gms | German Medical Science

Objective: Monosegmental „soft-disc“-herniation in the cervical spine with corresponding radicular neurologic symptoms was treated either by implantation of a cervical disc-prosthesis or fusion by a PEEK-Cage. The outcome in a two-year follow-up period was evaluated. Special interest of the investigation was to evaluate self-rated disability and neck-pain, impairing daily activity in parts of these patients.

Methods: 42 patients were included in matched groups. After a standard anterior cervical discectomy in 20 of them disc replacement was performed by implantation of a cervical disc-prosthesis (Prestige LP, Medtronic). 22 patients were fused by implantation of a PEEK-cage (Rabea, Signus). Emphasis was on strict inclusion criteria as monosegmental radicular „soft-disc“ pathology. Exclusion criteria were age older than 60 years, clear signs of degeneration, multisegmental disc protrusions, signs of instability, previous cervical spine operations, or diseases of the rheumatoid and psychosomatic field. Evaluations were performed preoperatively, on 3^rd day post-op, after 3, 6, 12 and 24 months including the Neck Disability Index (NDI), the Patient Satisfaction Index (PSI) as well as a visual analogue scale (VAS) on neckpain, headache and radicular pain. In addition neurological examinations and x-rays were performed. For statistical investigation an analysis of variance (ANOVA) was used.

Results: Both techniques of disc replacement lead to a significant improvement of investigated symptoms. There was no significant difference between the two groups. Even for neck-pain, as a disabling symptom in parts of the patients there was no significant difference.

Conclusions: A two-year follow-up period could not reveal an advantage of the disc-prosthesis to justify its higher costs. Results of long-term follow-up studies possibly showing a lower risk of adjacent-level-degeneration or other advantages of motion preserving disc replacement are still outstanding.