Our Summary

The research paper is a detailed study comparing two surgical procedures for neck issues - cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF). The concern being addressed is the potential for further complications in the segments of the spine adjacent to the surgery site, known as adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis).

The researchers looked at multiple studies conducted before May 2016. They evaluated parameters such as follow-up time, the segments operated on, adjacent segment motion, ASDeg and ASDis, and the need for additional surgery in the adjacent segments.

The main findings were that patients who had the CDA surgery were less likely to need additional surgery in the adjacent segments, especially as more time passed. The rate of ASDeg was also lower in the CDA group, but this was only statistically significant after a longer follow-up period. There was no clear difference between the two surgeries when it came to ASDis and the range of motion in the adjacent segments.

In simpler terms, the study suggests that CDA might be a better option than ACDF in terms of reducing the risk of needing more surgery and slowing down the degeneration of adjacent segments over time. However, both procedures seem to have similar effects on the disease in adjacent segments and the range of movement.

FAQs

  1. What were the main findings of the study comparing CDA and ACDF surgical procedures?
  2. How does the CDA surgery impact the need for additional surgery in the adjacent segments compared to the ACDF surgery?
  3. Did the study find any difference between the CDA and ACDF procedures in terms of affecting the disease in adjacent segments and the range of movement?

Doctor’s Tip

A doctor might tell a patient undergoing discectomy surgery to consider cervical disc arthroplasty (CDA) as it may reduce the risk of needing additional surgery in the adjacent segments and slow down the degeneration of those segments over time compared to anterior cervical discectomy and fusion (ACDF). It’s important to discuss these findings with your doctor to determine the best surgical option for your specific condition.

Suitable For

Patients who are typically recommended for discectomy are those who have cervical disc herniation causing symptoms such as neck pain, arm pain, numbness, weakness, and tingling. These symptoms can be severe and debilitating, affecting the patient’s quality of life and ability to perform daily activities. Discectomy is usually recommended when conservative treatments such as physical therapy, medications, and injections have not provided relief.

In the context of the research paper comparing CDA and ACDF, patients recommended for discectomy would be those with cervical disc herniation who have failed conservative treatments and are considering surgical options. The study suggests that CDA may be a better option for these patients in terms of reducing the risk of needing additional surgery and slowing down degeneration in adjacent segments over time. However, the decision between CDA and ACDF should be made on a case-by-case basis, taking into consideration factors such as the patient’s age, lifestyle, and preferences.

Timeline

Before a patient undergoes a discectomy:

  1. Patient experiences symptoms of neck or back pain, weakness, numbness, or tingling in the arms or legs.
  2. Patient undergoes diagnostic tests such as an MRI or CT scan to determine the extent of the disc herniation.
  3. Patient may undergo conservative treatments such as physical therapy, medications, or injections to manage symptoms.
  4. If conservative treatments are unsuccessful, patient and surgeon decide on surgical intervention.

After a patient undergoes a discectomy:

  1. Patient undergoes the discectomy surgery to remove the herniated disc and relieve pressure on the nerves.
  2. Patient may experience some pain and discomfort after surgery, which is managed with medication.
  3. Patient undergoes physical therapy to regain strength and mobility in the neck or back.
  4. Patient gradually resumes normal activities and work duties.
  5. Patient undergoes follow-up appointments with the surgeon to monitor recovery and address any concerns.
  6. Research studies like the one mentioned above may compare the outcomes of different surgical procedures to assess long-term effects on adjacent segments and overall spinal health.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy, based on the findings of this research paper, may include:

  1. What are the potential risks and complications associated with anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA)?
  2. What is the likelihood of needing additional surgery in the adjacent segments of the spine after undergoing ACDF or CDA?
  3. How does the rate of adjacent segment degeneration (ASDeg) differ between ACDF and CDA?
  4. Is there a difference in the need for additional surgery in the adjacent segments over time between ACDF and CDA?
  5. What are the long-term effects of ACDF and CDA on adjacent segment disease (ASDis)?
  6. How does the range of motion in the adjacent segments compare between ACDF and CDA?
  7. Based on the findings of this study, which surgical procedure would you recommend for me in terms of reducing the risk of needing additional surgery and slowing down degeneration in adjacent segments over time?

Reference

Authors: Dong L, Xu Z, Chen X, Wang D, Li D, Liu T, Hao D. Journal: Spine J. 2017 Oct;17(10):1549-1558. doi: 10.1016/j.spinee.2017.06.010. Epub 2017 Jun 15. PMID: 28625479