Abstract
Introduction
Cervical myelopathy secondary to cord compression may require surgical decompression with the aim of surgery being to arrest the progression of myelopathy and associated symptoms. Theoretical concerns have been raised regarding the use of cervical disc arthroplasty (CDA) in patients with myelopathy due to the fear that continued motion may cause continuing microtrauma to the cord. As such there is a paucity of reported data. We report the clinical results of anterior cervical decompression and CDA in patients with cervical myelopathy at our institution.
Patients and Methods
Patients who had undergone one- or two-level anterior cervical decompression and CDA for myelopathy were identified from the authors' institution's database. Prospectively collected data including neck disability index (NDI), visual analogue scale (VAS) for neck and arm pain, patient reported activity level, and hospital anxiety and depression scale were reviewed. Statistical analysis was performed for significance.
Results
Demographics: 40 patients. Mean age at surgery 51.3 years (range, 35–75). Operated levels, 63: 17 one- and 23 two-level procedures. Seven patients had cord compression at both levels; 21 had myelomalacia at one level and 3 at two levels. The average duration of preoperative symptoms was 37.5 months. Mean follow-up was 3.2 years (range, 1–7.4 years).
Surgery: Surgery was performed using four different implants; 28 PRESTIGE LP Cervical Disc System (Medtronic, Minnesota, United States), 24 NUNEC Cervical Arthroplasty System (RTI Surgical, Inc., Florida, United States), 10 Discocerv (Scient́x-Alphatec Spine, France), and one DISCOVER Cervical Arthroplasty Disc Replacement System (DePuy Spine, Inc., Massachusetts, United States). Overall, 34 procedures were performed at C5/6, 21 at C6/7, 7 at C4/5, and 1 at C3/4.
Outcomes: Mean NDI improved from 47.7 to 33.96 (p < 0.01), VAS arm 6.4 to 3.8 (p < 0.01), VAS neck 6.5 to 3.3 (p < 0.01), depression 8.9 to 7.1 (p = 0.01), and anxiety 9.4 to 7.8 (p = 0.06). A total of 26 patients (65%) reported same or better activity level, 27 (68%) would be satisfied with their current condition for life. A total of 29 (73%) said they would have the treatment again.
Conclusion
We report the clinical results of anterior cervical decompression and CDA in 40 patients with cervical myelopathy, with follow-up up to 7.4 years. Statistically significant improvements were seen in NDI and VAS scores. The level of improvement or maintenance of activity level is likely a reflection of a general patient reported activity measure being used rather than a specific myelopathy scale. We believe our results support further investigation of CDA in myelopathy.