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Study Design: Retrospective review of prospectively-collected registry data.Objectives: The aim of this study was to determine how different combinations of preoperative neck pain (NP) and arm pain (AP) influence functional outcomes, patient satisfaction, and return-to-work in patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical radiculopathy (DCR).Summary Of Background Data: Surgeons often base decisions on the traditional belief that the predominance of radicular upper extremity symptoms is a stronger indication for cervical spine surgery than axial pain. However, there is a paucity of literature supporting this notion.Methods: A prospectively maintained registry was reviewed for all patients who underwent primary ACDF for DCR. Patients were categorized into three groups depending on predominant pain location: AP predominant ([APP]; AP > NP), NP predominant ([NPP]; NP > AP), and equal pain predominance ([EPP]; NP = AP). Patients were prospectively followed for at least 2 years.Results: In total, 303 patients were included: 27.4% APP, 38.9% NPP, and 33.7% EPP cases. The APP group was significantly older (P = 0.030), although there were no other preoperative differences among the three groups. After adjusting for baseline differences, the SF-36 Physical Component Summary was significantly better in the APP group at 6 months (P = 0.048) and 2 years (P = 0.039). In addition, they showed a trend towards better 6-month Neck Disability Index (P = 0.077) and 2-year SF-36 Mental Component Summary (P = 0.059). However, an equal proportion of patients in each group achieved the Minimal Clinically Important Difference for each outcome, were satisfied, and returned to work 2 years after surgery.Conclusion: Although patients with NPP had slightly poorer function and quality of life, all patients experienced a clinically meaningful improvement in patient-reported outcomes, regardless of the predominant pain location. High rates of satisfaction and return-to-work were also achieved. In the context of proper indications, these findings suggest that ACDF can be equally effective for DCR patients with varying combinations of NP or AP.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The number of young patients with degenerative lumbar spondylosis is expected to increase, and with it, the number of younger patients seeking surgical treatment is likely to rise. The goals of young patients with degenerative spondylolisthesis may differ from those of older patients, but little is known about the levels of pain and function, complication rates, or radiographic union that young patients achieve after interbody fusion.Questions/purposes: (1) How likely were patients younger than 50 years to achieve a minimal clinically important difference (MCID) in improvement on any of several validated patient-reported outcomes scores after transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a minimum of 2 years after surgery? (2) What proportion developed complications or underwent reoperations? (3) What proportion achieved radiographic fusion or developed adjacent-segment degeneration?Methods: Longitudinally maintained institutional registry data of patients undergoing primary, single-level, transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a single institution from 2006 to 2013 were studied in this retrospective case series. Of the 96 patients who met inclusion criteria, 14% (13 of 96) were missing follow-up data, leaving 83 patients younger than 50 years with complete clinical and radiological data at a minimum of 2 years (97%, 93 of 96 had sufficient data to assess complications and radiographic fusion). The mean age of the cohort was 44 ± 7 years. Radiological parameters for each patient with spondylolisthesis were recorded. Clinical outcomes such as the numeric rating scale for back pain and leg pain, Oswestry Disability Index (ODI) and SF-36 were assessed preoperatively and postoperatively at 1, 3, 6 months and 2 years. The proportion of patients who had an improvement greater than the MCID of each outcome instrument was then calculated. The occurrence of any medical, surgical or wound complications, and reoperations for any reason were recorded. Radiographic fusion using Bridwell grading and adjacent-segment degeneration were assessed by an independent observer not involved in clinical care. The mean follow-up was 5 ± 3 years.Results: The proportions of patients younger than 50 years who achieved the MCID for the various patient-reported outcomes were 82% (68 of 