Artificial disk replacement in the treatment of degenerative cervical disk disorder: a 30-year follow-up study.

STUDY

DESIGN

Retrospective case series study.

OBJECTIVE

To clarify the results of a long-term (30 yr) follow-up study of artificial disk replacement (ADR) for the treatment of cervical disk disease.

SUMMARY OF BACKGROUND DATA: The use of the ADR procedure has become widespread during the past 10 years. Its purpose is to preserve motion of the functional spinal unit. However, the long-term results are unknown.

METHODS

Thirty-seven patients underwent ADR between 1980 and 1985 in the Department of Orthopedic Surgery, Changzheng Hospital. Twenty-one patients, who had a complete follow-up, underwent radiographical evaluation to detect heterotopic ossification, segmental range of motion, and adjacent segmental changes. In addition, patients were asked to complete preoperative and postoperative visual analogue scale, neck disability index, and 36-Item Short Form Health Survey questionnaires for evaluation of neurological function and pain severity. The occurrence of adverse events and reoperations was examined and these parameters served as indicators of device safety.

RESULTS

Twenty-one patients had a complete follow-up average of 30 years (range, 28-33 yr). The 21 patients reported improvement of the preoperative neurological symptoms. At the last follow-up, the motion was preserved in 19 of the 26 (73%) segments. None of the patients presented with symptomatic adjacent segment degeneration. Nineteen of the 21 (90%) patients presented heterotopic ossification, but none of them underwent reoperation correlated with heterotopic ossification. No device-related adverse events were recorded.

CONCLUSIONS

Artificial disk replacement to treat degenerative cervical disk disorders can preserve the motion of the spinal unit in young patients, which fulfills the original purpose of its design. We consider this procedure is worth applying in such a population. However, whether this procedure can prevent adjacent segment degeneration will require further investigation.

LEVEL OF EVIDENCE: 2.