RT Journal Article
SR Electronic
T1 Four-Level Cervical Disc Arthroplasty
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8603
DO 10.14444/8603
A1 Chang, Hsuan-Kan
A1 Chang, Chih-Chang
A1 Tu, Tsung-Hsi
A1 Kuo, Yi-Hsuan
A1 Wu, Ching-Lan
A1 Yeh, Mei-Yin
A1 Kuo, Chao-Hung
A1 Ko, Chin-Chu
A1 Fay, Li-Yu
A1 Huang, Wen-Cheng
A1 Wu, Jau-Ching
YR 2024
UL https://www.ijssurgery.com/content/early/2024/05/20/8603.abstract
AB Background Multilevel anterior cervical discectomy and fusion inevitably yields a higher chance of pseudarthrosis or require more reoperations than single-level procedures. Therefore, multilevel cervical disc arthroplasty (CDA) could be an alternative surgery for cervical spondylosis, as it (particularly 3- and 4-level CDA) could preserve more functional motility than single-level disc diseases. This study aimed to investigate the clinical and radiological outcomes of 4-level CDA, a relatively infrequently indicated surgery.Methods The medical records of consecutive patients who underwent 4-level CDA were retrospectively reviewed. These highly selected patients typically had multilevel disc herniations with mild spondylosis. The inclusion criteria were symptomatic cervical spondylotic myelopathy, radiculopathy, or both, that were medically refractory. The clinical outcomes were assessed. The radiographic outcomes, including global and individual segmental range of motion (ROM) at C3-7, and any complications were also analyzed.Results Data from a total of 20 patients (mean age: 56 ± 8 years) with an average follow-up of 34 ± 20 months were analyzed. All patients reported improved clinical outcomes compared with that of preoperation, and the ROMs at C3-7 were not only preserved but also trended toward an increase (35 ± 8 vs 37 ± 10 degrees, pre- vs postoperation, P = 0.271) after the 4-level CDA. However, global cervical alignment remained unchanged. There was one permanent C5 radiculopathy, but no other neurological deteriorations or any reoperations occurred.Conclusion For these rare but unique indications, 4-level CDA yielded clinical improvement and preserved segmental motility with low rates of complications. Four-level CDA is a safe and effective surgery, maintaining the ROM in patients with primarily disc herniations and mild spondylosis.Clinical Relevance For patients with mild spondylosis, whose degeneration at the cervical spine is not so severe, CDA is more suitable.Level of Evidence 4.