Licoes sobre a substituicao total de disco cervical após sete anos de acompanhamento

Abstract

Objective: To present the clinical and radiological experience of cervical arthroplasty in the treatment of intervertebral disc degeneration, maintaining movement and reducing adjacent segments stress and degeneration. Methods: We studied the radiographs of 280 levels in 161 patients (mean age 45.4 years) treated between cervical levels C3-4 and C7-T1. Seventy-one patients were operated at one disc level, 67 at two, 17 at three, and 6 at four levels. Radiological and clinical outcomes were collected preoperatively, 1 week and 1, 3 and 6 months and annually. NDI/ VAS questionnaires were used to assess pain and functional outcomes. For facet degeneration analysis, we used a four-grade scale based on CT scans. Results: The clinical outcomes significantly improved at all postoperative visits. The majority of patients progressed to grade I and II facet degeneration, and in these cases there was no clinical deterioration, unlike cases with grade III and IV. Among the studied levels, 25 (8.93%) revealed some degree of HO: 14 had grade I level (56%), 7 grade II (28%), 3 grade III (12%) and 1 grade IV (4%). In 92% of patients that developed HO it was found incipient presence of osteophytes. Adjacent level disease occurred in 5.7% of patients. Conclusion: The good clinical results also confirm the superiority of outcomes of CTDR in comparison with those of ACDF, described in the literature.