Professor Mayo Clinic Rochester Rochester, Minnesota, United States
Introduction: The role of cervical disc arthroplasty (CDA) in the management of cervical spondylotic myelopathy (CSM) has not been adequately investigated. To compare clinical and patient-reported outcomes between CDA and anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM) in the real-world clinical setting.
Methods: The Quality Outcomes Database (QOD) CSM dataset was queried for patients undergoing CDA or ACDF with myelopathy as the predominant symptom. The two surgical groups were individually matched at a 1:3 ratio on 16 baseline variables using propensity score matching, including demographics, symptoms, patient-reported measures, and levels treated.
Results: In this cohort, 29 patients underwent CDA, and 556 underwent ACDF. Mild myelopathy (mJOA≥15) was present in 37.9% of the CDA group and 25.9% of the ACDF group, and severe (mJOA≤11) in 20.7% and 34.5%, respectively (p=0.213). Following matching, 29 and 87 patients were included in the CDA and ACDF groups, respectively. At the 24-month follow-up, patients undergoing CDA reported high rates of satisfaction (92.9%) and achieved MCID in NDI, mJOA, and QALY in 70.4%, 73.9%, and 38.5% of cases, respectively – no statistically significant difference between the two groups was found. Subgroup analyses among mild and moderate-severe myelopathy yielded similar 24-month outcomes between the procedures, with CDA providing greater improvement than ACDF in NDI (mean: 33 vs. 21.4) among moderately-severely myelopathic patients but failing to reach statistically significant levels (p=0.065). No reoperations were noted among patients in the CDA group, while six patients (6.9%) underwent reoperation in the ACDF group (p=0.334).
Conclusion : In this real-world evaluation, outcomes following CDA were highly comparable to those following ACDF. The small sample size of the analysis impacts the strength of these conclusions, yet given proper patient selection, CDA may be a reliable alternative to ACDF in the management of patients with mild and moderate myelopathy.
