CERVICAL ARTHROPLASTY IN SINGLE-LEVEL SPONDYLOTIC RADICUOLPATHY WITH SEVERE NARROWING OF INTERVERTEBRAL DISC SPACE

Abstract

Cervical arthroplasty is usually performed for the treatment of soft disc herniation, but not for spondylotic radiculopathy. To our knowledge, there has no study to investigate the clinical and radiological results of cervical arthroplasty for spondylotic radiculopathy. We therefore performed the current study to evaluate clinical and radiological results of cervical arthroplasty for spondylotic radiculopathy with severe narrowing of the intervertebral disc space.

Eight patients, who underwent anterior decompression, overdistraction, and implantation of artificial cervical disc for primary, single-level spondylotic radiculopathy with severe narrowing of the disc space (decrease more than 50% of adjacent disc spaces) were included in this study. Four were male and 4 were female with mean age of 49.5 years. The operation level was 7 C5–6 and 1 C6–7. Five Prodisc-C and 3 Prestige LP prostheses were implanted. The clinical and radiological evaluations were performed with minimum one year follow-up (range, 12 – 19 months) after surgery.

VAS of the neck and arm pain improved (79.6 vs. 19.4 points, p < 0.01; 82.5 vs. 22.7 points, p < 0.01) at last follow-up, respectively. According to Odom’s criteria, satisfactory clinical outcome was achieved in 63% (5 out of 8, 3 excellent and 2 good) while fair result was achieved in 37% of the patients (3 out of 8). The disc space (3.0mm vs. 6.4mm, p < 0.01) and range of motion (1.4 vs. 6.3 degrees, p = 0.009) at the operated level increased, respectively. Overall sagittal alignment of the cervical spine was increased after surgery (5.2 vs. 11.3 degrees, p < 0.05). In 5 patients, segmental angle of the operated level was increased (0.2 vs. 5.3 degrees, p = 0.003) after surgery with maintained facet joint articulation overlap. However, in 3 patients, segmental angle of operated level became kyphotic from neutral (0 vs. −10.0 degrees, p = 0.295) with decreased facet joint articulation overlap.

In conclusions, cervical arthroplasty provided favorable clinical and radiological outcomes in most of the patients with spondylotic radiculopathy and severe narrowing of the disc space at minimum one year follow-up after surgery. However, in some of the patients, postoperative segmental kyphosis developed and clinical outcomes were not satisfactory.