Adjacent segment degeneration after single- and double-level cervical total disc replacement: a cohort with an over 12-year follow-up

• Published in: European spine journal Vol. 33; no. 1; pp. 232 - 242
• Main Authors: Liang, Yan, Qian, Yalong, Xia, Weiwei, Guo, Chen, Zhu, Zhenqi, Liu, Haiying, Xu, Shuai
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2024; Springer Nature B.V
• Subjects: Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Degeneration; Follow-Up Studies; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - surgery; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - epidemiology; Intervertebral Disc Degeneration - surgery; Intervertebral discs; Kinematics; Lordosis - surgery; Medicine; Medicine & Public Health; Mobility; Neurosurgery; Original Article; Ossification (ectopic); Ossification, Heterotopic - surgery; Prostheses; Retrospective Studies; Risk factors; Subsidence; Surgery; Surgical Orthopedics; Synchronization; Total Disc Replacement - adverse effects; Treatment Outcome; Long-term follow-up; Heterotopic ossification; Cervical total disc replacement; Adjacent segment degeneration
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-023-08018-3

Purpose To characterize the change of adjacent segment degeneration (ASD) after cervical total disc replacement (CTDR) with more than 12-year follow-up, and identify the risk factors for ASD. Method This process included 75 patients underwent CTDR from February 2004 to December 2012, with the follow-up of 151.9 ± 36.0 (m). The artificial disc included ProDisc-C, Prestige-LP and Mobi-C. ASD was followed up at 1 week, 6 months, 1 year, 2 years, 5 years, 10 years after CTDR and at the endpoint of June 2022. The radiographic measurements were cervical mobility, intervertebral disc height (IDH), cervical lordosis and balance status. The complications were implant migration, subsidence and heterotopic ossification (HO). Results Cervical mobility in adjacent segments, IDH and lordosis showed no statistical differences between ASD and NASD group. Balance status, subsidence and migration showed no relationship with ASD. Postoperative ASD increased at 6 m and especially between 6 m to 2y. There was no difference between the incidence of upper ASD and lower ASD all the time and few ASD-related reoperation. The majority of adjacent segments were C4/5 (33.6%) and C6/7 (34.2%), and ASD of C5/6 had the highest incidence (61.5%). Cox regression showed ASD was not related to the types of prosthesis or operated numbers. Generalized estimating equations (GEE) analysis showed severe HO had a higher (2.68 times) probability to suffer from ASD. Conclusions After over 12-year follow-up of CTDR, the occurrence of ASD and HO had temporal synchronization. ASD was not merely a natural progression but with the pathological process such as HO.