Artificial disc replacement has no long-term benefit over fusion following anterior decompression due to cervical degenerative radiculopathy

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Michael Kontakis

There is no clear benefit associated with artificial disc replacement (ADR) compared with fusion surgery when it comes to patient satisfaction, sustainability, and protection against adjacent-segment pathology (ASP) in those who have received anterior decompression due to cervical degenerative radiculopathy. This is main finding of new research which was published in the Journal of Neurosurgery: Spine by Michael Kontakis (Uppsala University Hospital, Uppsala, Sweden) et al.

According to the researchers, this was the first 10-year follow-up study to compare ADR with fusion surgery and to provide magnetic resonance imaging (MRI) information for the assessment of ASP.

A total of 153 patients who underwent ADR or fusion surgery after anterior decompression due to cervical degenerative radiculopathy were included in this retrospective study. Neck Disability Index (NDI), EQ-5D quality-of-life score, and Visual Analogue Scale (VAS) for neck and arm pain were obtained from the Swedish Spine Registry.

Information relating to secondary surgical procedures was collected from medical records and presented using Kaplan-Meier curves. MRI and flexion-extension radiography were performed, and ASP was graded according to the Miyazaki classification system.

Ten participants were lost to follow-up, which left 143 participants, 80 of which underwent ADR and 65 of which underwent anterior cervical discectomy and fusion. There were found to be no differences between the two groups in terms of patient-reported outcome measures (10-year difference in NDI scores 1.7 points, 95% confidence interval [CI] −5.1 to 8.5, p=0.61).

A total of 19 (24%) participants in the ADR group compared with nine (14%) in the fusion group underwent secondary surgical procedures. However, the higher reoperation rate of the ADR group was mainly due to 11 female participants who had device loosening say the researchers. In addition, the rates of reoperation due to ASP were similar between groups, which was confirmed with MRI assessment of ASP that also showed no differences between the groups (p=0.21).

Speaking to Spinal News International, Kontakis said: “Our group is very content that this work came to completion. We believe that we shed some light on the complications that are associated with each procedure in the long-term and we hope that this aids the surgeon in their decision-making.’’


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