***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To ascertain the relative frequencies of the causes of non-traumatic paraparesis and tetraparesis in adults . Design : Survey of patients enrolled prospect ively over a 3 year period between 1986 and 1989 and review of their case notes 1 year after enrollment ceased ( mean duration of follow up 30 months ) . Setting : Regional neurosciences centre in the UK serving over three million people in Merseyside and North Wales . Patients : Experienced clinicians from the centre saw most patients in the region with non-traumatic spastic paraparesis or tetraparesis . Primary investigation of patients was by myelography , for which patients were admitted to the centre . 585 consecutive patients with spastic paraparesis or tetraparesis were identified by daily screening of all 2104 patients undergoing myelography or radiculography during the 3 year period , ie selection by the intention to investigate them for myelopathy . Exclusions : age under 15 years , previous myelography for myelopathy . Interventions : None . Main outcome measures : Numbers and proportions of patients with each condition or category of disease . Results : Commonest diagnoses were cervical spondylotic myelopathy ( 23.6 % ) , extrinsic neoplastic or developmental tumour ( 16.4 % ) , multiple sclerosis ( 9.1 % rising to 17.8 % after MRI of a selected group ) , and motor neurone disease ( 4.1 % ) . Diagnosis was uncertain in 27.4 % , falling to 18.6 % after MRI . Conclusions : This survey shows the pattern of diseases producing non-traumatic myelopathy in the Mersey Region and in North Wales . Changing patterns of referral , investigation in peripheral hospitals and by non neurologically trained practitioners , and increasing use of outpatient MRI for primary investigation may make comparable surveys impossible in the future BACKGROUND CONTEXT Patient satisfaction is becoming an increasing common proxy for surgical quality ; however , the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated . PURPOSE The study aim ed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes ( PRO ) 2 and 5 years after anterior cervical spine surgery . STUDY DESIGN This is a retrospective analysis of prospect ively collected data . PATIENT SAMPLE The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion . OUTCOME MEASURES The outcome measures were visual analog scale ( VAS ) neck pain score , Neck Disability Index ( NDI ) , and Short-Form 12-Item scores , as well as patient satisfaction . METHODS Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction . Additionally , a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction . This research was supported by LDR ( Zimmer Biomet ) 13785 Research Boulevard - Suite 200 Austin , TX 78750 . RESULTS Data were available for 512 patients at 60 months . At 24 months postoperatively , NDI score improvement ( area under the curve [AUC]=0.806 ) , absolute NDI score ( AUC=0.823 ) , and absolute VAS neck pain score ( AUC=0.808 ) were all excellent predictors of patient satisfaction . At 60 months postoperatively , NDI score improvement ( AUC=0.815 ) , absolute NDI score ( AUC=0.839 ) , VAS neck pain score improvement ( AUC=0.803 ) , and absolute VAS neck pain score ( AUC=0.861 ) were all excellent predictors of patient satisfaction . CONCLUSIONS In patients undergoing one- and two-level anterior cervical spine surgery , between 2 and 5 years postoperatively , patient satisfaction is significantly predicted by PROs , including the VAS neck score and the NDI Study Design Post hoc analysis of prospect i ve , r and omized trial . Objective To investigate the disability associated with driving and single-level degenerative , cervical disc disease and to investigate the effect of surgery on driving disability . Methods Post hoc analysis of data obtained from three sites participating in a multicenter , r and omized , controlled trial comparing cervical disc arthroplasty ( TDA ) with anterior cervical discectomy and fusion ( ACDF ) .  