Cervical total disc replacement may lead to fewer adjacent-level procedures than ACDF
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.