{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:46:29Z","timestamp":1773189989375,"version":"3.50.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4\u20135 and C5\u20136 discs account for more motion than the C3\u20134 level, causing more DDD. This study aimed to compare the results of CDA at different levels.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3\u20134 and non-C3\u20134 CDA groups (i.e., those including C4\u20135, C5\u20136, and C6\u20137). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Eighty-eight patients (93.6%; mean age 45.62 \u00b1 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 \u00b1 1.13 years. There were 11 patients in the C3\u20134 CDA group and 77 in the non-C3\u20134 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75\u00b0 vs 7.03\u00b0; p = 0.58) and postoperative (8.18\u00b0 vs 8.45\u00b0; p = 0.59) ROMs were similar in both groups. The C3\u20134 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 \u00b1 0.3 vs 0.97 \u00b1 0.99; p = 0.0001) of HO.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Although CDA at C3\u20134 was infrequent, the improved clinical outcomes of CDA were similar at C3\u20134 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3\u20134 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.10.spine141217","type":"journal-article","created":{"date-parts":[[2016,1,29]],"date-time":"2016-01-29T15:03:22Z","timestamp":1454079802000},"page":"752-759","source":"Crossref","is-referenced-by-count":19,"title":["Differences between C3\u20134 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up"],"prefix":"10.3171","volume":"24","author":[{"given":"Peng-Yuan","family":"Chang","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Neurological Institute and"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsuan-Kan","family":"Chang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Neurological Institute 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