10 May Cervical Disc Replacement Added Benefits
A research study evaluating the 10-year outcome of patients undergoing single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York was recently published in the Journal of Neurosurgery – Spine (April 2023).
Although Anterior Cervical Diskectomy and Fusion (ACDF) is considered the gold standard for treatment of cervical disc disease that can cause radiculopathy or myelopathy, a number of studies have been conducted to show that cervical disc replacement (CDR) may have added benefits. Some of the benefits include increased range of motion and reduced risk of adjacent segment disease after surgery in the long term. The study highlighted here reviewed data from the New York State Database to assess each procedure and its effectiveness over 10 years.
The authors reviewed a retrospective cohort from the Statewide Planning and Research Cooperative System using diagnosis and surgical codes for adult patients who underwent either ACDFP or CDR at one level. The study included a total of 7,450 patients where 6,615 underwent ACDF and 835 underwent CDR. The analysis showed no significant differences in the incidence of revision risk between the two study groups. The CDR cohort had a higher incidence of postoperative swallowing difficulty while those patients undergoing ACDF had a longer average hospital stay.
The study did not highlight long-term success in terms of adjacent segment disease, only revision risk and immediate complications. They noted the revision risk; revision risk is simply when a patient is taken back to the operating room in the short term after the initial surgery. The database most likely did not track adjacent segment disease because it was probably not a feature of the database.
Overall, this was an excellent study to support both procedures in terms of the success and outcomes. It did not focus on the main topic of hypermobility or adjacent segment disease. My worry as a surgeon is that patients can have increased neck pain after cervical disc replacement.