Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for the treatment of cervical radiculopathy and myelopathy due to cervical disc disease. Although it is a generally successful and safe procedure (complication rate between 2 and 4%), more recent studies have raised concerns regarding alterations of cervical spine biomechanics following a fusion. The fusion of a cervical segment leads to increased stress and loading on the adjacent segments which in turn can accelerate the degeneration process. Current estimates suggest that 25% of patients treated with ACDF will develop adjacent segment degeneration at 10 years (3% per year) and half of these patients will require new surgical intervention. Cervical disc arthroplasty (CDA) was developed as an alternative procedure to preserve motion both at the affected and adjacent levels and theoretically lower rates of adjacent segment degeneration. Prospective randomized trials comparing ACDF with CDA were initiated in 2000 and have demonstrated significant differences in some clinical outcome measures favouring CDA and comparable safety profiles between the two techniques. Following these trials many different devices have been licensed and are currently available on the market. The typical candidate patient for CDA is the young active adult patient with single level symptomatic disc disease and with intact posterior facet joints. The aim of this article is to critically review available literature supporting clinical use of CDA. Cervical disc replacement is nowadays an accepted technique with established short and medium-term follow-up data, however only long-term data will be able to confirm the promise of decreased adjacent segment disease and fewer reoperations.
La discectomia ed artrodesi cervicale per via anteriore (anterior cervical discectomy and fusion, ACDF) rappresenta la procedura di scelta per il trattamento delle radicolopatie e mielopatie da ernia del disco cervicale. Sebbene si tratti di una procedura efficace e con tassi di complicanze modesti (2-4%), studi clinici e biomeccanici recenti hanno evidenziato come la tecnica di artrodesi cervicale anteriore alteri irrimediabilmente la biomeccanica del rachide cervicale. L’artrodesi del livello trattato determina una redistribuzione dei carichi meccanici sui livelli adiacenti con accelerazione del pro- cesso di degenerazione discale. Stime attuali suggeriscono che circa il 25% dei pazienti sottoposti ad ACDF svilupperà una discopatia del livello adiacente a 10 anni (3% all’anno) e la metà di questi richiederà un nuovo intervento chirurgico. La sostituzione protesica del disco cervicale si propone come procedura alternativa all’artrodesi anteriore (ma non alla decompressione!) per la prevenzione della degenerazione dei segmenti adiacenti. I primi trials prospettici e randomizzati su ACDF e pro- tesi discale hanno avuto inizio negli anni 2000 ed hanno dimostrato percentuali di successo simili o a volte superiori per le protesi discali rispetto all’ACDF ed una sostanziale sovrapposizione in termini di sicurezza tra le due metodiche. L’esito di questi trials ha portato all’immissione in commercio di numerosi dispositivi per la sostituzione protesica discale cervicale. Il candidato ideale resta tuttora il giovane adulto con radicolopatia sintomatica e con articolazioni posteriori intatte. L’obiettivo di questo articolo è di revisionare criticamente la Letteratura a supporto dell’utilizzo delle protesi discali cervicali tracciandone brevemente le linee di sviluppo future. La sostituzione protesica discale cer- vicale è oramai una tecnica matura e riconosciuta a livello internazionale; i dati di medio follow-up ad oggi disponibli sono incoraggianti, ma soltanto dati a più lungo termine potranno confermare la promessa di una riduzione della degenerazione dei segmenti adiacenti.
Sostituzione protesica del disco cervicale
NASTO L
2015
Abstract
Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for the treatment of cervical radiculopathy and myelopathy due to cervical disc disease. Although it is a generally successful and safe procedure (complication rate between 2 and 4%), more recent studies have raised concerns regarding alterations of cervical spine biomechanics following a fusion. The fusion of a cervical segment leads to increased stress and loading on the adjacent segments which in turn can accelerate the degeneration process. Current estimates suggest that 25% of patients treated with ACDF will develop adjacent segment degeneration at 10 years (3% per year) and half of these patients will require new surgical intervention. Cervical disc arthroplasty (CDA) was developed as an alternative procedure to preserve motion both at the affected and adjacent levels and theoretically lower rates of adjacent segment degeneration. Prospective randomized trials comparing ACDF with CDA were initiated in 2000 and have demonstrated significant differences in some clinical outcome measures favouring CDA and comparable safety profiles between the two techniques. Following these trials many different devices have been licensed and are currently available on the market. The typical candidate patient for CDA is the young active adult patient with single level symptomatic disc disease and with intact posterior facet joints. The aim of this article is to critically review available literature supporting clinical use of CDA. Cervical disc replacement is nowadays an accepted technique with established short and medium-term follow-up data, however only long-term data will be able to confirm the promise of decreased adjacent segment disease and fewer reoperations.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
