February 18, 2016
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Cervical total disc replacement may lead to fewer adjacent-level procedures than ACDF

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Researchers found in this prospective, multicenter, randomized, unblinded clinical trial that patients who underwent cervical total disc replacement for treatment of symptomatic degenerative disc disease had less risk of a subsequent surgical intervention at 5-year follow-up compared with patients who underwent an anterior cervical discectomy and fusion.

Researchers included 260 patients in the one-level treatment group and 339 patients in the two-level treatment group. In the one-level group, 179 patients underwent a cervical total disc replacement (TDR) using a Mobi-C Cervical Disc Prosthesis (LDR Medical) and 81 patients underwent an anterior cervical discectomy and fusion (ACDF). In the two-level treatment group, 234 patients underwent a TDR procedure and 105 patients underwent an ACDF procedure.

At 5-year follow-up, researchers found one-level and two-level ACDF patients had a significantly higher occurrence of subsequent surgical intervention compared with the TDR cohort. In total, 17.3% of one-level ACDF patients had subsequent surgical intervention compared with 4.5% of TDR patients. In the two-level cohort, 21% of ACDF patients had subsequent surgery compared with 7.3% of TDR patients.

Researchers noted ACDF patients also had a significantly higher rate of subsequent surgeries at adjacent levels than TDR patients for both arms of the study.

“Several authors have hypothesized that TDR may reduce the incidence of adjacent-segment degeneration compared with ACDF as a consequence of maintaining segmental motion and stress profiles. For our one-level arm at 60 months, we found that four-times fewer TDR patients required a subsequent operation at adjacent levels (2.2% TDR vs. 11.1% ACDF; P < 0.05). Similar results were shown in the two-level arm for adjacent-level surgeries (3.4% TDR vs. 11.4% ACDF; P < 0.05),” researchers wrote in the study.

Researchers concluded the results from the clinical trial suggest TDR provides a substantial benefit and lower risk for subsequent surgical intervention compared with ACDF procedures. – by Robert Linnehan.

Disclosures: Jackson reports he serves as a consultant for LDR. Please see the full study for a list of all other authors’ relevant financial disclosures.