Comparing Two Common Procedures for Treating Cervical Disc Disease

Each year, thousands of Americans endure episodes of acute or persistent neck and arm pain as a result of underlying cervical disc disease. For many years the standard treatment for the condition has been anterior cervical discectomy. Over 200,000 cervical procedures are performed annually to relieve painful compression on the spinal cord or nerve roots. Spinal fusion surgery creates a solid union between two or more vertebrae to reinforce the spine and treat the source of chronic neck pain.

In 2007, the FDA approved the first artificial cervical disc. Since that time, two other artificial cervical discs have met FDA approval. The goals of artificial cervical disc surgery are to remove the diseased disc, restore normal disc height, decrease neck pain and the associated arm pain and weakness, and preserve motion in the problem area. Compared to fusion surgery, artificial disc surgery may include more spine mobility after surgery and place less stress on neighboring discs. According to dead author Praven Mummaneni, M.D.,  "Given that this is a relatively new technology, this is the largest combined analysis of class 1 data to date comparing the efficacy of arthroplasty to the ACDF procedure."

Researchers at the University of California, San Francisco, compared the efficacy of three artificial discs. A total of 1,213 participants were randomly divided into two treatment groups in three FDA trials. The two groups had no statistical differences in age, sex, tobacco usage, litigation involvement, preoperative work status, or workman’s compensation claims.

The study data was then analyzed from these two groups and included previously unpublished source data. Statistical analysis was performed with a random effects model. The trials revealed the following results: joint motion in the arthroplasty group changed from 7° before the procedure to 8° following the procedure. All three devices demonstrated a promising range of motion at 2 years. The fusion group had no segmental motion following the procedure and had a 95 percent fusion rate.

Dr. Mummaneni concludes, "ACDF and artificial cervical discs both have excellent two year surgical results for one-level cervical disc disease with radiculopathy. We found that the artificial cervical discs were associated with lower rates of repeat surgery two years after implantation compared to ACDF. While both of these procedures yielded good results, the most important factor is proper patient selection"


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