Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion

Abstract
Background: The anterior cervical discectomy for cervical disc prolapse has been the work horse for ages and it works fine but the mechanical problems that follows is actually problematic hence the evolution of total disc replacement.
Aim of Study: The aim was to compare the efficacy and safety of arthroplasty using the artificial cervical disc with the standard Anterior Cervical Discectomy and Fusion (ACDF) for the management of cervical disc prolapse at single level.
Patients and Methods: Sixty patients were included and randomized to one of two groups: Investigational patients (30) underwent arthroplasty using a disc prosthesis, and a control group (30 patients) underwent ACDF with a cervical cage. Patients were assessed pre-operatively, immediate post-operative period and at six weeks, three months, six, twelve, eighteen and-twenty-four months postoperatively. Efficacy and safety outcomes were measured according to the Neck Disability Index (NDI), visual analogue score, gait disturbance, disc height, range of motion (arthroplasty group) or bony fusion (control group), complications, rate of second surgery, and neurological outcome. Overall outcome was considered successful according to four pivot criteria: (1): Improvement of post-operative NDI score more than fifteen points over the preoperative score, (2): Improved neurological presenting symptoms, (3): No serious complications caused by the prosthesis or by the surgical procedure, and (4): No resurgery needed (superimposed fixation, revision, or non-elective implant removal).
Results: The one year rate of overall outcome were ninety five percent for the arthroplasty group and eighty six percent for the control group, the arthroplasty group was better than the control group for the NDI score improvement. The per-centage of patients experiencing any adverse effects was six percent in the arthroplasty group and eight percent in the control group, which were not statistically different. Radio-graphic success was achieved in 9 ninety five percent of the arthroplasty group (maintenance of range of motion without bony fusion) and one hundred percent of control patients (fusion).
Conclusions: Arthroplasty is as efficient and successful as ACDF for the management of cervical disc pathology.