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. 2012 Feb;3(Suppl 1):19–30. doi: 10.1055/s-0031-1298605

Table 1. Characteristics of included studies.*.

Author (year)/study design CoE Demographics Diagnosis Interventions Follow-up Funding
Studies comparing multilevel C-ADR and multilevel ACDF
Cheng et al 1 (2009) RCT
Single site		 II C-ADR

  • N = 31

  • Male %: 52

  • Mean age: 45 y

ACDF

  • N = 34

  • Male: 50%

  • Mean age: 47 y

 Spondylotic myelopathy or cervical radiculopathy due to a disc herniation or stenosis C-ADR using the Bryan disc; all procedures performed by same surgeon
ACDF with iliac crest autograft; anterior cervical plating with the Orion Cervical Plate System		 2 y
C-ADR: 96.8% (30/31)
ACDF: 94.1% (32/34)		 NR
Kim et al 6 (2009)
Prospective cohort		 III C-ADR†

  • N = 12

  • Male: 67%

  • Mean age: 46.9 (30–58) y

ACDF†

  • N = 28

  • Male: 61%

  • Mean age: 52.7 (30–78) y

 Symptomatic single- or 2-level cervical disc disease
Radiculopathy

  • C-ADR: 83% (10/12)

  • ACDF: 86% (24/28)

Myelopathy

  • C-ADR: 17% (2/10)

  • ACDF: 14% (4/28)

 C-ADR using Bryan disc
ACDF with autogenous bone using various types of anterior cervical plates (ABC, Atlantis) or stand-alone cages (Blackstone, Solis)		 C-ADR

  • Mean 18 (13–37) mo

  • % Followed up NR

ACDF

  • Mean 21 (14–38) mo

  • % Followed-up NR

 NR
Studies comparing single-level C-ADR and multilevel C-ADR
Coric et al 7 (2010)
Prospective cohort‡ 		II N = 57
Male: 41.5%
Mean age: 46.6 y		 Symptomatic cervical radiculopathy or myelopathy C-ADR Follow-up: 2 y
(93%; n = 53/57)		 Primary author is a consultant for Depuy Spine and Spinal Motion
Goffin et al 3 (2010)§
Retrospective cohort		 III N = 98
Single level, n = 89

  • Male: 42.7%

  • Mean age (± SD): 43.2 ± 9.0 y

Multilevel, n = 9

  • Male: 77.8%

  • Mean age (± SD): 49.3 ± 7.2 y

 Radiculopathy due to:
Disc herniation

  • Single level: 56.2%

  • Multilevel: 0%

Spondylosis

  • Single level: 20.2%

  • Multilevel: 88.9%

Both

  • Single level: 15.7%

  • Multilevel: 0%

Myelopathy due to:
Disc herniation

  • Single level: 5.6%

  • Multilevel: 0%

Spondylosis

  • Single level: 2.2%

  • Multilevel: 11.1

 C-ADR with Bryan disc Follow-up: 4–6 y

  • 4 y: 100%

  • 6 y: 60.2% (59/98)

Single level: 59.6% (53/89)
Multilevel: 66.7% (6/9)		 Research support and editorial assistance for this study was received from Medtronic Sofamor Danek.
In addition, statistical analysis was conducted in collaboration with Medtronic.
A nonstudy-related institutional grant for research and education was also received from Medtronic.
Dr Lipscomb serves as a consultant for and owns stock in Medtronic.
Huppert et al 5 (2011)
Prospective cohort		 III N = 231∥
Single level, n = 175

  • Male: 40.0%

  • Mean age (range): 43.8 (23–63) y

Multilevel, n = 56

  • Male: 39.3%

  • Mean age (range): 48.2 - (34–65) y

 DDD causing radiculopathy and/or myelopathy Mobi-C C-ADR
Single-level and multilevel procedures performed by same surgeons, using same operative procedure, during the same time interval
No. of levels treated in multilevel group:

  • 2-level, n = 51;

  • 3-level, n = 4;

  • 4-level, n = 1

 Single level:
Mean 2.1 (1.5–2.6) y
% Followed-up NR
Multilevel:

