Deeptee Jain1, Michael P Kelly2, Matthew F Gornet3, J Kenneth Burkus4, Scott D Hodges5, Randall F Dryer6, Jeffrey R McConnell7, Todd H Lanman8, K Daniel Riew9. 1. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA deeptee.jain@gmail.com. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. 3. The Orthopedic Center of St. Louis, St Louis, MO, 63017. 4. Wilderness Spine Services, Columbus, GA, USA. 5. Center for Sports Medicine & Orthopaedics, Chattanooga, TN, USA. 6. Central Texas Spine Institute, Austin, TX, USA. 7. OAA Orthopedic Specialists, Allentown, PA, USA. 8. Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 9. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Abstract
BACKGROUND: Driving an automobile requires the ability to turn the neck laterally. Anecdotally, patients with multilevel fusions often complain about restricted turning motion. The purpose of this study was to compare the effectiveness of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) on driving disability improvement at 10-year follow-up after a 2-level procedure. METHODS: In the original randomized controlled trial, patients with cervical radiculopathy or myelopathy at 2 levels underwent CDA or ACDF. The driving disability question from the Neck Disability Index was rated from 0 to 5 years preoperatively and up to 10 years postoperatively. Severity of driving disability was categorized into "none" (score 0), "mild" (1 or 2), and "severe" (3, 4, or 5). Score and severity were compared between groups. RESULTS: Out of 397 patients, 148 CDA and 118 ACDF patients had 10-year follow-up. Driving disability scores were not different between the groups preoperatively (CDA: 2.65; ACDF: 2.71, P = 0.699). Postoperatively, the scores in the CDA group were significantly lower than those in the ACDF group at 5 (0.60 vs 1.08, P ≤ 0.001) and 10 years (0.66 vs 1.07, P = 0.001). Mean score improvement in the CDA group was significantly greater than the ACDF group at 10-year follow-up (-1.94 vs -1.63, P = 0.003). The majority of patients reported severe driving disability (CDA: 56.9%, ACDF: 58.0%, P = 0.968) before surgery. After surgery, a greater proportion of patients in the CDA group had neck pain-free driving compared with the ACDF group at 5 (63.3% vs 41.8%, P < 0.001) and 10 years (61.8% vs 41.2%, P = 0.003). CONCLUSION: In patients with cervical radiculopathy/myelopathy and 2-level disease, CDA provided greater improvements in driving disability as compared with ACDF at 10-year follow-up. This is the first report of its kind. This finding may be attributable to preservation of motion associated with CDA. CLINICAL RELEVENCE: This study provides valuable information regarding the improvement of driving disability after both CDA and ACDF. It demonstrates that both procedures result in significant improvements, with CDA resulting in even better improvements than ACDF, up to 10 year follow-up. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: Driving an automobile requires the ability to turn the neck laterally. Anecdotally, patients with multilevel fusions often complain about restricted turning motion. The purpose of this study was to compare the effectiveness of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) on driving disability improvement at 10-year follow-up after a 2-level procedure. METHODS: In the original randomized controlled trial, patients with cervical radiculopathy or myelopathy at 2 levels underwent CDA or ACDF. The driving disability question from the Neck Disability Index was rated from 0 to 5 years preoperatively and up to 10 years postoperatively. Severity of driving disability was categorized into "none" (score 0), "mild" (1 or 2), and "severe" (3, 4, or 5). Score and severity were compared between groups. RESULTS: Out of 397 patients, 148 CDA and 118 ACDF patients had 10-year follow-up. Driving disability scores were not different between the groups preoperatively (CDA: 2.65; ACDF: 2.71, P = 0.699). Postoperatively, the scores in the CDA group were significantly lower than those in the ACDF group at 5 (0.60 vs 1.08, P ≤ 0.001) and 10 years (0.66 vs 1.07, P = 0.001). Mean score improvement in the CDA group was significantly greater than the ACDF group at 10-year follow-up (-1.94 vs -1.63, P = 0.003). The majority of patients reported severe driving disability (CDA: 56.9%, ACDF: 58.0%, P = 0.968) before surgery. After surgery, a greater proportion of patients in the CDA group had neck pain-free driving compared with the ACDF group at 5 (63.3% vs 41.8%, P < 0.001) and 10 years (61.8% vs 41.2%, P = 0.003). CONCLUSION: In patients with cervical radiculopathy/myelopathy and 2-level disease, CDA provided greater improvements in driving disability as compared with ACDF at 10-year follow-up. This is the first report of its kind. This finding may be attributable to preservation of motion associated with CDA. CLINICAL RELEVENCE: This study provides valuable information regarding the improvement of driving disability after both CDA and ACDF. It demonstrates that both procedures result in significant improvements, with CDA resulting in even better improvements than ACDF, up to 10 year follow-up. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
Authors: Matthew F Gornet; Todd H Lanman; J Kenneth Burkus; Randall F Dryer; Jeffrey R McConnell; Scott D Hodges; Francine W Schranck Journal: J Neurosurg Spine Date: 2019-06-21
Authors: Michael J Moses; Jared C Tishelman; Saqib Hasan; Peter L Zhou; Ioanna Zevgaras; Justin S Smith; Aaron J Buckland; Yong Kim; Afshin Razi; Themistocles S Protopsaltis Journal: Spine (Phila Pa 1976) Date: 2018-10-15 Impact factor: 3.468
Authors: Matthew F Gornet; Todd H Lanman; J Kenneth Burkus; Scott D Hodges; Jeffrey R McConnell; Randall F Dryer; Anne G Copay; Hui Nian; Frank E Harrell Journal: J Neurosurg Spine Date: 2017-03-17
Authors: Daniel G Cobian; Andrew C Sterling; Paul A Anderson; Bryan C Heiderscheit Journal: Spine (Phila Pa 1976) Date: 2009-03-15 Impact factor: 3.468