83) for leg pain, 75% (62 of 83) for back pain, 87% (72 of 83) for ODI and 71% (59 of 83) for SF-36 physical component summary at 2 years. Two perioperative complications occurred, and two reoperations were performed for implant-related complications. A total of 85% (79 of 93) of young patients achieved stable fusion, 8% (seven of 93) had radiologic adjacent-segment degeneration, and one patient underwent a revision procedure.Conclusions: Young patients with lumbar degenerative spondylolisthesis commonly, but do not always, experience clinically meaningful gains in pain relief, function, and quality of life after transforaminal lumbar interbody fusion. A low risk of complications, reoperations, nonunion and adjacent-segment degeneration were also noted in this population.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review of prospectively-collected registry data.Objective: To compare the patient-reported outcomes, satisfaction, and return to work among a large cohort of patients stratified by preoperative myelopathy severity undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Degenerative Cervical Myelopathy.Summary Of Background Data: Recent clinical practice guidelines noted a lack of studies stratifying their sample based on preoperative disease severity. The benefits of early surgical intervention for patients with mild myelopathy remain uncertain.Methods: A prospectively-maintained registry was retrospectively reviewed for all patients who underwent primary ACDF for Degenerative Cervical Myelopathy. Patients were stratified based on severity of preoperative myelopathy symptoms according to the Japanese Orthopaedic Association (JOA) scale: mild (>13), moderate (9-13), or severe (<9). Patients were prospectively followed for at least 2 years.Results: In total, 219 patients were included: 74 mild, 94 moderate, and 51 severe cases. The mild group had significantly better Neurogenic Symptoms (NS), Neck Disability Index (NDI), SF-36 Physical (PCS), and Mental Component Summary at baseline (P < 0.05). Neck and arm pain scores were similar at all time points. At 2 years, the severe group still had significantly worse patient-reported outcomes and lower rates of satisfaction, expectation fulfilment and return to work. However, they had significantly greater improvement in JOA, Neurogenic Symptoms, NDI, PCS, and Mental Component Summary, and a larger proportion attained minimal clinically important difference (MCID) for NDI and PCS. All three groups had similar proportions attaining MCID for JOA.Conclusion: Patients with severe myelopathy experienced a greater improvement after ACDF. Although fewer patients attained MCID, early surgical intervention for patients with mild myelopathy should also be considered, as this may allow patients to maintain their higher functional status. They also had high rates of postoperative satisfaction and return to work. The clinical trajectory outlined in this study may provide valuable prognostic information for patients.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.Questions/purposes: We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.Methods: Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.Results: There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).Conclusions: When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study using prospectively collected registry data.Objective: The authors examine the influence of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) and determine the impact of ACDF on postoperative mental health.Summary Of Background Data: While studies have reported a negative correlation between preoperative mental health and outcomes following lumbar spine surgery, the influence on outcomes following cervical spine surgery remains relatively understudied.Methods: Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Patients were dichotomized into top and bottom halves based on preoperative SF-36 MCS (Mental Component Summary) using a cutoff of 48. Outcomes assessed were visual analogue scale for neck pain, arm pain, AAOS Neck Pain and Disability, Neurogenic Symptoms, Neck Disability Index, Short-Form 36, Japanese Orthopaedic Association myelopathy score, return to work, return to function, satisfaction and expectation fulfilment up to 2 years postoperatively.Results: The preoperative MCS was 37.5 ± 8.1 and 57.4 ± 6.3 in the Low and High MCS groups respectively (P < 0.001). The Low MCS group had poorer preoperative scores (P < 0.05). There was no significant difference in length of stay or comorbidities (P > 0.05). The High