Comparison of Clinical Outcomes After Anterior Cervical Discectomy and Fusion Versus Cervical Total Disk Replacement in Patients With Modic-2 Changes on MRI.

STUDY DESIGN: A retrospective investigation.

OBJECTIVE: The aim of this research is to compare the clinical and radiologic outcomes of patients with Modic-2 changes who underwent anterior cervical discectomy and fusion (ACDF) or cervical total disk replacement (TDR) in single level.

SUMMARY OF BACKGROUND DATA: There were few studies focused on the clinical and radiologic outcomes of patients with Modic-2 changes who underwent ACDF or cervical TDR in single level.

MATERIALS AND METHODS: A total of 76 patients with Modic-2 changes who underwent TDR or ACDF with complete follow-up data were analyzed retrospectively. Patients with chronic axial symptoms resulting from single-level cervical spine disease manifested as radiculopathy or myelopathy following 6 months of invalid conservative treatment. Clinical evaluations were performed preoperatively and repeated at 5 years after operation.

RESULTS: In this study, a total of 72 patients (94.7%) with a minimum of 5 years of follow-up data were available for analysis. There were 35 (18 men and 17 women) in the TDR group and 37 (20 men and 17 women) in the ACDF group. There was no difference in preoperative Japanese Orthopedic Association, Neck Disability Index, range of motion (ROM), and Visual Analogue Scale (VAS), on arm pain and neck pain between the 2 groups (P=0.663), but the TDR group showed significant differences in VAS for neck pain and ROM compared with that of the ACDF group at the last follow-up (P<0.05). Both groups reported significant improvements in Japanese Orthopedic Association, Neck Disability Index, ROM, and VAS, on arm pain and neck pain from the preoperative means (P<0.05).

CONCLUSIONS: Patients with Modic-2 changes in TDR group received a large discectomy and leading to the removal of the majority of the inflammatory disk tissue. TDR is a significantly better maintenance of index-level ROM than ACDF. The mid-term outcomes demonstrated that the both TDR and ACDF groups maintain favorable clinical results on patients with Modic-2 changes, who received TDR have significantly better maintenance of ROM than ACDF.