Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review.

BACKGROUND: Meta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery. AIM: The objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations. METHODS: A literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy. RESULTS: Eight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score of 15.6, indicating better clinical outcome than the radiculopathy patients that received a prosthesis though not reaching clinical importance. CONCLUSIONS: ACDF and ACDA are comparably effective in treating cervical radiculopathy due to a herniated disc in radiculopathy patients. Comparing the 8 radiculopathy with the 29 mixed population studies demonstrated that no clinically relevant differences were present in clinical outcome between the two types of patients. These slides can be retrieved under Electronic Supplementary Material.

Two-dimensional video analysis can discriminate differences in running kinematics between recreational runners with and without running-related knee injury.

OBJECTIVES: To determine whether two-dimensional video analysis could discriminate running kinematics between recreational runners with and without a running-related knee injury. DESIGN: Case-control. SETTING: Research laboratory. PARTICIPANTS: Forty-two recreational runners (5 male-13 female injured; 7 male-17 female non-injured). Running-related knee injury was defined as the presence of anterior or lateral knee pain, resulting in altered running activity for at least one week. MAIN OUTCOME MEASURES: Foot and tibia inclination at initial contact, and lateral trunk position, contralateral pelvic drop, femoral adduction, hip adduction, knee flexion and ankle dorsiflexion at midstance were measured with two-dimensional video analysis during running. Participant characteristics (sex, age, body weight, body length, body mass index, running volume before injury, running speed) and two-dimensional measured angles were compared between groups. RESULTS: No significant differences in participant characteristics between groups were identified (P > .05). The injured group ran with greater contralateral pelvic drop (P = .035), femoral adduction (P = .021) and hip adduction (P = .001) at midstance, and significantly smaller foot inclination at initial contact (P = .031). CONCLUSION: Two-dimensional video analysis can discriminate kinematics between runners with and without running-related knee injury. Greater contralateral pelvic drop, femoral adduction and hip adduction at midstance may provide running retraining targets for runners with running-related knee injury.

The NECK trial: Effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blinded randomized controlled trial.

BACKGROUND: Motion preserving anterior cervical disc arthroplasty (ACDA) in patients with cervical radiculopathy was introduced to prevent symptomatic adjacent disc degeneration as compared with anterior cervical discectomy and fusion (ACDF). Prior reports suggest that ACDF is not more effective than anterior cervical discectomy (ACD) alone for the treatment of cervical radiculopathy. PURPOSE: To evaluate whether patients with cervical radiculopathy due to a herniated disc benefit more from undergoing ACDA, ACDF, or ACD in terms of clinical outcome measured by the neck disability index (NDI). STUDY DESIGN: Double-blinded randomized controlled trial. METHODS: One hundred-nine patients with one level herniated disc were randomized to one of the following treatments: ACDA, ACDF with intervertebral cage, ACD without fusion. Clinical and radiological outcome was measured by NDI, Visual Analogue Scale (VAS) neck pain, VAS arm pain, SF36, EQ-5D, patients' self-reported perceived recovery, radiographic cervical curvature, and adjacent segment degeneration parameters at baseline and until two years after surgery. BBraun Medical paid €298.837 to cover the costs for research nurses. RESULTS: The NDI declined from 41 to 47 points at baseline to 19 ± 15 in the ACD group, 19 ± 18 in the ACDF group, and 20 ± 22 in the ACDA group after surgery (p=.929). VAS arm and neck pain declined to half its baseline value and decreased below the critical value of 40 mm. Quality of life, measured by the EQ-5D, increased in all three groups. Adjacent segment degeneration parameters were comparable in all three groups as well. No statistical differences were demonstrated between the treatment groups. CONCLUSIONS: The hypothesis that ACDA would lead to superior clinical outcome in comparison to ACDF or ACD could not be confirmed during a 2-year follow-up time period. Single level ACD without implanting an intervertebral device may be a reasonable alternative to ACDF or ACDA.

Test-retest reliability of two-dimensional video analysis during running.

OBJECTIVES: To examine test-retest reliability of two-dimensional measured frontal and sagittal plane kinematics during running, and to determine how many steps to include to reach and maintain a stable mean. DESIGN: Reliability study. SETTING: Research laboratory. PARTICIPANTS: Twenty-one recreational runners. MAIN OUTCOME MEASURES: Lateral trunk position, contralateral pelvic drop, femoral adduction, hip adduction, knee flexion and ankle dorsiflexion during midstance, and foot and tibia inclination at initial contact were measured with two-dimensional video analysis during running for 10 consecutive steps for both legs. All participants were tested twice one week apart. A sequential estimation method was used to determine the number of steps needed to reach a stable mean. Intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated. RESULTS: The minimal number of steps was 6.3 ±â€¯0.3. Lateral trunk position, femoral adduction and foot inclination showed excellent reliability (ICC 0.90-0.99; SDD 1.3°-2.3°). Tibia inclination and ankle dorsiflexion showed good to excellent reliability (ICC 0.73-0.92; SDD 2.2°-4.8°). Hip adduction and knee flexion showed good reliability (ICC 0.82-0.89; SDD 2.3°-3.8°). Contralateral pelvic drop showed moderate to good reliability (ICC 0.59-0.77; SDD 2.7°-2.8°). CONCLUSION: Two-dimensional video analysis is reliable to assess running kinematics on different days. The mean of at least 7 steps should be included.

Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review.

OBJECTIVE: The objective of this study was to review current literature on the comparison of the radiological outcome of cervical arthroplasty with fusion after anterior discectomy for radiculopathy. MATERIALS AND METHODS: A literature search was performed in PubMed, Embase, Web of Science, Cochrane, CENTRAL, and CINAHL using a sensitive search string combination. Studies were selected by predefined selection criteria (patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane checklist adjusted for this purpose. Additionally, an overview of results of articles published in 21 meta-analyses was added, considering a group of patients with myelopathy with or without radiculopathy. RESULTS: Seven articles that compared intervertebral devices in patients with radiculopathy (excluding patients with myelopathy) were included in the study. Another 31 articles were studied as a mixed group, including patients with myelopathy and radiculopathy. Apart from three studies with low risk of bias, all other articles showed intermediate or high risk of bias. Heterotopic ossification was reported to be present in circa 10% of patients, seemingly predominant in patients with radiculopathy, with a very low level of evidence. Radiological signs of adjacent segment disease were present at baseline in 50% of patients, and there is a low level of evidence that this increased more (10%-20%) in the fusion group at long-term follow-up. However, this was only studied in the mixed study population, which is degenerative by diagnosis. CONCLUSION: Although the cervical disc prosthesis was introduced to decrease adjacent level disease, convincing radiological evidence for this benefit is lacking. Heterotopic ossification as a complicating factor in the preservation of motion of the device is insufficiently studied. Regarding purely radiological outcomes, currently, no firm conclusion can be drawn for implanting cervical prosthesis versus performing fusion.