title: Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.
abstract: Cervical artificial disc replacement (ADR) is indicated for the treatment of severe radiculopathy permitting neural decompression and maintenance of motion. We evaluated the clinical and radiographic outcomes in cervical ADR patients using the ProDisc-C device (DePuy Synthes, West Chester, PA, USA) with a 5-9 year follow-up. Data were collected through a prospective registry, with retrospective analysis performed on 24 consecutive patients treated with cervical ADR by a single surgeon. All patients underwent single- or two-level ADR with the ProDisc-C device. Outcome measures included neck and arm pain (visual analogue scale), disability (neck disability index [NDI]), complications and secondary surgery rates. Flexion-extension cervical radiographs were performed to assess range of motion (ROM) of the device and adjacent segment disease (ASD). Average follow-up was 7.7 years. Neck and arm pain improved 60% and 79%, respectively, and NDI had an improvement of 58%. There were no episodes of device migration or subsidence. Mean ROM of the device was 6.4°. Heterotopic ossification was present in seven patients (37%). Radiographic ASD below the device developed in four patients (21%) (one single-level and three two-level ADR). No patient required secondary surgery (repeat operations at the index level or adjacent levels). Fourteen out of 19 patients (74%) were able to return to employment, with a median return to work time of 1.3 months. The ProDisc-C device for cervical ADR is a safe option for patients providing excellent clinical outcomes, satisfactory return to work rates and maintenance of segmental motion despite radiographic evidence of heterotopic ossification and ASD on long-term follow-up.
authors.affiliation: Epworth Hospital, Richmond, VIC, Australia. Electronic address: gmalham@bigpond.net.au.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.affiliation: Greg Malham Neurosurgeon, Suite 2, Level 1, 517 St. Kilda Road, Melbourne, VIC 3004, Australia.
authors.forename: Rhiannon M
authors.initials: RM
authors.lastname: Parker
authors.affiliation: Greg Malham Neurosurgeon, Suite 2, Level 1, 517 St. Kilda Road, Melbourne, VIC 3004, Australia.
authors.forename: Ngaire J
authors.initials: NJ
authors.lastname: Ellis
authors.affiliation: The Alfred Hospital, Prahran, VIC, Australia.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Chan
authors.affiliation: The Alfred Hospital, Prahran, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Varma
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D059145:Total Disc Replacement / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
keywords: Adjacent segment disease; Artificial disc replacement; Cervical; Heterotopic ossification; ProDisc-C; Range of motion; Reoperation