Arthroplasty and Discectomy with Fusion Surgical Techniques in Patients with Cervical Degenerative Disc Disease: A Critically Appraised Topic
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Abstract
Arthroplasty and Discectomy with Fusion Surgical Techniques in Patients with Cervical Degenerative Disc Disease: A Critically Appraised Topic
Logan Rupnow & Kaitlyn Ward, MSAT Students
Nora Kraemer, PhD, LAT, ATC & Brandon Donahue, DAT, LAT, ATC
Clinical Scenario
Cervical Degenerative Disc Disease (CDDD) can be identified in over 60% of the population with patients describing pain that incites numbness, tingling, and weakness in the extremities. The gold-standard for CDDD surgery has been anterior cervical discectomy and fusion (ACDF), but improvements in medical technology offers anterior disc cervical replacement (ACDR) as another option that is less invasive and easier to perform. The purpose of this appraisal is to review the current evidence regarding the differences in ACDR and ACDF on patient-reported outcomes (PROs) to help guide future providers and patients on CDDD surgical options.
Focused Clinical Question
In patients with cervical degenerative disc disease, what is the effect of ACDR versus ACDF on PROs?
Search Strategy
A literature search was conducted to find studies that investigated the effectiveness of ACDR verses ACDF on PROs. Databases that were used to search for studies were PubMed, CINAHL, ProQuest Nursing Collection, and Cochrane Library. The search terms included: “patients with cervical degenerative disc disease,” “cervical arthroplasty,” “cervical discectomy and fusion,” “cervical disc replacement,” “cervical disc herniation,” and “patient reported outcomes.” The following inclusion criteria was utilized: studies on ACDF and ACDR surgeries, all genders, single cervical spine levels, patients with degenerative disc disease, and randomized control studies. Studies were excluded if there were use of cervical steroid injections, no surgical interventions, acute cervical injury/surgery, or articles published before 2005. The search yielded a total of 10 articles that met the inclusion criteria.
Evidence Quality Assessment
All studies were critically appraised utilizing the PEDro and Oxford Centre for Evidence-Based Medicine (OCEBM). PEDro scores ranged from 4-7/10 and OCEBM scores ranged from 2-3.
Results and Summary of Search
All 10 studies used the Neck Disability Index (NDI) to measure the impact of surgery on pain, personal care, lifting, work, headaches, concentration, sleeping, driving, reading, and recreation. Additional PROs utilized in studies included the Visual Analogue Scale (VAS),Short Form Health Survey questionnaire (SF-36),EuroQol-5 Dimension (EQ-5D), Numeric Rating Scales (NRS), and Core Outcome Measures Index (COMI). All studies reported an improvement of scores for NDI for both ACDR and ACDF groups. Three studiesidentified ACDR as being statistically significant for improvement of the NDI score. A research strength included the large sample sizes that combat patient drop-out rates. A research weakness was the high variability in the timing of post-surgical follow-up between studies.
Clinical Bottom Line
Both ACDR and ACDF surgical interventions have shown to provide improved NDI scores 48 months following surgery. The ACDR surgery may provide improved outcomes over ACDF with caution support deriving from 3 of 10 studies. A Grade B is recommended on the Strength of Recommendation Taxonomy system.
Implications
This research indicates that both surgical options should be presented by the provider and that patient preference should drive decision-making based on comparable outcomes between the two procedures. Future research should investigate the efficacy of the BRYAN cervical disc device as a novel treatment of CDDD.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer
Second Advisor/Mentor
Brandon Donahue
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Arthroplasty and Discectomy with Fusion Surgical Techniques in Patients with Cervical Degenerative Disc Disease: A Critically Appraised Topic
Arthroplasty and Discectomy with Fusion Surgical Techniques in Patients with Cervical Degenerative Disc Disease: A Critically Appraised Topic
Logan Rupnow & Kaitlyn Ward, MSAT Students
Nora Kraemer, PhD, LAT, ATC & Brandon Donahue, DAT, LAT, ATC
Clinical Scenario
Cervical Degenerative Disc Disease (CDDD) can be identified in over 60% of the population with patients describing pain that incites numbness, tingling, and weakness in the extremities. The gold-standard for CDDD surgery has been anterior cervical discectomy and fusion (ACDF), but improvements in medical technology offers anterior disc cervical replacement (ACDR) as another option that is less invasive and easier to perform. The purpose of this appraisal is to review the current evidence regarding the differences in ACDR and ACDF on patient-reported outcomes (PROs) to help guide future providers and patients on CDDD surgical options.
Focused Clinical Question
In patients with cervical degenerative disc disease, what is the effect of ACDR versus ACDF on PROs?
Search Strategy
A literature search was conducted to find studies that investigated the effectiveness of ACDR verses ACDF on PROs. Databases that were used to search for studies were PubMed, CINAHL, ProQuest Nursing Collection, and Cochrane Library. The search terms included: “patients with cervical degenerative disc disease,” “cervical arthroplasty,” “cervical discectomy and fusion,” “cervical disc replacement,” “cervical disc herniation,” and “patient reported outcomes.” The following inclusion criteria was utilized: studies on ACDF and ACDR surgeries, all genders, single cervical spine levels, patients with degenerative disc disease, and randomized control studies. Studies were excluded if there were use of cervical steroid injections, no surgical interventions, acute cervical injury/surgery, or articles published before 2005. The search yielded a total of 10 articles that met the inclusion criteria.
Evidence Quality Assessment
All studies were critically appraised utilizing the PEDro and Oxford Centre for Evidence-Based Medicine (OCEBM). PEDro scores ranged from 4-7/10 and OCEBM scores ranged from 2-3.
Results and Summary of Search
All 10 studies used the Neck Disability Index (NDI) to measure the impact of surgery on pain, personal care, lifting, work, headaches, concentration, sleeping, driving, reading, and recreation. Additional PROs utilized in studies included the Visual Analogue Scale (VAS),Short Form Health Survey questionnaire (SF-36),EuroQol-5 Dimension (EQ-5D), Numeric Rating Scales (NRS), and Core Outcome Measures Index (COMI). All studies reported an improvement of scores for NDI for both ACDR and ACDF groups. Three studiesidentified ACDR as being statistically significant for improvement of the NDI score. A research strength included the large sample sizes that combat patient drop-out rates. A research weakness was the high variability in the timing of post-surgical follow-up between studies.
Clinical Bottom Line
Both ACDR and ACDF surgical interventions have shown to provide improved NDI scores 48 months following surgery. The ACDR surgery may provide improved outcomes over ACDF with caution support deriving from 3 of 10 studies. A Grade B is recommended on the Strength of Recommendation Taxonomy system.
Implications
This research indicates that both surgical options should be presented by the provider and that patient preference should drive decision-making based on comparable outcomes between the two procedures. Future research should investigate the efficacy of the BRYAN cervical disc device as a novel treatment of CDDD.
