Cervical disc replacement in patients with and without previous adjacent level fusion surgery: A prospective study

Frank M. Phillips, Todd R. Allen, John J. Regan, Todd J. Albert, Andrew Cappuccino, John G. Devine, Jeanette E. Ahrens, John A. Hipp, Paul C. McAfee

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

STUDY DESIGN.: Prospective 6-center study. OBJECTIVE.: To evaluate outcomes of cervical disc replacement performed adjacent to a prior cervical fusion. SUMMARY OF BACKGROUND DATA.: The use of disc replacement adjacent to a prior anterior cervical decompression and fusion (ACDF) is an attractive reconstructive option, obviating the need for a multilevel fusion. This study reports outcomes from patients with and without previous ACDF receiving the porous coated motion (PCM) artificial cervical disc in a United States Federal Drug Administration Investigational Device Exemption trials. METHODS.: Patients between ages of 18 and 65 with single-level cervical radiculopathy and/or myelopathy, unresponsive to at least 6 weeks of nonsurgical therapy, or experiencing progressive neurologic symptoms were enrolled. Clinical outcomes are compared for patients receiving a PCM disc at a level adjacent to a prior ACDF ("adjacent") and those without having previously had fusion ("primary"). RESULTS.: 126 PCM patients were primary (mean age: 44.4 years.) and 26 patients had previous "adjacent level" fusion surgery (mean age: 46.4 years). Surgery time was similar in both groups (96 minutes and 98 minutes, respectively; P = 0.761), and mean blood loss was 76 mL and 66 mL in the 2 groups, respectively (P = 0.491). Clinical outcomes using Neck Disability Index and Visual Analog Scores neck and arm scores showed significant improvement after surgery and were similar between groups at all time points. Revision surgery occurred in 2 of 126 primary patients, and in 2 of 26 patients in the adjacent-to-fusion group. CONCLUSION.: Although the level adjacent to a prior cervical fusion is subject to increased biomechanical forces, potentially leading to a higher risk of failure, the PCM disc was well tolerated in the short term. The early clinical results of disc replacement adjacent to a prior fusion are good and comparable to the outcomes after primary disc replacement surgery. However, in view of the small study population and short-term follow-up, continued study is mandatory.

Original languageEnglish (US)
Pages (from-to)556-565
Number of pages10
JournalSpine
Volume34
Issue number6
DOIs
StatePublished - Mar 15 2009
Externally publishedYes

Fingerprint

Prospective Studies
Decompression
Neck
Investigational Drugs
Radiculopathy
Spinal Cord Diseases
Neurologic Manifestations
Reoperation
Arm
Outcome Assessment (Health Care)
Equipment and Supplies
Population
Therapeutics

Keywords

  • Adjacent level
  • Cervical disc replacement
  • Fusion
  • PCM

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Phillips, F. M., Allen, T. R., Regan, J. J., Albert, T. J., Cappuccino, A., Devine, J. G., ... McAfee, P. C. (2009). Cervical disc replacement in patients with and without previous adjacent level fusion surgery: A prospective study. Spine, 34(6), 556-565. https://doi.org/10.1097/BRS.0b013e31819b061c

Cervical disc replacement in patients with and without previous adjacent level fusion surgery : A prospective study. / Phillips, Frank M.; Allen, Todd R.; Regan, John J.; Albert, Todd J.; Cappuccino, Andrew; Devine, John G.; Ahrens, Jeanette E.; Hipp, John A.; McAfee, Paul C.

In: Spine, Vol. 34, No. 6, 15.03.2009, p. 556-565.

Research output: Contribution to journalArticle

Phillips, FM, Allen, TR, Regan, JJ, Albert, TJ, Cappuccino, A, Devine, JG, Ahrens, JE, Hipp, JA & McAfee, PC 2009, 'Cervical disc replacement in patients with and without previous adjacent level fusion surgery: A prospective study', Spine, vol. 34, no. 6, pp. 556-565. https://doi.org/10.1097/BRS.0b013e31819b061c
Phillips, Frank M. ; Allen, Todd R. ; Regan, John J. ; Albert, Todd J. ; Cappuccino, Andrew ; Devine, John G. ; Ahrens, Jeanette E. ; Hipp, John A. ; McAfee, Paul C. / Cervical disc replacement in patients with and without previous adjacent level fusion surgery : A prospective study. In: Spine. 2009 ; Vol. 34, No. 6. pp. 556-565.
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AU - Cappuccino, Andrew

AU - Devine, John G.

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N2 - STUDY DESIGN.: Prospective 6-center study. OBJECTIVE.: To evaluate outcomes of cervical disc replacement performed adjacent to a prior cervical fusion. SUMMARY OF BACKGROUND DATA.: The use of disc replacement adjacent to a prior anterior cervical decompression and fusion (ACDF) is an attractive reconstructive option, obviating the need for a multilevel fusion. This study reports outcomes from patients with and without previous ACDF receiving the porous coated motion (PCM) artificial cervical disc in a United States Federal Drug Administration Investigational Device Exemption trials. METHODS.: Patients between ages of 18 and 65 with single-level cervical radiculopathy and/or myelopathy, unresponsive to at least 6 weeks of nonsurgical therapy, or experiencing progressive neurologic symptoms were enrolled. Clinical outcomes are compared for patients receiving a PCM disc at a level adjacent to a prior ACDF ("adjacent") and those without having previously had fusion ("primary"). RESULTS.: 126 PCM patients were primary (mean age: 44.4 years.) and 26 patients had previous "adjacent level" fusion surgery (mean age: 46.4 years). Surgery time was similar in both groups (96 minutes and 98 minutes, respectively; P = 0.761), and mean blood loss was 76 mL and 66 mL in the 2 groups, respectively (P = 0.491). Clinical outcomes using Neck Disability Index and Visual Analog Scores neck and arm scores showed significant improvement after surgery and were similar between groups at all time points. Revision surgery occurred in 2 of 126 primary patients, and in 2 of 26 patients in the adjacent-to-fusion group. CONCLUSION.: Although the level adjacent to a prior cervical fusion is subject to increased biomechanical forces, potentially leading to a higher risk of failure, the PCM disc was well tolerated in the short term. The early clinical results of disc replacement adjacent to a prior fusion are good and comparable to the outcomes after primary disc replacement surgery. However, in view of the small study population and short-term follow-up, continued study is mandatory.

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