PMID- 35984083
OWN - NLM
STAT- MEDLINE
DCOM- 20220822
LR  - 20220822
IS  - 1940-5480 (Electronic)
IS  - 1067-151X (Linking)
VI  - 30
IP  - 17
DP  - 2022 Sep 1
TI  - Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk 
      Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients 
      With Myeloradiculopathy.
PG  - e1137-e1147
LID - 10.5435/JAAOS-D-21-01276 [doi]
AB  - INTRODUCTION: This study compares perioperative and postoperative clinical 
      outcomes in patients undergoing anterior cervical diskectomy and fusion (ACDF) or 
      cervical disk replacement (CDR) at C5-C6 in patients with myeloradiculopathy. 
      METHODS: Primary, elective, single-level CDR or ACDF procedures at C5-C6 for 
      patients with myeloradiculopathy were included. Patient-reported outcome measures 
      (PROMs) included visual analog scale (VAS) neck, VAS arm, Neck Disability Index 
      (NDI), Patient-Reported Outcomes Measurement Information System Physical Function 
      (PROMIS-PF), and Short-Form 12-Item Physical Composite Score (SF-12 PCS) 
      collected at preoperative/6-week/12-week/6-month/1-year time points. Surgical 
      cohorts were assessed for differences in demographics/perioperative 
      characteristics using the chi square test and unpaired Student t-test for 
      categorical and continuous variables, respectively. Achievement of minimum 
      clinically important difference (MCID) was determined by comparing DeltaPROMs with 
      established thresholds. Outcome measures were compared at postoperative time 
      points with the Student t-test, and improvement from preoperative baseline was 
      assessed with a paired sample t-test. RESULTS: One hundred thirty-seven patients 
      were included, 43 CDR and 94 ACDF. CDR patients demonstrated significantly 
      reduced surgical times (46.3 versus 55.1 minutes), estimated blood loss (24.4 
      versus 43.6 mL), revision surgery rates (0.0% versus 5.3%), postoperative length 
      of stay (8.9 versus 23.0 hours), and postoperative narcotic consumption (P < 
      0.017, all). Complication rates and mean PROMs did not differ between cohorts. 
      The CDR cohort markedly improved from baseline for all PROMs postoperatively 
      except SF-12 PCS/PROMIS-PF at 6 weeks. The ACDF cohort markedly improved at each 
      time point except VAS arm at 1 year, NDI at 6 weeks/1 year, and SF-12 
      PCS/PROMIS-PF at 6 weeks. A majority of both cohorts achieved overall MCID for 
      VAS neck/NDI/PROMIS-PF. MCID achievement rates did not differ except NDI at 12 
      weeks/1 year and SF-12 PCS at 6 months, both favoring CDR. DISCUSSION: Both 
      procedural cohorts demonstrated similar long-term clinical outcomes for arm/neck 
      pain and physical function; however, patients undergoing CDR at C5-C6 
      demonstrated an improved ability to maintain 1-year postoperative progress for 
      neck disability with improved 1-year NDI MCID achievement. The CDR cohort, in 
      addition, demonstrated an improved perioperative profile and reduced rate of 
      revision surgery.
CI  - Copyright (c) 2022 by the American Academy of Orthopaedic Surgeons.
FAU - Jacob, Kevin C
AU  - Jacob KC
AD  - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
FAU - Patel, Madhav R
AU  - Patel MR
FAU - Parsons, Alexander W
AU  - Parsons AW
FAU - Prabhu, Michael C
AU  - Prabhu MC
FAU - Ribot, Max A
AU  - Ribot MA
FAU - Pawlowski, Hanna
AU  - Pawlowski H
FAU - Vanjani, Nisheka N
AU  - Vanjani NN
FAU - Singh, Kern
AU  - Singh K
AUID- ORCID: 0000-0002-6118-7273
LA  - eng
PT  - Journal Article
DEP - 20220613
PL  - United States
TA  - J Am Acad Orthop Surg
JT  - The Journal of the American Academy of Orthopaedic Surgeons
JID - 9417468
SB  - IM
MH  - Cervical Vertebrae/surgery
MH  - Diskectomy/adverse effects
MH  - Humans
MH  - Neck Pain/etiology
MH  - Retrospective Studies
MH  - *Spinal Cord Diseases/etiology
MH  - *Spinal Fusion/methods
MH  - Treatment Outcome
EDAT- 2022/08/20 06:00
MHDA- 2022/08/23 06:00
CRDT- 2022/08/19 08:13
PHST- 2021/12/30 00:00 [received]
PHST- 2022/04/28 00:00 [accepted]
PHST- 2022/08/19 08:13 [entrez]
PHST- 2022/08/20 06:00 [pubmed]
PHST- 2022/08/23 06:00 [medline]
AID - 00124635-202209010-00011 [pii]
AID - 10.5435/JAAOS-D-21-01276 [doi]
PST - ppublish
SO  - J Am Acad Orthop Surg. 2022 Sep 1;30(17):e1137-e1147. doi: 
      10.5435/JAAOS-D-21-01276. Epub 2022 Jun 13.