Analysis Of Clinical Efficacy And Radiological Changes Of Cervical Total Disc Replacement Vs ACDF

ObjectiveThe purpose of this study was to compare the clinical efficacy and radiological changes between cervical total disc replacement(CTDR)and anterior cervical discectomy and fusion(ACDF).MethodsFrom January 2008 to April 2016,67 patients with single-level cervical degenerative disease undergoing CTDR(n=18)or ACDF(n=49)were retrospectively reviewed.All patients were followed up for more than 24 months.The age,sex distribution,time of follow-up,diagnosis and operation time were not significantly different between the two groups.The visual analogue scale(VAS)of neck and arm pain scores,Neck Disability Index(NDI),Japanese Orthopaedic Association Scores(JOA),C2-C7 range of motion(ROM),C2-C7 lordosis,ROM of adjacent segments and the degenerative changes of adjacent segments before surgery and at final follow-up.Cases of CTDR additionally recorded ROM,curvature and height of functional spine unit(FSU).ResultsAt final follow-up,the scores of VAS,NDI,JOA improved significantly in all patients(P<0.05).Postoperative JOA scores in ACDF group was better than that in CTDR group at final follow-up(P<0.05),but there was no significant difference in pre-and postoperative scores of VAS and NDI and preoperative JOA between the two groups(P>0.05).C2-C7 and FSU ROM reminded the same in CTDR group(P>0.05).C2-C7 ROM was decreased significantly in ACDF group(P<0.05).C2-C7 and FSU lordosis was improved in CTDR group(P<0.05),and C2-C7 lordosis was restored in ACDF group(P>0.05).The height of FSU was preserved in CTDR group(P>0.05).There was no significant difference in preoperative C2-C7 ROM,preoperative and postoperative C2-C7 lordosis,ROM of adjacent segments between the two groups(P>0.05).Incidence of adjacent segment disease(ASD)in CTDR group reminded the same at final follow-up(P>0.05)but that in ACDF group was significantly increased(P<0.05).There was no significant difference in incidence of ASD between 2 groups whether before or after operation(P>0.05).Occurance of ASD in two groups was related to time of follow-up,but had no connection with sex distribution,age,smoke,surgical segments,operation time and blood loss.2 patients in CTDR group suffered from prosthesis shift,and heterotopic ossification was occurred in 5 patients.1 patient in ACDF group suffered from spontaneous spinal epidural hematoma,and 2 patients received reoperation.ConclusionWhether receiving CTDR or ACDF,patients suffering from single-level cervical disc degeneration disease can gain the same clinical success after operation.CTDR is able to preserve the physiological motion,cervical lordosis and height of treated space.Besides,incidence of ASD in 2 groups was related to duration after surgery.Long-term application of CTDR requires more clinical evidence with larger sample and longer follow-up.