Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty

• Published in: Yonsei medical journal Vol. 63; no. 1; pp. 72 - 81
• Main Authors: Shin, Jun Jae, Kim, Kwang-Ryeol, Son, Dong Wuk, Shin, Dong Ah, Yi, Seong, Kim, Keung-Nyun, Yoon, Do-Heum, Ha, Yoon
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.01.2022; 연세대학교의과대학
• Subjects: Arthroplasty; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Follow-Up Studies; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - surgery; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - surgery; Original; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; 의학일반; Cervical disc replacement; cervical disc arthroplasty; adjacent segment; artificial disc replacement; degenerative cervical disc disease
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2022.63.1.72

The purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty. A total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up. The mean follow-up period was 38 months (range, 25-114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis. CDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.