Two Level Artificial Disc Replacement Effective in Treating Cervical Myelopathy

, , , Cervical Disc Replacement, Herniated Disc, News

congress of neurological surgeons

At the October, 2017 Congress of Neurological Surgeons meeting in Boston, Jeff McConnell, MD, gave a presentation entitled:  “Long-term Outcomes of Arthroplasty for Cervical Myelopathy versus Radiculopathy, And Arthroplasty versus Arthrodesis for Cervical Myelopathy”

The study results were significant because the conclusion challenges the traditional treatment of patients with cervical myelopathy (spinal cord dysfunction) due to herniated discs in the neck.  The standard recommended treatment for this condition has been decompression and fusion. However, fusion has been shown to have detrimental effects on the function of the cervical spine leading to adjacent segment problems. Cervical artificial disc replacement has been shown to be superior to fusion in treating patients with one or two level herniated discs and radiculopathy (nerve root pain). Additionally, the role of decompression and cervical disc replacement in treating patients with myelopathy has been controversial.

The information presented in the study was based upon the FDA IDE clinical trial data for the two-level Prestige LP artificial cervical disc, in which 2 comparisons were made:

  • The first found that clinical outcomes between artificial disc replacement in patients with myelopathy versus patients with radiculopathy (nerve root pain) alone were equally safe and effective.
  • The second comparison examined the difference between patients with myelopathy treated with artificial disc replacement and those treated with fusion. Compared to fusion, patients treated with disc replacement demonstrated similar levels of clinical improvement and had less implant related complications.

The results of this study challenge the traditional thinking that fusion is the only option for treating patients with two-level cervical disc herniation and myelopathy – it demonstrated that artificial disc replacement is a safe and effective alternative for managing this condition. Learn more about cervical artificial disc replacement.

X-ray showing two level artificial disc replacement using the Prestige-LP performed by Dr. McConnell

Published: Artificial Disc Replacement at Two Levels in the Neck is Superior to Fusion

, , , , , Cervical Disc Replacement, Herniated Disc, News

Dr Jeff McConnell was co-author of the recently published article in the Journal of Neurosurgery Spine (2017 March 17:1-15) titled: Cervical Disc Arthroplasty with the Prestige LP Disc Versus Anterior Cervical Discectomy and Fusion, at 2 Levels: Results of a Prospective, Multicenter Randomized Controlled Clinical Trial at 24 Months.

This landmark study was the culmination of an FDA Investigational Device Exemption clinical trial comparing artificial disc replacement at two consecutive levels in the neck versus the traditional surgical treatment of fusion. Fusion for painful herniated discs in the neck is effective, however this type of surgery permanently stops movement of the vertebra that are fused together. It is now well established that fusing vertebrae in the neck can cause detrimental effects on the remaining normal discs in the neck. It has been shown that patients who have had fusion in their neck can develop accelerated degeneration of the discs above and below the fused levels. These degenerative changes can then cause additional problems and may require additional surgery for treatment.

In the article published in the Journal of Neurosurgery, patients requiring surgery for two herniated discs in the neck were randomized to undergo either total disc replacement using the Prestige-LP device or the traditional fusion surgery. Overall success and Neck Disability Index scores were superior for total disc replacement when compared to fusion. The authors concluded that total disc replacement with the Prestige-LP device at two contiguous levels is safe and effective and is a very good alternative to the traditional fusion surgery treatment.

Prestige-LP artificial cervical disc.

X-ray showing two level artificial disc replacement using the Prestige-LP performed by Dr. McConnell.

X-ray of traditional 2-level anterior fusion with spinal plate and screws.