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Two-Year Results of Cervical Artificial Disc Versus Fusion

Until recently, surgery for cervical disc degeneration has been with fusion. But 25 per cent of those patients end up with further problems in the next 10 years. Artificial disc replacement (ADR) may help change that.

This study was done in order to compare the results of fusion versus ADR. ADRs are designed to restore normal neck motion. Another goal is to get patients back to daily activities and work quickly.

Complications and problems usually linked with fusion are not a problem with ADR. For example, bone graft is not required with ADR. So there is no risk of graft site fracture, infection, nerve damage, or pain. And with cervical fusion, there is always the risk of motion recurring from a pseudoarthrosis (false joint). This doesn't happen with ADRs.

Data from three centers carrying out FDA-approved research on the Bryan ADR combined the results of 99 patients. All patients had a diagnosis of cervical degenerative disc disease. Neck and arm pain from pressure on the spinal cord or spinal nerve roots was the main cause of disability.

Half the patients had an ADR at one level. The other half had a single-level anterior cervical discectomy and fusion (ACDF). Follow-up was for a full two years. Outcomes were measured using pain levels, X-ray results, and range of motion. Function (both mental and physical) was also assessed.

Patients in both groups improved compared to before surgery. Blood loss and length of hospital stay were slightly more for the ADR patients. But pain and disability after two years were less than for the fusion patients.

Current studies (including this one) show that ADR is comparable to the gold standard of fusion for cervical disc disease. The two-year ADR results were very favorable. Only time will tell if the long-term results are better for ADR compared with fusion. The hope is for less adjacent level degeneration that occurs so often with fusion procedures.

References: Rick C. Sasso, MD, et al. Artificial Disc Versus Fusion. In Spine. December 15, 2007. Vol. 32. No. 26. Pp. 2933-2940.

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