脊椎ジャーナル

Comparison of Motion Changes and Clinical Outcomes between Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion in Single Level Cervical Degenerative Disease: Retrospective Analysis

Abstract

Sang-Deok Kim, Jung-Kil Lee, Jae-Won Jang, Hyung-Sik Moon, Soo-Han Kim and Dae-Yong Kim

Objective: Cervical Total Disc Replacement (CTDR) has recently been developed as an alternative to Anterior Cervical Discectomy and Fusion (ACDF) in cervical degenerative disease to preserve the motion at the treated level. The aim of this study is to investigate the safety and efficacy of CTDR by comparing it with ACDF in the treatment of
single-level cervical degenerative disease, retrospectively.

Methods: This study included 61 patients, who underwent either stand-alone single-level ACDF (n = 33) or singlelevel CTDR (Bryan cervical artificial disc, n = 28) at C3 to C7 for degenerative cervical disease between June 2007 and December 2009. Cervical radiographs were obtained to measure overall and regional cervical angle and Range
of Motion (ROM). For evaluation for patient’s pain, visual analogue scale and Japanese Orthopedic Association score was measured.

Results: The changes of the overall Cervical Sagittal Angle (CSA) were not significantly different between the two groups. The Segmental Angle (SA) was maintained at a significantly higher in the CTDR group compared to the ACDF group during the follow-up period (p < 0.05). The ROM of the upper adjacent segment was significantly increased in the ACDF group compared to the CTDR group.

Conclusions: Clinically, CTDR is at least as efficient as ACDF. CTDR using a Bryan artificial disc provided a significant maintenance of the SA and the ROM at the treated level, and prevented the hyper-mobility at the upper adjacent segment compared to the ACDF. In the Future, prospective, randomized, long-term follow-up study with
large-number will be required to clarify the efficacy of CTDR.