Long-term Outcomes of the US FDA IDE Prospective, Randomized Controlled Clinical Trial Comparing PCM Cervical Disc Arthroplasty With Anterior Cervical Discectomy and Fusion

Prospective, multicenter, randomized clinical trial. To evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior cervical discectomy and fusion (ACDF) in treatment of patients with symptomatic single-level degenerative spondylosis between C3-C4 and C7-T1 with o...

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Vydáno v:Spine (Philadelphia, Pa. 1976) Ročník 40; číslo 10; s. 674
Hlavní autoři: Phillips, Frank M, Geisler, Fred H, Gilder, Kye M, Reah, Christopher, Howell, Kelli M, McAfee, Paul C
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 15.05.2015
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ISSN:1528-1159, 1528-1159
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Abstract Prospective, multicenter, randomized clinical trial. To evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior cervical discectomy and fusion (ACDF) in treatment of patients with symptomatic single-level degenerative spondylosis between C3-C4 and C7-T1 with or without prior cervical fusion. The 2-year results of the PCM Cervical Disc trial have been reported previously. The current study reports the long-term results of the same trial. Patients with single-level cervical spondylosis and radiculopathy with or without myelopathy unresponsive to nonoperative treatment were enrolled. The per protocol patient sample at 5 years included 293 patients (163 PCM, 130 ACDF). Adverse events and secondary surgical procedures are reported on the cohorts through current follow-up, which include 110 patients (68 PCM, 42 ACDF) at 7 years. At 5 years postoperative, all patient-reported outcomes-neck and arm pain visual analogue scale score, neck disability index, and general health (36-Item Short Form Health Survey physical and mental component scores: physical component summary, mental component summary)-were significantly improved from baselines in both groups, and mean scores were significantly better in the PCM group for neck disability index (P=0.001), neck pain (P=0.002), general health (Pphysical component summary=0.014; Pmental component summary=0.004), and patient satisfaction (P=0.005). PCM patients trended toward fewer 2- to 7-year device-related serious adverse events (1/214, 0.5% PCM; 2/190, 1.1% ACDF) and secondary surgical procedures (7/211, 3.3% PCM; 14/290, 7.6% ACDF). Adjacent-level degeneration was radiographically more frequent after ACDF (33.1% PCM, 50.9% ACDF; P=0.006) and was the primary indication for the increase in late-term secondary surgical procedures after ACDF. The long-term results show good clinical outcomes after ACDF and PCM arthroplasty. PCM patients showed greater improvement in neck disability index and neck pain scores with a lower rate of radiographical adjacent-level degeneration and a trend toward fewer secondary surgical procedures. These data support PCM arthroplasty to be a viable and sustainable alternative to ACDF. 1.
AbstractList Prospective, multicenter, randomized clinical trial.STUDY DESIGNProspective, multicenter, randomized clinical trial.To evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior cervical discectomy and fusion (ACDF) in treatment of patients with symptomatic single-level degenerative spondylosis between C3-C4 and C7-T1 with or without prior cervical fusion.OBJECTIVETo evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior cervical discectomy and fusion (ACDF) in treatment of patients with symptomatic single-level degenerative spondylosis between C3-C4 and C7-T1 with or without prior cervical fusion.The 2-year results of the PCM Cervical Disc trial have been reported previously. The current study reports the long-term results of the same trial.SUMMARY OF BACKGROUND DATAThe 2-year results of the PCM Cervical Disc trial have been reported previously. The current study reports the long-term results of the same trial.Patients with single-level cervical spondylosis and radiculopathy with or without myelopathy unresponsive to nonoperative treatment were enrolled. The per protocol patient sample at 5 years included 293 patients (163 PCM, 130 ACDF). Adverse events and secondary surgical procedures are reported on the cohorts through current follow-up, which include 110 patients (68 PCM, 42 ACDF) at 7 years.METHODSPatients with single-level cervical spondylosis and radiculopathy with or without myelopathy unresponsive to nonoperative treatment were enrolled. The per protocol patient sample at 5 years included 293 patients (163 PCM, 130 ACDF). Adverse events and secondary surgical procedures are reported on the cohorts through current follow-up, which include 110 patients (68 PCM, 42 ACDF) at 7 years.At 5 years postoperative, all patient-reported outcomes-neck