Is cervical disc arthroplasty an effective treatment option for patients with cervical spondylotic myelopathy? A matched cohort analysis compared to anterior cervical discectomy and fusion.

Abstract

Background context: Cervical spondylotic myelopathy (CSM) is a progressive condition characterized by spinal cord compression secondary to disc degeneration. While anterior cervical discectomy and fusion (ACDF) has long been considered the standard surgical treatment for CSM, loss of motion segments after this procedure may lead to sequelae, including adjacent segment disease (ASD), further propagating loss of function and the potential requirement for revision procedures. More recently, cervical disc arthroplasty (CDA) has been introduced as a motion-preserving alternative to ACDF in CSM.

Purpose: This study compares ACDF to CDA in patients with preoperative CSM.

Study design/setting: A matched cohort retrospective study.

Patient sample: About 110 patients were included in the final analysis; 55 underwent ACDF, and 55 underwent CDA.

Outcome measures: Complication rates, myelopathic severity measured by the Nurick scale, and patient-reported outcomes measured by VAS-neck, VAS-arm, and NDI scores METHODS: We examined patients who underwent either one or two-level ACDF or CDA with a minimum follow-up of 2 years. Patients were matched for age, sex, comorbid conditions, preoperative myelopathy severity, and the number of indicated operative levels. Demographics, perioperative data, and complication rates were compared between the two cohorts of patients. Patient-reported outcome measures were assessed at multiple follow-up intervals.

Results: No significant differences were observed in demographics or perioperative data. Overall complication rates were similar between the two cohorts (p=.167). Rates of dysphagia (p=1.00), dysphonia (p=.157), infection (p=1.00), construct failure (p=.154), heterotopic ossification (p= .132), and ASD (p=.315) were similar between the two groups. Furthermore, revision rates were similar between the two groups (p=.315). No significant differences were observed in median postoperative Nurick scores between the two cohorts (p=1.00). NDI improvements were greater in the CDA cohort (p=.040).

Conclusions: ACDF and CDA had statistically similar complication rates and improvements in myelopathic symptoms. However, patients who underwent CDA had superior PROMs to those who had undergone ACDF.