The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of Anterior Cervical Discectomy with or Without Interbody Fusion and Arthroplasty in the Treatment of Cervical Disc Herniation; a Double-blind Randomised Multicenter Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2010 Jun 18

PMID 20553591

Citations 11

Authors

Mark P Arts

Ronald Brand

Elske van den Akker

Bart W Koes

Wilco C Peul

Affiliations

Soon will be listed here.

Abstract

Background: Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation.

Methods/design: Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years.

Discussion: Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prosthesis is necessary and cost-effective will be determined by this trial.

Trial Registration: Netherlands Trial Register NTR1289.

Citing Articles

The impact of mental health on outcome after anterior cervical discectomy: cohort study assessing the influence of mental health using predictive modelling.

Goedmakers C, van Beelen I, Komen F, van Zwet E, Peul W, Arts M Acta Neurochir (Wien). 2022; 164(11):3035-3046.

PMID: 36109365 PMC: 9613752. DOI: 10.1007/s00701-022-05362-z.

Prosthesis in Anterior Cervical Herniated Disc Approach Does Not Prevent Radiologic Adjacent Segment Degeneration.

Yang X, Donk R, Arts M, Bartels R, Vleggeert-Lankamp C Spine (Phila Pa 1976). 2020; 45(15):1024-1029.

PMID: 32675601 PMC: 7373492. DOI: 10.1097/BRS.0000000000003453.

Comparing Heterotopic Ossification in Two Cervical Disc Prostheses.

Yang X, Donk R, Bartels R, Arts M, Depreitere B, Vleggeert-Lankamp C Spine (Phila Pa 1976). 2020; 45(19):1329-1334.

PMID: 32576776 PMC: 7497598. DOI: 10.1097/BRS.0000000000003537.

The association of cervical sagittal alignment with adjacent segment degeneration.

Yang X, Bartels R, Donk R, Arts M, Goedmakers C, Vleggeert-Lankamp C Eur Spine J. 2019; 29(11):2655-2664.

PMID: 31606815 DOI: 10.1007/s00586-019-06157-0.

Porous silicon nitride spacers versus PEEK cages for anterior cervical discectomy and fusion: clinical and radiological results of a single-blinded randomized controlled trial.

Arts M, Wolfs J, Corbin T Eur Spine J. 2017; 26(9):2372-2379.

PMID: 28382392 DOI: 10.1007/s00586-017-5079-6.

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