Artikel
Disc replacement with pro-disc C versus fusion: a prospective randomized and controlled radiographic and clinical study
Vergleich zervikaler Bandscheibenersatz "Pro-Disc C" mit Fusion: prospektive, randomisierte, und kontrolierte klinische und radiologische Studie
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Veröffentlicht: | 11. April 2007 |
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Objective: Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artifical disc replacement by disc prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to judge and has not yet been proven.
The aim of the current study was first to analyze segmental motion following artificial disc replacement using a disc prosthesis. A second aim was, to compare both segmental motion as well as clinical result to the current gold standard (ACDF).
Methods: This is a prospective controlled study. Twenty-five patients with cervical disc herniation were enrolled and assigned to either study groups (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate). Radio Stereometric Analysis (RSA) was used to quantify intervertebral motion immediately as well as 3, 6, 12 weeks, 6 months as well as 1 and 2 years postoperatively. Also, clinical results were judged using visual analog scale and neuro-exam at even RSA follow-up.
Results: Cervical spine segmental motion decreased over time in the presence of both disc prosthesis or fusion device. However, the loss segmental motion is significantly higher in the fusion group, when looked 3, 6, 12 weeks and 6 months, as well as 1 und 2 years after surgery. We observed significant pain reduction in neck and arm postoperatively, with out significant difference between both groups.
Conclusions: Cervical spine disc prosthesis remains cervical spine segmental motion within 2 years after surgery. The clinical results are the same when compared to the early results following ACDF.