  • Mean 2.0 (1.4–2.5) y

  • % Followed-up NR

 NR
Kim et al 2 (2009)
Retrospective cohort		 III N = 52
Male: 55.8%
Mean age (range): 47.2 (28–77) y
Single level: n = 36 (69%)
Multilevel: n = 16 (31%)		 Herniated disc: 44.2%
Spondylosis: 34.6%
Mixed: 15.8%
OPLL: 5.8%		 Bryan C-ADR
Concomitantly performed surgeries included:

  • interbody fusion (13.5%);

  • anterior microforaminotomy (15.4%)

 Follow-up: mean 2.4 (1.5–3) y
% Followed-up NR		 NR
Kim et al 6 (2009)
Prospective
cohort		 III N = 51
Single level, n = 39
Male: 53.8%
Mean age (range): 43.6 (24–74) y
Multilevel, n = 12

  • Male: 66.7%

  • Mean age (range): 46.9 (30–58) y

 Radiculopathy
Single level: 92.3%
Multilevel: 83.3%
Myelopathy
Single level: 7.7%
Multilevel: 16.7%		 Bryan C-ADR
All procedures performed by same surgeon		 Follow-up: mean 1.5 (1.1–3.3) y
% Followed-up NR		 NR
Pimenta et al 4 (2007)
Prospective cohort		 II N = 140
Single level, n = 71

  • Male: 39.4%

  • Mean age (range): 45.5 (28–77) y

Multilevel, n = 69

  • Male: 40.6%

  • Mean age (range): 46.6 (29–80) y

 HNP

  • Single level: 32.4%

  • Multilevel: 42.0%

Spondylosis

  • Single level: 67.6%

  • Multilevel: 58.0%

Radiculopathy

  • Single level: 73.2%

  • Multilevel: 66.7%

Myelopathy

  • Single level: 26.8%

  • Multilevel: 33.3%

 C-ADR using the PCM Porous Coated Motion Device Intervertebral Dynamic Disc Spacer
No. of levels treated in multilevel group:

  • 2-level, n = 53

  • 3-level, n = 12

  • 4-level, n = 4

 Follow-up: mean 2.2 (1–3.5) y
Follow-up 100%		 Corporate/ industry and foundation funds were received in support of this work.
One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
Tu et al 8 (2011)
Retrospective cohort		 III N = 36
Male: 58.3%
Mean age (range): 46.6 (29–60) y
Singlelevel, n = 20 (55.6%)
Multilevel, n = 16 (44.4%)		 Disc herniation: 61.1%
Spondylosis: 38.9%
Radiculopathy: 50.0%
Myelopathy: 13.9%
Both: 19.4%
Axial neck pain: 16.7%		 C-ADR using Bryan Follow-up: mean 1.6 (range, 1–2.3) y
1 y: 100%
2 y : 69.4% (25/36)		 This study was supported by grant VGH 99-S6-001 from Taipei Veterans General Hospital.
The authors report no conflict of interest.
*

C-ADR indicates cervical artificial disc replacement; ACDF, anterior cervical discectomy and fusion; FSU, functional spinal unit; CoE, level of evidence; NR, not reported; RCT, randomized control trial; DDD, degenerative disc disease; OPLL, ossification of the posterior longitudinal ligament; HNP, herniated nucleus pulposis.

†

The study reported comparisons between both single-level and multilevel C-ADR and ACDF. Only 2-level cases are reported for the purpose of this article.

‡

This study compared pooled groups of patients from three RCTs who underwent C-ADR vs ACDF (N = 98). Only the C-ADR group is reported here. Demographics are after loss to follow-up (n = 53).

§

Long-term follow-up results from Goffin et al3. The 98 patients included in this study agreed to participate in follow-up studies for up to 10 years; the original study had a total of 146 patients enrolled.

∥

A total of 384 patients were enrolled in this study; a total of 231 (60.2%) have completed their 2-month follow-up evaluation and were included in the analysis.

Only the comparison between single-level and multilevel C-ADR is reported.