Artificial disc versus spinal fusion in the treatment of cervical spine degenerations in tetraplegics: A comparison of clinical results

Abstract

Study design:Comparative prospective study.Objectives:To determine functionality of the cervical spine when using ProDisc C in comparison with the conventional method of treatment (decompression and fusion) in paraplegics.Setting:Spinal Cord Injury Centre in Germany.Methods:Two homogeneous groups were studied. The patients were treated with ventral decompression and either had a fusion with an iliac bone graft and plate (group 1) or had received a disc replacement (group 2). Pre- and postoperatively, the subjective scores of SF 36 and Neck Disability Score were determined. Also, objective data of the Spinal Cord Independence Measure (SCIM) III and mobility of the cervical spine, using the neutral-0-method, were evaluated. Prosthesis implementation and union or fusion were monitored by X-rays. Complications and alterations of the neurology were recorded according to the American Spinal Injury Association Score.Results:Neurological remissions of the radicular syndrome that caused the operation were observed. In one case, the dislocation of the prosthesis necessitated an alternative treatment. Mobility of the cervical spine after 6 months was higher in group 2. Both groups showed signs of improvement in the Neck Disability Score and in SF 36. None of the two groups had changes in their SCIM score. One case in group 2 showed ventral blocking; all cases of group 1 fused successfully.Conclusion:Usage of prostheses results in improved total mobility of the cervical spine in comparison with the outcomes of a fusion. This study also confirmed these results in tetraplegics. © 2009 International Spinal Cord Society All rights reserved.