A Systematic Review of Outcomes Following Cervical Disc Arthroplasty: Implications for Post Surgical Rehabilitation

Abstract

Study Design: Systematic literature review Purpose: To compare outcomes following single level cervical disc arthroplasty and describe the postoperative rehabilitation guidelines following this procedure. Methods: Electronic searches were conducted on 7 databases from their inception to November 2011. Included studies required: outcome or comparative study of one of the FDA approved cervical disc prostheses to ACDF, randomized controlled trial, clinical trial or cohort study, and outcome measures such as the Neck Disability Index(NDI). Quality assessment was performed using the CONSORT framework. Results: 229 articles were identified, which were narrowed down to 5 that met the inclusion criteria; 3 investigating the Bryan device, 1 each on the ProDisc-C, and Prestige devices. All were compared to ACDF. Outcomes for all devices showed improvement in NDI scores and fewer adverse effects compared to ACDF. NDI improvements were statistically significant for the Bryan at 12 and 24 months, the Prestige at 6 weeks and 3 months and the ProDisc-C at 3 months. All arthroplasty cohorts showed decreases in pain compared to ACDF, which were statistically significant for the Bryan at 24 months and the Prestige at 1.5, 3, and 12 months. The Bryan and Prestige cohorts returned to work sooner than ACDF groups. Postoperative protocols were not specified in any of the trials. Conclusion: Cervical disc arthroplasty is an effective alternative to ACDF. Limited information exists regarding specific post operative rehabilitation. Implications: Continued follow up is needed to assess long term outcomes and develop effective post operative rehabilitation approaches following cervical disc arthroplasty.