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

Dr. Jeff McConnell First in the U.S. to Implant New, Larger Sized Cervical Artificial Disc.

, Cervical Disc Replacement, Herniated Disc, News

The size of your Cervical Artificial Disc Replacement makes a difference.

Mobi-C cervical artificial disc replacement

Dr. McConnell implanting larger sized Mobi-C implant at C6-7 level

Cervical artificial disc replacement is an excellent alternative to the traditional treatment of fusion for one or two herniated discs in the neck.  Artificial disc replacement in the cervical spine preserves normal motion between vertebrae allowing the neck to move in a more natural way.  Several recent long-term follow-up studies have demonstrated that patients treated with cervical disc replacement have higher rates of overall clinical success when compared to patients treated with fusion.

Mobi-C cervical artificial disc

Mobi-C cervical artificial disc replacement

One of the goals of cervical artificial disc replacement is to match, as closely as possible, the dimensions (or ‘footprint”) of the disc being replaced.  The cervical discs you’re born with vary in shape and size from person to person, men and women, and by their level in the neck. Filling as much of the disc space and covering as much of the vertebral body end plate as possible helps prevent subsidence (settling) of the artificial disc and the likelihood of bone growing around the replacement disc, which restricts its movement.  That’s why it’s important that a surgeon choose an artificial disc that most closely matches the size of the patient’s natural cervical disc.  There are 6 different cervical artificial disc replacements available commercially and the decision of which disc to use for a particular patient is often determined by the range of sizes offered by the manufacturer.

Zimmer-Biomet, maker of the Mobi-C cervical disc replacement, recently increased the number of sizes available for the Mobi-C. Specifically, the company is now offering a 17 x 17 mm and a 17 x 19 mm footprints which will allow a better fit for mostly male patients requiring disc replacement surgery at C5-6 and/or C6-7.

x-ray of implanted Mobi-C cervical artificial disc

Lateral x-ray of the cervical spine showing new, larger sized 17 x 17 mm Mobi-C implant at C6-7 (lower level)

Dr. McConnell was the first surgeon in the United States to successfully implant the 17 x 17 mm Mobi-C cervical artificial disc.  His patient was a 45 year old male suffering with two pinched nerves in his neck due to herniated discs at C5-6 and C6-7.  Dr. McConnell was pleased at how well he could match the size of the patient’s disc space with the new larger sized Mob-C: “Having the right size implant for my patients is important to the long-term outcome of their cervical disc replacement surgery.”

As the use of cervical artificial disc replacement grows, Dr. McConnell predicts custom designed, digitally printed, implants that fit each patient’s unique anatomy are the next evolution in artificial disc replacement.

Learn more about cervical artificial disc replacement.

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

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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.