Cervical kinematics and radiological changes after Discover artificial disc replacement versus fusion
Department of Orthopaedic Surgery, Changzheng Hospital, No. 415 Feng Yang Rd, Shanghai 200003, China.The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 09/2013; 14(6). DOI: 10.1016/j.spinee.2013.07.432
The cervical disc arthroplasty has emerged as a promising alternative to the anterior cervical discectomy and fusion (ACDF) in patients with radiculopathy or myelopathy with disc degeneration disease. The advantages of this technique have been reported to preserve the cervical mobility and possibly reduce the adjacent segment degeneration. However, no studies have compared the clinical outcomes and radiological results in patients treated with Discover artificial disc replacement to those observed in matched group of patients that have undergone ACDF.
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ABSTRACT: Study Design. A Markov transition state model was developed to evaluate the cost-effectiveness of Anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) at five years.Objective. To determine the cost-effectiveness of ACDF and CDR at five years.Introduction. ACDF and CDR are surgical options for the treatment of an acute cervical disc herniation with associated myelopathy/radiculopathy. Cost-effectiveness analysis (CEA) provides valuable information regarding which intervention will lead to a more efficient utilization of healthcare resourcesMethods. Outcome and complication probabilities were obtained from existing literature. Physician costs were based on a fixed percentage of 140% of 2010 Medicare reimbursement. Hospital costs were determined from the Nationwide Inpatient Sample (NIS). Utilities were derived from responses to health state surveys (Short Form 36) at baseline and at 5 years from the treatment arms of the Prodisc-C trial. Incremental cost effectiveness ratios (ICER) were used to compare treatments. One-way sensitivity analyses were performed on all parameters within the model.Results. CDR generated a total five-year cost of $102,274, while ACDF resulted in a five-year cost of $119,814. CDR resulted in a generation of 2.84 QALY's, whereas ACDF resulted in 2.81. The ICER was -$557,849 per QALY gained. CDR remained the dominant strategy below a cost of $20,486. ACDF was found to be a cost-effective strategy below a cost of $18,607. CDR was the dominant strategy when the utility value was above 0.713. CDR remained the dominant strategy assuming an annual complication rate less than 4.37%.Conclusions. ACDF and CDR were both shown to be cost effective strategies at five years. CDR was found to be the dominant treatment strategy in our model. Further long-term studies evaluating the clinical and quality of life outcomes of these two treatments are needed to further validate the model.
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ABSTRACT: This study is to investigate the effect of anterior cervical discectomy with internal fixation and fusion at different levels on adjacent segments in rabbits. Sixty New Zealand rabbits were randomly divided into four groups, one control group and three model groups, with 15 in each group. Each group underwent anterior cervical internal fixation and fusion at C3-4, C4-5, and C5-6 levels respectively. X-ray film was examined three, six and nine months after fusion to observe the changes in intervertebral space and endplate of adjacent segment. Immunohistochemistry was utilized to evaluate the effects of different fusion methods on adjacent segments of spine. As time went by, in model groups, the majority of cartilage endplates were calcified, as examined by X-ray. Immunohistochemical results of the intervertebral disc showed that the expression levels of collagen type II in nucleus pulposus were decreased significantly, while the expression levels collagen type I in annular fibrosus were increased. And collagen type I tends to replace collagen type II gradually in nucleus pulposus as time goes by. The change in collagen between upper and lower adjacent segments at C3-4 and C4-5 showed no statistical significance after fixation and fusion (p > 0.05). But for C5-6, the change showed statistical significance (p < 0.05). Cervical internal fixation and fusion can induce intervertebral disc degeneration of adjacent segment in rabbits, and cervical internal fixation and fusion operated at different levels may result in different effects on adjacent segments of cervical intervertebral disc.
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ABSTRACT: BACKGROUND: Adjacent segment disease is a long-term complication of anterior cervical decompression and fusion, and has been paid great attention recently. Cause of disease contains increased range of motion in surgery adjacent segment, intervertebral height loss and high intradiscal pressure. In the clinic, compared with fusion surgery, whether cervical non-fusion can effectively decrease the incidence of adjacent segment disease remains poorly understood. OBJECTIVE: To systematically assess the effects of cervical fusion and cervical non-fusion on adjacent segment degeneration. METHODS: We retrieved the randomized controlled trial concerning cervical fusion versus cervical non-fusion to repair cervical syndrome in the Medline, PubMed, Embase and Cochrane databases from January 2000 to December 2013. This study compared the effects of two repair methods on adjacent segment disease and evaluated methodological quality of the included studies. A meta-analysis was performed using RevMan 5.2 software. Outcome indicators: second surgery was undergone due to postoperative adjacent segment disease. RESULTS AND CONCLUSION: After screening, five randomized controlled trials met the inclusion criteria. There were 1 602 patients. All patients received surgery due to cervical syndrome. 785 cases underwent anterior decompression and fusion, and 817 cases underwent intervertebral disc replacement. 1 066 patients completed all follow-up, with a total follow-up rate of 66.54%. There were 494 patients treated with anterior decompression and fusion and 572 patients with intervertebral disc replacement. A total of 68 patients underwent second surgery due to adjacent segment disease. Total second surgery rate was 6.38% (68/1 066), including 28 cases after intervertebral disc replacement and 40 cases after anterior decompression and fusion. The grade of quality evaluation of the included studies was high, including five studies with grade A. Moreover, heterogeneity was small (I2 = 14%). Meta-analysis results revealed that the second surgery rate of adjacent segment disease was lower after cervical non-fusion than after cervical fusion, which showed significant differences (odd ratio = 0.58, 95% confidence interval: 0.35, 0.96). These results suggested that the second surgery rate of adjacent segment disease was higher after cervical fusion than after cervical non-fusion. The alterations in cervical biomechanics caused by fusion greatly affected the occurrence of adjacent segment disease. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
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