Cervical total disc replacement (CTDR) aims to decrease the incidence of adjacent segment disease through motion preservation in the operated disc space. Ongoing data collection and increasing number of studies describing heterotopic ossification (HO) resulting in decreased mobility of implants, forced us to carefully evaluate our long-term clinical and morphological results of patients with CTDR. We present the first 54 consecutive patients treated with 65 ProdiscC prostheses during a 12-month period (2/2004-3/2005). All patients signed an informed consent and were included in prospective long-term study approved by hospital ethical committee. The 1- and 2-year follow-up analysis were available for all patients included and 4-year results for 50 patients (60 implants). Clinical (neck disability index-NDI, visual analog scale-VAS) and radiological follow-up was conducted at 1-, 2- and 4-years after the procedure. The Mehren/Suchomel modification of McAfee scale was used to classify the appearance of HO. Mean preoperative NDI was 34.5%, VAS for neck pain intensity 4.6 and VAS for arm pain intensity 5.0. At 1-, 2- and 4-year follow-up, the mean NDI was 30.7, 27.2, and 30.4, mean VAS for neck pain intensity 2.5, 2.1 and 2.9 and mean VAS for arm pain intensity pain 2.2, 1.9 and 2.3, respectively. Significant HO (grade III) was present in 45% of implants and segmental ankylosis (grade IV) in another 18% 4 years after intervention. This finding had no clinical consequences and 92% of patients would undergo the same surgery again. Our clinical results (NDI, VAS) are comparable with fusion techniques. Although, advanced non-fusion technology is used, a significant frequency of HO formation and spontaneous fusion in cervical disc replacement surgery must be anticipated during long-term follow-up.

Department of Neurosurgery Regional Hospital Liberec Liberec Czech Republic

See more in PubMed

Baba H, Furusawa N, Imura S, Kawahara N, Tsuchiya H, Tomita K. Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine (Phila Pa 1976) 1993;18:2167–2173. PubMed

Bartels RH, Donk R. Fusion around cervical disc prosthesis: case report. Neurosurgery. 2005;57:E194. doi: 10.1227/01.NEU.0000163419.59635.78. PubMed DOI

Beaurain J, Bernard P, Dufour T, Fuentes JM, Hovorka I, Huppert J, Steib JP, Vital JM, Aubourg L, Vila T. Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J. 2009;18:841–850. doi: 10.1007/s00586-009-1017-6. PubMed DOI PMC

Bertagnoli R. Heterotopic ossification at the index level after Prodisc-C surgery: what is the clinical relevance? Spine J. 2008;8:123S. doi: 10.1016/j.spinee.2008.06.687. DOI

Bertagnoli R, Duggal N, Pickett GE, Wigfield CC, Gill SS, Karg A, Voigt S. Cervical total disc replacement, part two: clinical results. Orthop Clin North Am. 2005;36:355–362. doi: 10.1016/j.ocl.2005.02.009. PubMed DOI

Brooker AF, Bowerman JW, Robinson RA, Riley LH., Jr Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632. PubMed

Cloward RB. The treatment of ruptured lumbar intervertebral disc by vertebral body fusion. III. Method of use of banked bone. Ann Surg. 1952;136:987–992. doi: 10.1097/00000658-195212000-00011. PubMed DOI PMC

Datta JC, Janssen ME, Beckham R, Ponce C. Sagittal split fractures in multilevel cervical arthroplasty using a keeled prosthesis. J Spinal Disord Tech. 2007;20:89–92. doi: 10.1097/01.bsd.0000211258.90378.10. PubMed DOI

DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003;16:314–323. PubMed

Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 2005;30:1165–1172. PubMed

Doran SE, Walsh J, Kinkaid A, Cutler D (2003) Prospective analysis of dysphagia following anterior cervical spine fusion. In: 31st annual meeting of the Cervical Spine Research Society. Scottsdale, Arizona, December 11–13, 2003

Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, An HS. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 2002;27:2431–2434. PubMed

Goffin J, Calenbergh F, Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine (Phila Pa 1976) 2003;28:2673–2678. PubMed

Goffin J, Loon J, Calenbergh F, Plets C. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord. 1995;8:500–508. doi: 10.1097/00002517-199512000-00014. PubMed DOI

Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81:519–528. PubMed

Hilibrand AS, Yoo JU, Carlson GD, Bohlman HH. The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine (Phila Pa 1976) 1997;22:1574–1579. PubMed

Janssen M, Goldstein J, Murrey D, Delamarter R. Heterotopic ossification at the index level after Prodisc-C: what is the clinical significance? Spine J. 2007;7:48S–49S. doi: 10.1016/j.spinee.2007.07.117. DOI

Kjaersgaard-Andersen P, Schmidt SA. Total hip arthroplasty. The role of antiinflammatory medications in the prevention of heterotopic ossification. Clin Orthop Relat Res. 1991;263:78–86. PubMed

Leung C, Casey AT, Goffin J, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V. Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery. 2005;57:759–763. doi: 10.1227/01.NEU.0000175856.31210.58. PubMed DOI

McAfee PC, Cunningham BW, Devine J, Williams E, Yu-Yahiro J. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech. 2003;16:384–389. PubMed

Mehren C, Suchomel P, Grochulla F, Barsa P, Sourkova P, Hradil J, Korge A, Mayer HM. Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 2006;31:2802–2806. PubMed

Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007;6:198–209. doi: 10.3171/spi.2007.6.3.198. PubMed DOI

Murrey D, Janssen M, Delamarter R, Goldstein J, Zigler J, Tay B, Darden B. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J. 2009;9:275–286. doi: 10.1016/j.spinee.2008.05.006. PubMed DOI

Nabhan A, Ahlhelm F, Pitzen T, Steudel WI, Jung J, Shariat K, Steimer O, Bachelier F, Pape D. Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study. Eur Spine J. 2007;16:423–430. doi: 10.1007/s00586-006-0226-5. PubMed DOI PMC

Parkinson JF, Sekhon LH. Cervical arthroplasty complicated by delayed spontaneous fusion. Case report. J Neurosurg Spine. 2005;2:377–380. doi: 10.3171/spi.2005.2.3.0377. PubMed DOI

Pimenta L, McAfee PC, Cappuccino A, Bellera FP, Link HD. Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J. 2004;4:315S–321S. doi: 10.1016/j.spinee.2004.07.024. PubMed DOI

Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine. 2005;3:417–423. doi: 10.3171/spi.2005.3.6.0417. PubMed DOI

Sasso RC, Smucker JD, Hacker RJ, Heller JG. Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech. 2007;20:481–491. doi: 10.1097/BSD.0b013e3180310534. PubMed DOI

Shim CS, Shin HD, Lee SH. Posterior avulsion fracture at adjacent vertebral body during cervical disc replacement with ProDisc-C: a case report. J Spinal Disord Tech. 2007;20:468–472. doi: 10.1097/BSD.0b013e31803b95db. PubMed DOI

Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A:607–624. PubMed

Sola S, Hebecker R, Mann S (2008) Bryan cervical disc prosthesis: 5 years follow-up. Motion preservation technology 8th annual meeting. Miami, Florida, May 6–9, 2008

Weinhoffer SL, Guyer RD, Herbert M, Griffith SL. Intradiscal pressure measurements above an instrumented fusion. A cadaveric study. Spine (Phila Pa 1976) 1995;20:526–531. PubMed

Quality of Life Following Prestige LP Cervical Disc Arthroplasty in a Prospective Multicountry Study

Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis

Cervical total disc replacement C5/6