MCS group had less neck pain (P = 0.002) and showed a trend towards lower Neck Disability Index (P = 0.062) at 2 years. The Low MCS group demonstrated greater improvement in Japanese Orthopaedic Association (P = 0.007) and similar improvement in other scores (P > 0.05). There was no significant difference in proportion that achieved minimal clinically important difference for each score (P > 0.05). Both groups had similar rates of return to work, return to function, expectation fulfilment, and satisfaction (P > 0.05). Lower preoperative MCS was predictive of greater improvement in MCS (r = -0.477, P < 0.001).Conclusion: Despite relatively greater pain and disability at 2 years, patients with poor baseline mental health experienced similar improvement in clinical outcomes, return to work, and satisfaction rates.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study using prospectively collected registry data.Objectives: To evaluate the effect of obesity on patient-reported outcome measures of pain, disability, quality of life, satisfaction, and return to work after single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Summary Of Background Data: MIS-TLIF is an appealing alternative for obese patients with potentially lower complication risk. However, there is limited data investigating the influence of obesity on outcomes 5 years after MIS-TLIF.Methods: Prospectively collected registry data of 296 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had complete 2- and 5-year follow-up data. Patients were stratified into control (<25.0 kg/m), overweight (25.0-29.9 kg/m), and obese (≥30.0 kg/m) groups. Outcomes assessed were visual analogue scale for back pain, leg pain, Oswestry Disability Index, Short-form 36, North American Spine Society score for neurogenic symptoms, return to work (RTW), return to function (RTF), satisfaction, and expectation fulfilment. Length of operation, length of stay, and comorbidities were recorded.Results: Among the patients, 156 (52.7%) had normal weight, 108 (36.5%) were overweight, and 32 (10.8%) were obese. There was no difference in length of operation or hospitalization (P > 0.05). All three groups had comparable preoperative scores at baseline (P > 0.05). At 5 years, the control group had significantly higher PCS compared with the overweight (P = 0.043) and obese groups (P = 0.007), although the change in scores was similar (P > 0.05). The rate of MCID attainment, RTW, RTF, expectation fulfilment, and satisfaction was comparable.Conclusion: Nonobese patients had better physical well-being in the mid-term, although obese patients experienced a comparable improvement in clinical scores. Obesity had no impact on patients' ability to RTW or RTF. Equivalent proportions of patients were satisfied and had their expectations fulfilled up to 5 years after MIS-TLIF.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study using prospectively collected registry data.Objective: To determine factors which influence return-to-work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine if early RTW affects functional outcomes.Summary Of Background Data: MIS-TLIF has been associated with accelerated return to work. RTW in non-WC working-age adults after MIS-TLIF is not well understood.Methods: Prospectively collected registry data of 907 patients who underwent MIS-TLIF at a single institution from 2004 to 2013 were reviewed. One hundred ten working adults who underwent single-level MIS-TLIF with complete preoperative and 5-year postoperative follow-up data were included. Patients were assigned into Early RTW (≤60 d, n = 40) and Late RTW (>60 d, n = 70). All patients were assessed pre- and postoperatively at 2 and 5 years. Length of operation, length of stay, and comorbidities were also recorded.Results: The Early RTW group had significantly lower Oswestry Disability Index (ODI), North American Spine Society score for neurogenic symptoms (NASS NS), numerical pain rating scale (NPRS) back and leg pain scores than the Late RTW group (<0.01) There were no significant differences in age, body mass index (BMI) and prevalence of medical comorbidities (P > 0.05). In addition, there were no differences in terms of duration of surgery or length of hospitalization. There were no significant differences in ODI, NASS NS, Short-form 36 physical and mental component scores (SF-36 PCS/MCS), NPRS, satisfaction/expectation fulfilment between the Early and Late RTW groups at 2-year and 5-year follow-up. Both groups reported similar proportions that RTW without limitations and return-to-function (RTF) at 2-years and 5-years.Conclusion: Patients who RTW late have significantly poorer preoperative SF-36 physical component scores and higher ODI, NASS NS, NPRS back/leg pain scores. Surgeons should be cognizant that working adults with poorer preoperative function will tend to return to work later, but should reassure them that they will likely achieve similar clinical outcomes, satisfaction and expectation fulfilment when compared with patients who returned to work early.