and arm pain visual analogue scale score, neck disability index, and general health (36-Item Short Form Health Survey physical and mental component scores: physical component summary, mental component summary)-were significantly improved from baselines in both groups, and mean scores were significantly better in the PCM group for neck disability index (P=0.001), neck pain (P=0.002), general health (Pphysical component summary=0.014; Pmental component summary=0.004), and patient satisfaction (P=0.005). PCM patients trended toward fewer 2- to 7-year device-related serious adverse events (1/214, 0.5% PCM; 2/190, 1.1% ACDF) and secondary surgical procedures (7/211, 3.3% PCM; 14/290, 7.6% ACDF). Adjacent-level degeneration was radiographically more frequent after ACDF (33.1% PCM, 50.9% ACDF; P=0.006) and was the primary indication for the increase in late-term secondary surgical procedures after ACDF.RESULTSAt 5 years postoperative, all patient-reported outcomes-neck and arm pain visual analogue scale score, neck disability index, and general health (36-Item Short Form Health Survey physical and mental component scores: physical component summary, mental component summary)-were significantly improved from baselines in both groups, and mean scores were significantly better in the PCM group for neck disability index (P=0.001), neck pain (P=0.002), general health (Pphysical component summary=0.014; Pmental component summary=0.004), and patient satisfaction (P=0.005). PCM patients trended toward fewer 2- to 7-year device-related serious adverse events (1/214, 0.5% PCM; 2/190, 1.1% ACDF) and secondary surgical procedures (7/211, 3.3% PCM; 14/290, 7.6% ACDF). Adjacent-level degeneration was radiographically more frequent after ACDF (33.1% PCM, 50.9% ACDF; P=0.006) and was the primary indication for the increase in late-term secondary surgical procedures after ACDF.The long-term results show good clinical outcomes after ACDF and PCM arthroplasty. PCM patients showed greater improvement in neck disability index and neck pain scores with a lower rate of radiographical adjacent-level degeneration and a trend toward fewer secondary surgical procedures. These data support PCM arthroplasty to be a viable and sustainable alternative to ACDF.CONCLUSIONThe long-term results show good clinical outcomes after ACDF and PCM arthroplasty. PCM patients showed greater improvement in neck disability index and neck pain scores with a lower rate of radiographical adjacent-level degeneration and a trend toward fewer secondary surgical procedures. These data support PCM arthroplasty to be a viable and sustainable alternative to ACDF.1.LEVEL OF EVIDENCE1.
Prospective, multicenter, randomized clinical trial. To evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior cervical discectomy and fusion (ACDF) in treatment of patients with symptomatic single-level degenerative spondylosis between C3-C4 and C7-T1 with or without prior cervical fusion. The 2-year results of the PCM Cervical Disc trial have been reported previously. The current study reports the long-term results of the same trial. Patients with single-level cervical spondylosis and radiculopathy with or without myelopathy unresponsive to nonoperative treatment were enrolled. The per protocol patient sample at 5 years included 293 patients (163 PCM, 130 ACDF). Adverse events and secondary surgical procedures are reported on the cohorts through current follow-up, which include 110 patients (68 PCM, 42 ACDF) at 7 years. At 5 years postoperative, all patient-reported outcomes-neck and arm pain visual analogue scale score, neck disability index, and general health (36-Item Short Form Health Survey physical and mental component scores: physical component summary, mental component summary)-were significantly improved from baselines in both groups, and mean scores were significantly better in the PCM group for neck disability index (P=0.001), neck pain (P=0.002), general health (Pphysical component summary=0.014; Pmental component summary=0.004), and patient satisfaction (P=0.005). PCM patients trended toward fewer 2- to 7-year device-related serious adverse events (1/214, 0.5% PCM; 2/190, 1.1% ACDF) and secondary surgical procedures (7/211, 3.3% PCM; 14/290, 7.6% ACDF). Adjacent-level degeneration was radiographically more frequent after ACDF (33.1% PCM, 50.9% ACDF; P=0.006) and was the primary indication for the increase in late-term secondary surgical procedures after ACDF. The long-term results show good clinical outcomes after ACDF and PCM arthroplasty. PCM patients showed greater improvement in neck disability index and neck pain scores with a lower rate of radiographical adjacent-level degeneration and a trend toward fewer secondary surgical procedures. These data support PCM arthroplasty to be a viable and sustainable alternative to ACDF. 1.
