PROCERV: Arthroplasty Versus Fusion in Anterior Cervical Surgery: Prospective Study of the Impact on the Adjacent Level
Study Details
Study Description
Brief Summary
The aim of the study is to evaluate the impact of the cervical disk surgery on the deterioration of the adjacent levels. The investigators compare the radiological deterioration of adjacent levels, at 3 years, in both situation of fusion and arthroplasty. 220 patients are enrolled and randomized to receive fusion or prosthesis. Radiological and clinical follow-up is organized for a period of 3 years.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 4 |
Detailed Description
Anterior surgery of the cervical spine is one of the most practiced procedures in spine surgery. Its immediate accuracy and safety is proved since a long time in case of degenerative disk disease or disk herniation. But the segmental arthrodesis leads to an overload of the adjacent disk. A lot of studies have shown that the increasing mobility and pressure of the adjacent segments can be responsible of new degeneration and clinical symptoms. Recently, cervical disk prosthesis have been developed to maintain the mobility at the level of the surgery. This technique is supposed to decrease the risk of adjacent disk disease but, at this time, the analysis of the results is difficult, due to the lack of randomized studies with long term follow up.
The aim of our prospective randomized study is to evaluate the aftermath of the arthroplasty compared to the fusion on the adjacent disk degeneration.
The main objective is to show a radiological difference at 3 years in term of adjacent disk degeneration.
The secondary objectives are:
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evaluate the rate of new clinical symptoms during three years
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show differences during the postoperative period, especially concerning the length of the hospital stay, the use of pain killers and return to work.
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verify the maintaining of mobility pf the prosthesis during three years.
This is a controlled study with two group of equal size: one group is treated by discectomy and arthrodesis and the other by discectomy and prosthesis/ The criteria for the inclusion of the patients are: clinical radiculopathy and/or myelopathy due to a cervical disk disease (disk herniation or osteophytosis), lack of effect of the medical treatment, CT scan or MRI showing a compression of roots and/or spinal cord.
The main exclusion criteria are: plurisegmental disk disease, injuries happened during professional activities, previous cervical surgery.
During the study, we perform a clinical (standardized scales: Neck Disability Index, Short Form 36, and neurological exam) and a radiological (height of the adjacent disks, ostheophytis,…) follow-up.
The analysis of the current literature and statistical process leads to a total amount of 220 patients enrolled in the study. This is a multicentric study organized for a total duration of five years (two years for inclusions and three years of follow-up).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Other: A patient receiving cervical disc prosthesis with a mobile insert named Mobi-C and product by LDR médical |
Device: cervical disc prosthesis with a mobile insert named Mobi-C
Stage 1: partial discectomy
stage 2: location of the medial axis
stage 3: centering pin
stage 4: installation of the caspar spacer
stage 5: total discectomy
stage 6: parallel distraction
stage 7: depth measurement
stage 8: trial implant
stage 9: assembly
stage 10: implant insertion
stage 11: anchorage optimization
|
Other: B patient receiving intersomatic cage |
Procedure: arthrodesis - cervical disk surgery
discectomy and arthrodesis
|
Outcome Measures
Primary Outcome Measures
- show significant difference of degeneration of disc above and below the operated stage between the two groups [3 years after surgery]
Secondary Outcome Measures
- show difference of neurological pain between the two groups [during the 3 years of follow-up]
- show difference of duration of hospitalization and consumption of medication [during the first month after surgery]
Eligibility Criteria
Criteria
Inclusion Criteria:
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clinical radiculopathy
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myelopathy due to a cervical disk disease
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lack of effect of the medical treatment
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CT scan or MRI showing a compression of roots and/or spinal cord
Exclusion Criteria:
-
plurisegmenta disk disease
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injuries happened during professional activities
-
previous cervical surgery
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Department of Neurosurgery, CHU de Nice | Nice | France | 06000 |
Sponsors and Collaborators
- Centre Hospitalier Universitaire de Nice
Investigators
- Principal Investigator: Stephane LITRICO, Dr, Centre Hospitalier Universitaire de Nice
Study Documents (Full-Text)
None provided.More Information
Publications
- Albert TJ, Eichenbaum MD. Goals of cervical disc replacement. Spine J. 2004 Nov-Dec;4(6 Suppl):292S-293S. Review.
- Bertagnoli R, Duggal N, Pickett GE, Wigfield CC, Gill SS, Karg A, Voigt S. Cervical total disc replacement, part two: clinical results. Orthop Clin North Am. 2005 Jul;36(3):355-62.
- Bertagnoli R, Yue JJ, Pfeiffer F, Fenk-Mayer A, Lawrence JP, Kershaw T, Nanieva R. Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine. 2005 Apr;2(4):403-10.
- Chi JH, Ames CP, Tay B. General considerations for cervical arthroplasty with technique for ProDisc-C. Neurosurg Clin N Am. 2005 Oct;16(4):609-19, vi. Review.
- Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976). 2005 May 15;30(10):1165-72.
- Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, An HS. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002 Nov 15;27(22):2431-4.
- Fager CA. Cervical arthroplasty. J Neurosurg Spine. 2005 Mar;2(3):394-5; author reply 395.
- Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, Van Calenbergh F, van Loon J. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004 Apr;17(2):79-85.
- Hacker RJ. Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005. J Neurosurg Spine. 2005 Dec;3(6):424-8. Erratum in: J Neurosurg Spine. 2006 Feb;4(2):189.
- Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004 Nov-Dec;4(6 Suppl):190S-194S. Review.
- Link HD, McAfee PC, Pimenta L. Choosing a cervical disc replacement. Spine J. 2004 Nov-Dec;4(6 Suppl):294S-302S. Review.
- McAfee PC. The indications for lumbar and cervical disc replacement. Spine J. 2004 Nov-Dec;4(6 Suppl):177S-181S. Review.
- Murray BE, Lopardo HA, Rubeglio EA, Frosolono M, Singh KV. Intrahospital spread of a single gentamicin-resistant, beta-lactamase-producing strain of Enterococcus faecalis in Argentina. Antimicrob Agents Chemother. 1992 Jan;36(1):230-2.
- Parkinson JF, Sekhon LH. Cervical arthroplasty complicated by delayed spontaneous fusion. Case report. J Neurosurg Spine. 2005 Mar;2(3):377-80.
- Phillips FM, Garfin SR. Cervical disc replacement. Spine (Phila Pa 1976). 2005 Sep 1;30(17 Suppl):S27-33. Review.
- Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine (Phila Pa 1976). 2005 Sep 1;30(17):1949-54.
- Pickett GE, Sekhon LH, Sears WR, Duggal N. Complications with cervical arthroplasty. J Neurosurg Spine. 2006 Feb;4(2):98-105.
- Pracyk JB, Traynelis VC. Treatment of the painful motion segment: cervical arthroplasty. Spine (Phila Pa 1976). 2005 Aug 15;30(16 Suppl):S23-32. Review.
- Puttlitz CM, DiAngelo DJ. Cervical spine arthroplasty biomechanics. Neurosurg Clin N Am. 2005 Oct;16(4):589-94, v. Review.
- Puttlitz CM, Rousseau MA, Xu Z, Hu S, Tay BK, Lotz JC. Intervertebral disc replacement maintains cervical spine kinetics. Spine (Phila Pa 1976). 2004 Dec 15;29(24):2809-14.
- Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine. 2005 Dec;3(6):417-23.
- Singh M, Gopinath R. Topical analgesia for chest tube removal in cardiac patients. J Cardiothorac Vasc Anesth. 2005 Dec;19(6):719-22.
- 06-APN-01