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective matched pair cohort study using prospectively collected registry data.Objectives: The aim of this study was to determine whether patients with DM have poorer patient-reported outcomes and poorer fusion rates after undergoing a single-level anterior cervical discectomy and fusion (ACDF) for cervical myelopathy.Summary Of Background Data: ACDF remains the most common procedure in the treatment of cervical spondylotic myelopathy (CSM); however, there is a paucity of literature with regards to patient-reported outcome measures (PROMs), health-related quality-of-life (HRQOL) scores, and fusion rates post-ACDF in diabetic patients with CSM.Methods: From 2002 to 2012, 29 diabetic patients were matched with 29 nondiabetic controls. Patient demographics, perioperative data, and validated spine-specific scores including the Numerical Pain Rating Scale on Neck Pain and Upper Limb Pain, American Academy of Orthopaedic Surgeons (AAOS) neck pain and disability scores, AAOS Neurogenic Symptoms Score, Neck Disability Index, Japanese Orthopaedic Association Cervical Myelopathy Score, and Short Form 36 Physical/Mental Component Summaries were recorded. Fusion rates based on Bridwell grading were assessed at 2 years.Results: After matching, there were no significant preoperative differences in patient demographics, clinical outcomes, PROMs or HRQoL measures between the DM and control group (P > 0.05). There was no difference in either length of hospital stay (P = 0.92) or length of surgery (P = 0.92) between the two groups. At 2 years postoperatively, there were no significant differences between validated spine-specific scores, PROMs, HRQoL scores, satisfaction rates, or fulfilment of expectations between the two groups. Significant poorer Bridwell fusion grades were noted in the DM group at 2 years postoperatively (P < 0.05). Subgroup analysis within the DM group demonstrated that glycated hemoglobin levels had no impact on functional outcomes, fulfilment of expectations, or patient satisfaction at 2 years (P > 0.05).Conclusion: Despite poorer fusion outcomes following single-level ACDF for symptomatic CSM, there was no significant difference in validated spine outcome scores, PROMs, HRQoL measures, or satisfaction levels when compared to nondiabetic controls at short-term follow-up.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: This is a prospective study. OBJECTIVE.: A 2-year outcome of erectile dysfunction (ED) in patients younger than 50 years with fracture-unrelated lumbar spine disease requiring surgical decompression for ED is evaluated. Risk factors for ED were also evaluated. SUMMARY OF BACKGROUND DATA.: There is no literature documenting 2-year follow-up of ED status in young patients with atraumatic lumbar spine disease. METHODS.: All male patients younger than 50 years who underwent lumbar spine surgery between June 2006 and November 2007 without risk factors for ED were included. Patient demographics, neurological dysfunction, visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index, North American Spine Society score for neurogenic symptoms, and the international index of erectile function-5 scores were recorded preoperatively and at 2 years. Patients who did not complete a 2-year follow-up were excluded. RESULTS.: A total of 75 patients were eligible for the study. Nineteen patients did not complete a 2-year follow-up giving a response rate of 75%. There were 56 patients in the study with a mean age of 38.4 (SD, 7.2; range, 20-49). The most common diagnosis was prolapsed intervertebral disc (77%) for which patients underwent discectomy. Preoperatively, 21 of 56 (37.5%) patients had ED. Despite significant improvement in mean VAS scores for back pain and leg pain, Oswestry Disability Index, and North American Spine Society score for neurogenic symptoms at 2 years (P < 0.01), the mean international index of erectile function-5 scores remained stable. Patients with ED at 2 years had greater back pain (mean VAS score 3.4) compared with patients without back pain (mean VAS score, 1.6; P <= 0.01). CONCLUSION.: Despite excellent outcome in most spine scores postoperatively after lumbar spine surgery, one has to be less optimistic about any improvement in the ED status of patients after surgery. ED is still a problem 2 years after surgery. Back pain reduction may have a significant role in dealing with ED at 2 years postoperatively.