A systematic review of randomized controlled trials (RCTs). To assess the effects of arthroplasty versus fusion in the treatment of radiculopathy or myelopathy, or both, due to single-level cervical degenerative disc disease. There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single-level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty compared with fusion, prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long-term results become available, it is important to know whether results of 1 of the 2 treatments are superior to the other in the first 1 to 2 years. We searched electronic databases for randomized controlled trials. We included randomized controlled trials that directly compared any type of cervical fusion with any type of cervical arthroplasty, with at least 1 year of follow-up. Study selection was performed independently by 3 review authors, and "risk of bias" assessment and data extraction were independently performed by 2 review authors. In case of missing data, we contacted the study authors or the study sponsor. We assessed the quality of evidence. Nine studies (2400 participants) were included in this review; 5 of these studies had a low risk of bias. Results for the arthroplasty group were better than the fusion group for all primary comparisons, often statistically significant. For none of the primary outcomes was a clinically relevant difference in effect size shown. Quality of the evidence was low to moderate. There is low to moderate quality evidence that results are consistently in favor of arthroplasty, often statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. 1.

Cervical sagittal balance parameters are an important aid in surgical decision-making and influence outcome in cervical spine surgery. In current literature, the normative values of these parameters vary highly within and between patients. This variability might be attributed to body posture. The primary aim is to review the literature on the influence of body posture, including studies that compare sitting or standing positions possibly varying in arm positions, on cervical alignment measured in the sagittal plane on X-rays. A systematic review was performed. PubMed, Embase, Cochrane Library, Web of Science, and CINAHL were systematically searched for articles published up to and including May 2024. The primary outcome was variability in cervical alignment in the sagittal plane as measured in altering body postures on X-rays. Quality of the included articles was assessed with the QUADAS-2 tool. Out of 17,628 screened articles, 8 were eligible for inclusion. Articles were excluded based on irrelevant outcomes (n=10,372), duplicates (n=4,315), wrong study design (n=1,462), or the influence of body posture was not described (n=612). Overall cervical alignment ranged from 33.3° lordosis to 3.5° kyphosis. In all studies, statistically significant differences in T1 Slope (T1S), C2C7 Sagittal Vertical Axis (SVA), McGregor Slope (McGS), or C7 SVA were observed with respect to body posture. The observed differences between postures for cervical alignment ranged from 1° to 16.6°. Body posture significantly influences cervical alignment values measured in the sagittal plane on X-rays. Studies investigating this influence are scarce and vary highly in investigated body postures. Standardization of body posture is imperative to enable optimal comparison of cervical sagittal balance parameters within and between patients, but also between studies. Moreover, the high variability observed raises questions about the comparability of measured values in previously published studies.

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating a mean sensitivity of 90% and specificity of 85%. However, the extensive time that is required limits its applicability. This study investigated the feasibility of implementing a deep-learning model to analyze qualitative cervical motion. Methods: A U-Net architecture was implemented as 2D and 2D+t models. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to assess the performance of the models. Intraclass Correlation Coefficient (ICC) was used to compare the relative rotation of individual vertebrae and segments to the ground truth. Results: IoU ranged from 0.37 to 0.74 and DSC ranged from 0.53 to 0.80. The ICC scores for relative rotation ranged from 0.62 to 0.96 for individual vertebrae and from 0.28 to 0.72 for vertebral segments. For segments, 2D+t models presented higher ICC scores compared to 2D models. Conclusions: This study showed the feasibility of implementing deep-learning models to analyze qualitative cervical motion in dynamic X-ray recordings. Future research should focus on improving model segmentation by enhancing recording contrast and applying post-processing methods. Improved segmentation accuracy will enable routine use of the analysis of motion patterns in clinical research. The absence or presence of a motion pattern, or identification of new patterns has the potential to aid in clinical decision-making.

Background and Objectives: All intervertebral discs (IVDs) degenerate with the progression of age. Currently we are unable to differentiate physiological lumbar intervertebral disc degeneration (LIDD) from pathophysiological using imaging. The first step in differentiating physiological from pathophysiological degeneration is to determine physiological LIDD. Biochemical and histological analysis are not viable tools to look at the IVD in patients or healthy subjects due to their invasive character. For this reason, a non-invasive MRI could be the solution to study the lumbar IVD and LIDD. Therefore, the purpose of this systematic literature review is to identify the physiological aging process of the lumbar IVD based on MRI studies in patients of all ages without a history of spine pathology or surgery. Materials and Methods: After searching four databases (PubMed, Embase, Web of Science, and Cochrane), titles and abstracts of the identified studies were screened using inclusion and exclusion criteria. Eligible articles were subjected to a full-text review. Quality assessment was performed using ROBINS-I for risk of bias and Oxford level of evidence. Results: In total, 38 articles were included in this review. Most studies were non-consecutive studies (n = 36). Two studies were exploratory cohort studies. Twenty-two studies were prospective studies and sixteen were retrospective. Level of evidence ranged from 2b–3b. After analysis, we could construct a timeline of physiological degeneration from the age of 20 until 50. A shift in biochemical composition of the IVD and small structural changes can be detected in this timeline. The loss and breakdown of proteoglycan (PG) appears to have a primary role in this initial stadium of LIDD. After the age of 50, degeneration accelerates, resulting in more ultrastructural changes of the IVD as well as loss of height, volume, and disc convexity. No significant difference in degree of LIDD was found between men and women. Finally, the lower lumbar levels L4/5 and L5/S1 had a significantly higher degree of LIDD than upper lumbar levels (L1/2, L2/3, and L3/4). Conclusions: This systematic literature review conceptualizes the theory of physiological ageing in the lumbar IVD based on MRI. Initially, there is change in biochemical composition of the IVD, which eventually results in ultrastructural changes. Future research should aim to validate this theory, preferably in a prospective cohort study.