[Publications]

Abstract

Aim: To assess the clinical and radiological outcome of single and multiple level anterior cervical decompression and disc replacement (ACDR) using new peek on peek (POP) cervical disc replacement prosthesis (NuNec™ Cervical Arthroplasty System, Pioneer Surgical Technology, München, USA). Methods and Materials: Over the period of six months from Jan 2009 to July 2009, 31 patients underwent ACDR form single level to multiple levels with total of 66 cervical level replacements. All patients completed pre op questionnaire using GPOS system (Global Patient Outcome Scores www.gpos.info). All patients were followed at 6 weeks ,3 months and at 6months, to asses the clinical and radiological outcome. Neck disability index (NDI), Visual Analogue score for Neck pain (VAS- NP) Visual Analogue Score for Arm pain (VAS-AP) were used as clinical outcome measures. All post-op x-rays were reviewed to assess the kyphotic angle correction and improvement in disc height. Results: Out of 31 ACDR patients, 7 had single level, 16 had two levels, 6 had three levels and 2 had four level disc replaced. Total of 66 discs were replaced, of which 8 at C3/4 level, 11-C4/5, 29-C5/6 and 17 at C6/7. There were 19 male and 12 female patients and the mean age at the time of operation was 45 (R- 29 to 76 yrs).The average duration of follow up was 20 weeks (R 9 to 32 weeks) In Single level ACDR patients mean NDI improved from 44.34(R 28-66) pre-operatively to 32.83(R 3-64) post-operatively. The mean pre op VAS-NP & VAS-AP scores were 6.5(R 2-9) & 5.84(R 2-9) which were reduced to 4.17 ( R 1-8) & 5.33(R 0-9) respectively post-operatively. In two level ACDR patients Mean pre op NDI, VAS-NP and VAS-AP were 45 (R 16-72), 7.3(R 2-10) & 7 (R 1-10) pre-operatively which improved to 35(R 4-92), 46(R 0-10 ) and 3(R 0-10) post-operatively respectively. The NDI, VAS-NP, VAS-AP for three level ACDR patients were 61.67(R 40-84 ), 8.17 ( R 5-10 ),8.17 ( R 7-10 ) preoperatively which were reduced to 47.0 (R 20-84 ),4.83(R0-8 ) and 7.50(R 3-10 ) respectively postoperatively. Among four level ACDR patients NDI, VAS-NP and VAS-AP improved from 30, 7, 7 pre-operatively to 4, 0, 0 post-operatively respectively. Kyphotic angle correction were 33.95% ,110.77 %, 18.8% and 360% for single, two ,three and four level ACDR patients respectively. Anterior disc height improvement at C3/4, C4/5, C5/6 and C6/7 were 82, 78%, 102% and 181% respectively. Posterior disc height improved to 95%, 98%, 104% and 140% at C3/4, C4/5, and C5/6 and C6/7 level respectively. Conclusions: Peek on Peek cervical disc prosthesis are considered superior to existing metal prosthesis in terms of decreasing artifacts in case of MR imaging is necessary after the primary surgery. Our initial short term results of new peek on peek cervical disc prosthesis are promising. Long term clinical and radiological outcome studies are awaited.