Prospective, randomized comparison of one-level Mobi-C cervical total disc replacement vs. anterior cervical discectomy and fusion: Results at 5-year follow-up

Michael S. Hisey, Jack E. Zigler, Robert Jackson, Pierce D. Nunley, Hyun W. Bae, Kee D Kim, Donna D. Ohnmeiss

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Introduction There is increasing interest in the role of cervical total disc replacement (TDR) as an alternative to anterior cervical discectomy and fusion (ACDF). Multiple prospective randomized studies with minimum 2 year follow-up have shown TDR to be at least as safe and effective as ACDF in treating symptomatic degenerative disc disease at a single level. The purpose of this study was to compare outcomes of cervical TDR using the Mobi-C® with ACDF at 5-year follow-up. Methods This prospective, randomized, controlled trial was conducted as a Food and Drug Administration regulated Investigational Device Exemption trial across 23 centers with 245 patients randomized (2:1) to receive TDR with Mobi-C® Cervical Disc Prosthesis or ACDF with anterior plate and allograft. Outcome assessments included a composite overall success score, Neck Disability Index (NDI), visual analog scales (VAS) assessing neck and arm pain, Short Form-12 (SF-12) health survey, patient satisfaction, major complications, subsequent surgery, segmental range of motion, and adjacent segment degeneration. Results The 60-month follow-up rate was 85.5% for the TDR group and 78.9% for the ACDF group. The composite overall success was 61.9% with TDR vs. 52.2% with ACDF, demonstrating statistical non-inferiority. Improvements in NDI, VAS neck and arm pain, and SF-12 scores were similar between groups and were maintained from earlier follow-up through 60 months. There was no significant difference between TDR and ACDF in adverse events or major complications. Range of motion was maintained with TDR through 60 months. Device-related subsequent surgeries (TDR: 3.0%, ACDF: 11.1%, p < 0.02) and adjacent segment degeneration at the superior level (TDR: 37.1%, ACDF: 54.7%, p < 0.03) were significantly lower for TDR patients. Conclusions Five-year results demonstrate the safety and efficacy of TDR with the Mobi-C as a viable alternative to ACDF with the potential advantage of lower rates of reoperation and adjacent segment degeneration, in the treatment of onelevel symptomatic cervical degenerative disc disease.

Original languageEnglish (US)
Article number10
JournalInternational Journal of Spine Surgery
Volume10
DOIs
StatePublished - 2015

Keywords

  • Anterior cervical fusion
  • Artificial disc
  • Cervical arthroplasty
  • Cervical spine
  • Clinical outcome
  • Degenerative disc disease
  • Mobi-C® cervical disc prosthesis
  • Randomized trial
  • Total disc replacement

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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