervical disc replacement (ACDR) and single-level anterior cervical discectomy and fusion (ACDF) in patients with preoperative reversible kyphosis (RK).Methods Twenty-seven ACDR patients (male/female:14/13) with a mean age of (42.3±6.9)years (range,37~51 years) and 29 ACDF patients (male/female:12/17) with a mean age of (43.7±7.6)years (range,38~53 years) were included.The Japanese orthopedic association(JOA) score,neck disability index(NDI),and visual analogue scale(VAS) were used to evaluate clinical outcomes.Range of motion(ROM),the segmental angle at the index level,C2~7 angle,functional spinal unit(FSU) angle,adjacent segment degeneration(ASD),and heterotopic ossification(HO) were assessed.Results The follow-up averaged (40.6±10.4)months (range,25~66 months) in ACDR and (39.7±9.5)months(range,21~63 months) in ACDF.Both groups had significant improvements in clinical outcomes without significant intergroup differences.Compared with preoperative values,C2~7 angle and FSU increased significantly in both groups,while the C2~7 ROM was preserved.At the last follow-up,the C2~7 angle,FSU,and C2~7 ROM remained comparable between groups.The ACDR group had a significantly higher segmental ROM at the surgical level than ACDFgroup.Three ASD cases were noticed in ACDR group,while 5 cases were observed in ACDF group.According to McAfee classification,59.3%(16/27) ACDR patients developed HO (5 cases of grade Ⅲ;2 cases of grade Ⅳ).Conclusion Both ACDR and ACDF have satisfactory clinical results for the treatment of single-level disc degenerative disease with preoperative RK.ACDR is non-inferior to ACDF regarding the radiological outcomes of cervical alignment.ACDR group had a relatively high incidence of HO formation.
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