Author Geisler, Fred H
Reah, Christopher
Gilder, Kye M
McAfee, Paul C
Howell, Kelli M
Phillips, Frank M
Author_xml – sequence: 1
  givenname: Frank M
  surname: Phillips
  fullname: Phillips, Frank M
  organization: Midwest Orthopaedics at Rush University Medical Center, Chicago, IL †Chicago Back Institute, Chicago, IL ‡Kye Gilder Consulting, LLC, San Diego, CA §NuVasive, Inc., San Diego, CA; and ¶University of Maryland St. Joseph Medical Center, Baltimore, MD
– sequence: 2
  givenname: Fred H
  surname: Geisler
  fullname: Geisler, Fred H
– sequence: 3
  givenname: Kye M
  surname: Gilder
  fullname: Gilder, Kye M
– sequence: 4
  givenname: Christopher
  surname: Reah
  fullname: Reah, Christopher
– sequence: 5
  givenname: Kelli M
  surname: Howell
  fullname: Howell, Kelli M
– sequence: 6
  givenname: Paul C
  surname: McAfee
  fullname: McAfee, Paul C
BackLink https://www.ncbi.nlm.nih.gov/pubmed/25955086$$D View this record in MEDLINE/PubMed
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PublicationYear 2015
References 26537354 - Evid Based Med. 2016 Feb;21(1):15
References_xml – reference: 26537354 - Evid Based Med. 2016 Feb;21(1):15
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Snippet Prospective, multicenter, randomized clinical trial. To evaluate the long-term safety and effectiveness of the PCM Cervical Disc compared with anterior...
Prospective, multicenter, randomized clinical trial.STUDY DESIGNProspective, multicenter, randomized clinical trial.To evaluate the long-term safety and...
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StartPage 674
SubjectTerms Biomechanical Phenomena
Cervical Vertebrae - physiopathology
Cervical Vertebrae - surgery
Device Approval
Disability Evaluation
Diskectomy - adverse effects
Diskectomy - methods
Humans
Neck Pain - diagnosis
Neck Pain - etiology
Neck Pain - surgery
Pain Measurement
Pain, Postoperative - diagnosis
Pain, Postoperative - etiology
Prosthesis Design
Radiculopathy - complications
Radiculopathy - diagnosis
Radiculopathy - physiopathology
Radiculopathy - surgery
Recovery of Function
Spinal Cord Diseases - complications
Spinal Cord Diseases - diagnosis
Spinal Cord Diseases - physiopathology
Spinal Cord Diseases - surgery
Spinal Fusion - adverse effects
Spinal Fusion - methods
Spondylosis - complications
Spondylosis - diagnosis
Spondylosis - physiopathology
Spondylosis - surgery
Time Factors
Total Disc Replacement - adverse effects
Total Disc Replacement - instrumentation
Treatment Outcome
United States
United States Food and Drug Administration
Title Long-term Outcomes of the US FDA IDE Prospective, Randomized Controlled Clinical Trial Comparing PCM Cervical Disc Arthroplasty With Anterior Cervical Discectomy and Fusion
URI https://www.ncbi.nlm.nih.gov/pubmed/25955086
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