Cervical Artifiial Disc Replacement: Indications And Outcomes

Objective: To explore the indications of cervical artificial disc replacement(ADR) based onradiographic evaluation and different anterior decompression methods.Methods: From January 2008 to July 2009,175 patients with cervical spondylosis ordisc herniation who underwent anterior decompression were involved in this study. Patients weredistributed to different operative groups based on the preoperative radiographic evaluation. Onehundred and forty-five cases were treated with fusion operation,and the others received ADR.Operative methods were as follows: 1) Anterior cervical discectomy and fusion(ACDF)ï¼›2)Anterior cervical discectomy and subtotal vertebrectomy and fusionï¼›3) Anterior subtotalvertebrectomy and fusionï¼›4) Prodisc-C ADR. The patients with Single-level spondyloticmyelopathy were divided into ACDF and ADR groups according to different operative methods.Clinical outcomes of two groups were evaluated by Japanese Orthopaedic Association(JOA)scoreï¼›The motion of rang(ROM) of the segment were recorded in ADR group at 1st month,3rd month,6th month and 12th month postoperatively.Results: The indication of ADR was cervical spondylosis with slight disc calcification orsmall vertebral posterior osteophytes. Under this condition,decompression could be obtainedthrough intervertebral space and ADR be inplanted. If cervical spondylosis was associated withvertebral posterior huge osteophytes,serious intervertebral narrow or fusion,serious disccalcification,,ossification of posterior longitudinal ligament (OPLL)and extensive cervicalspinal stenosis,subtotal vertebrectomy was necessary. The mean improvement rates of ACDFand ADR were 66.05% and 67.13%. There were no difference between two groups(P>0.05) . Nodifference of ROM was found before and after surgery in ADR group (P>0.05).Conclusion: Only decompression can be achieved thorough through the intervertebralspace,and ADR is suitable for cervical spondylosis. ACDF and ADR have similar outcomesin treatment of single-level cervical spondylotic myelopathy,but ADR has the advantage ofmaintaining ROM of the operative segment.