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Introduction: Tumor susceptibility gene 101 (Tsg101), a key member of the endosomal sorting complex required for transport (ESCRT), plays a significant role in endosome-mediated recycling of membrane receptors. Considering that the insulin-like growth factor-1 receptor (IGF-1R) has been shown to be critical for physiological cardiac hypertrophy, it would be of great interest to investigate whether Tsg101-mediated endosome recycling contributed to IGF-1R signaling and physiological heart growth. Hypothesis: Tsg101 regulates physiological cardiac hypertrophy through endosomal recycling of IGF-1R. Methods & Results: Mice were subjected to high-intensity treadmill training for one week (25m/min, 1h/day) to induce a physiological cardiac hypertrophy. Western blot analysis revealed that the expression level of Tsg101 in treadmill-trained hearts was increased by 3-fold, compared to sedentary controls (n=9, p <0.01). Then, we generated a transgenic (TG) mouse model with cardiac-specific overexpression of Tsg101 (two TG lines: 11- and 4-fold overexpression). Both TG-lines exhibited a physiological cardiac hypertrophy-like phenotype, as evidenced by: 1) the higher ratio of heart/body weight without cardiac fibrosis, 2) enhanced cardiac function, and 3) increased myocyte membrane levels of IGF-1R, compared to wild-type controls (n=6-8, p <0.05). Co-immunoprecipitation analysis and size exclusion chromatography showed that Tsg101 existed in a complex with IGF-1R and Rab11-family interacting protein 3 (FIP3), a well-known initiator of endosome recycling of membrane receptors. In addition, we generated an inducible cardiac-specific Tsg101 knockdown (KD) mouse model, which failed to develop cardiac hypertrophy after intense treadmill training. Lastly, Tsg101-TG mice were resistant to cardiac dysfunction and fibrosis induced by the pathological hypertrophy model of transverse aortic constriction (TAC) surgery. Conclusion: Together, these data identify Tsg101 as a novel regulator of endosomal mediated recycling of IGF-1R and physiological cardiac hypertrophy and is cardio-protective against pathological cardiac remodeling. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac mitochondria l dysfunction and subsequent inflammation are hallmarks of sepsis-induced cardiomyopathy. The p62/Parkin pathway has recently been identified to activate autophagy of damaged mitochondria (mitophagy), regeneration of mitochondria and protection from LPS-induced cardiac dysfunction. Our latest data indicate that p62/Parkin interacted with tumor susceptibility gene 101 (Tsg101) in myocytes, and all three proteins were dysregulated in mouse hearts at 24 h post-injection of LPS. Hypothesis: Overexpression of Tsg101 may protect against endotoxin-induced cardiac injury by promoting of p62/Parkin-induced autophagic removal of damaged mitochondria. Methods and Results: We generated a transgenic (TG) mouse model with cardiac-specific overexpression of Tsg101. TG and wild-type (WT) hearts were subjected to intraperitoneal injection of LPS (10μg/g) to induce endotoxemia. TG hearts exhibited preserved cardiac contractile function and decreased mortality compared to WT mice (n=8, p <0.05). These beneficial effects were accompanied by decreased cardiomyocyte apoptosis (DNA fragmentation and TUNEL-positive nuclei) (n=6, p<0.05) in TG hearts compared with WT. In addition, myocardial inflammation was greatly reduced in endotoxemic-TG hearts compared with WTs, evidenced by lower levels of cytokines, TNF-α, IL-1β and IL-6 (n=6, p<0.05). Mechanistically, co-immunoprecipitation analysis showed that Tsg101 was directly bound to p62 and Parkin in myocytes and protein levels of p62 and Parkin were increased in TG hearts, compared to WTs. Hence, TG hearts showed an enhanced mitophagy, reduced mitochondria damage and lower levels of mitochondria DNA (mtDNA) and reactive oxygen species (mtROS) upon LPS treatment, compared to WTs. Consequently, the use of mitophagy inhibitor, bafilomycin, abrogated the Tsg101-mediated cardioprotection against LPS-induced cardiac damage. In vitro , overexpression of Tsg101 in cardiomyocytes led to increased cell survival upon LPS challenge, which was blocked by either siRNA-mediated knockdown of p62 or Parkin. Conclusion: Our data indicate that elevation of Tsg101 could protect against endotoxin-triggered myocardial injury by promoting p62/Parkin-induced mitophagy. [ABSTRACT FROM AUTHOR]

