Artificial Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion in the Management of Single Level Cervical Disc Prolapse: Randomized Control Single Blinded Study

Abstract Background: Anterior cervical decompression and inter-body fusion can result in the loss of range of motion with accelerated adjacent disc degeneration. Aim of Study: This study details the analysis of the indi-cations, safety, efficacy and complications of cervical dynamic artificial disc replacement (CDR) for cases of cervical disc diseases compared to PEEK (polyetheretherketone) cage insertion, in addition statistical comparison between both techniques. Patient and Methods: The study included 30 patients with single level disc disease with radiculopathy both confirmed by clinical and radiological data, with failed medical treatment for 6 weeks at least. Results: Average age of presentation was 37.7 years (age range 18-50) for both groups, female ratio for the fixed group was 1:1.5, and 1:0.8 for the dynamic group. The average duration of symptoms was 51.4 weeks, 21 cases had left, while 9 had right sided radiculopathy. The most common presenting symptom after neck pain was the brachialgia, most common sign was sensory changes. Most common operated level was C5-6 for both groups. The average follow-up period in our study was 6 months, during which no recurrence, instability or progressive kyphosis occurred. The neck disability index, in the Anterior Cervical Dis-cectomy and Fixation (ACDF) group (66.7% scored from 5 to 14), (33.3% from 15 to 24), versus in the artificial disc group (53.3% scored from 5 to 14), (46.7% scored from 15 to 24). The clinical assessment as regard the motor and sensory shows no different out comes where the both study groups give the same final surgical results. Conclusion: Cervical dynamic implants offer many distinct advantages over the traditional (ACDF) to include preserved segmental motion, decreased adjacent level strain, offers adequate motion to avoid overloading and accelerating adjacent level degeneration.
Overall, the results provided suggest that CDR although being more expensive, but may be a safe and effective alter-native surgical procedure to fusion for the treatment for single level cervical disc.