Background: Current view shows that M1 macrophages (pro-inflammatory) are enhanced while M2 macrophages (anti-inflammatory) are reduced in diabetic patients. Nonetheless, how to modulate macrophage polarization in diabetic conditions remains unclear, and the functional role of Sectm1a in macrophages or diabetes has never been investigated. Methods: Diabetes was induced in wild-type (WT) or Sectm1a knockout (KO) mice by either daily injection of streptozotocin (STZ, 50mg/kg body weight) for 5 days (T1DM), or 60% high fat diet (HFD, T2DM) feeding for 18 weeks. Cardiac function was assessed by echocardiography. Results: When treated with 0.25mM palmitate for 24hr, expression levels of Sectm1a were reduced in macrophage cell line RAW264.7 or bone marrow-derived macrophages (BMDMs). Similarly, Sectm1a was downregulated by 60% in T2DM diabetic hearts. These data suggest that Sectm1a is associated with macrophage behavior in response to metabolic stress. Next, we characterized polarization marker genes in macrophages transfected with adenovirus encoding Sectm1a gene. We observed that the expression of M2 marker genes (i.e. Arg1, CD206) was elevated, whereas the expression of M1 markers (i.e. iNOS, TNFα) were decreased. In addition, overexpression of Sectm1a suppressed the expression of chemokines (i.e., Ccl2 and Vcam1) and cytokines (i.e., TNFα, IL-1β, and IL-6). By contrast, ablation of Sectm1a in BMDMs exhibited the opposite results. Of importance, in both T1DM and T2DM conditions, absence of Sectm1a disrupted glucose homeostasis (worsened glucose tolerance and insulin sensitivity), and caused diastolic dysfunction while preserving systolic function. This was attributed to increased inflammation mediated by M1 macrophages in the heart, evidenced by flow cytometry analysis. Conclusion: Our study demonstrates for the first time that Sectm1a could modulate macrophage polarization and suppress inflammatory cytokine/chemokine production. Deficiency of Sectm1a in diabetic condition results in enhanced inflammatory response in the heart, leading to exacerbated cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Study Design: prospective study. Objective: present results of Prestige LP artificial cervical disc replacement (ADR). Summary Of Background Data: motion preservation with ADR can potentially reduce adjacent segment degeneration. METHODS.: Forty patients with 59 Prestige LP ADR were analyzed. Cervical range of motion, Neck Disability Index, Visual Analogue, Short Form-36, Modified American Academy of Orthopedic Surgeons, and Japanese Orthopedic Association scores and radiographs were evaluated. Clinical results were compared with anterior cervical discectomy and fusion. Results: there were 21 females and 19 males. Mean age was 43.9 years. Mean follow-up was 2.9 years. Of the patients, 62.5% had single level replacement-mainly C56 level (56%); 52.5% had myelopathy and 47.5% radiculopathy; 50% of neural compression was due to herniated disc, 45% due to spondylosis, and 5% due to both. There was significant improvement in the American Academy of Orthopedic Surgeons and Visual Analogue scores (P < 0.05) at 6 months and 2 years. There was significant improvement in the Neck Disability Index from a mean of 42.2 preoperation to 16.4 at 6 months and 15.2 at 2 years (P < 0.05). The mean Japanese Orthopedic Association score improved significantly from 14.7 preoperation to 15.7 at 6 months and 15.6 at 2 years (P < 0.05). There was significant improvement in all aspects of the Short Form-36 scores except general health (P < 0.05) at 6 months and 2 years. There was no significant difference in the clinical outcomes between ADR and anterior cervical discectomy and fusion. Segmental alignment (mean 8°, 14°, and 13° lordotic at preoperation, 6 months, and 2 years postoperation, respectively) and global alignment (mean 15.7°, 16.2°, and 17.3° lordotic at preoperation, 6 months, and 2 years postoperation, respectively) were maintained. Dynamic radiographs showed significant segmental motion with a 6 month's mean motion of 11.1° and a 2-year mean motion of 13.9° (P < 0.05). Conclusion: prestige LP ADR showed significant improvement in clinical outcomes at 2 years. It restores segmental lordosis and preserves segmental motion up to 2 years postoperation. [ABSTRACT FROM AUTHOR]