The driving subscale of the Neck Disability Index ( NDI ) was analyzed for all patients . A dichotomous severity score was created from the NDI . Statistical comparisons were made within and between groups . Results Two-year follow-up was available for 118/135 ( 87 % ) patients . One half of the study population ( 49.6 % ) reported moderate or severe preoperative driving difficulty . This disability associated with driving was similar among the two groups ( ACDF : 2.5 ± 1.1 , TDA : 2.6 ± 1.0 , p = 0.646 ) . The majority of patients showed improvement , with no or little driving disability , at the sixth postoperative week ( ACDF : 75 % , TDA : 90 % , p = 0.073 ) . At no follow-up point did a difference exist between groups according to the severity index . Conclusions Many patients suffering from radiculopathy or myelopathy from cervical disc disease are limited in their ability to operate an automobile . Following anterior cervical spine surgery , most patients are able to return to comfortable driving at 6 weeks BACKGROUND CONTEXT Cervical total disc replacement ( TDR ) is intended to address radicular pain and preserve functional motion between two vertebral bodies in patients with symptomatic cervical disc disease ( SCDD ) . PURPOSE The purpose of this trial is to compare the safety and efficacy of cervical TDR , ProDisc-C ( Synthes Spine Company , L.P. , West Chester , PA ) , to anterior cervical discectomy and fusion ( ACDF ) surgery for the treatment of one-level SCDD between C3 and C7 . STUDY DESIGN / SETTING The study was conducted at 13 sites . A noninferiority design with a 1:1 r and omization was used . PATIENT SAMPLE Two hundred nine patients were r and omized and treated ( 106 ACDF ; 103 ProDisc-C ) . OUTCOME MEASURES Visual analog scale ( VAS ) pain and intensity ( neck and arm ) , VAS satisfaction , neck disability index ( NDI ) , neurological exam , device success , adverse event occurrence , and short form-36 ( SF-36 ) st and ardized question naires . METHODS A prospect i ve , r and omized , controlled clinical trial was performed . Patients were enrolled and treated in accordance with the US Food and Drug Administration ( FDA ) -approved protocol . Patients were assessed pre- and postoperatively at six weeks , 3 , 6 , 12 , 18 , and 24 months . RESULTS Demographics were similar between the two patient groups ( ProDisc-C : 42.1+/-8.4 years , 44.7 % males ; Fusion : 43.5 + /- 7.1 years , 46.2 % males ) . The most commonly treated level was C5-C6 ( ProDisc-C : 56.3 % ; Fusion=57.5 % ) . NDI and SF-36 scores were significantly less compared with presurgery scores at all follow-up visits for both the treatment groups ( p<.0001 ) . VAS neck pain intensity and frequency as well as VAS arm pain intensity and frequency were statistically lower at all follow-up timepoints compared with preoperative levels ( p<.0001 ) but were not different between treatments . Neurologic success ( improvement or maintenance ) was achieved at 24 months in 90.9 % of ProDisc-C and 88.0 % of Fusion patients ( p=.638 ) . Results show that at 24 months postoperatively , 84.4 % of ProDisc-C patients achieved a more than or equal to 4 degrees of motion or maintained motion relative to preoperative baseline at the operated level . There was a statistically significant difference in the number of secondary surgeries with 8.5 % of Fusion patients needing a re-operation , revision , or supplemental fixation within the 24 month postoperative period compared with 1.8 % of ProDisc-C patients ( p=.033 ) . At 24 months , there was a statistically significant difference in medication usage with 89.9 % of ProDisc-C patients not on strong narcotics or muscle relaxants , compared with 81.5 % of Fusion patients . CONCLUSIONS The results of this clinical trial demonstrate that ProDisc-C is a safe and effective surgical treatment for patients with disabling cervical radiculopathy because of single-level disease . By all primary and secondary measures evaluated , clinical outcomes after ProDisc-C implantation were either equivalent or superior to those same clinical outcomes after Fusion OBJECT The authors report the results of a prospect i ve r and omized multicenter study in which the results of cervical disc arthroplasty were compared with anterior cervical discectomy and fusion ( ACDF ) in patients treated for symptomatic single-level cervical degenerative disc disease ( DDD ) . METHODS Five hundred forty-one patients with single-level cervical DDD and radiculopathy were enrolled at 32 sites and r and omly assigned to one of two treatment groups : 276 patients in the investigational group underwent anterior cervical discectomy and decompression and arthroplasty with the PRESTIGE ST Cervical Disc System ( Medtronic Sofamor Danek ) ;  265 patients in the control group underwent decompressive ACDF . Eighty percent of the arthroplasty-treated patients ( 223 of 276 ) and 75 % of the control patients ( 198 of 265 ) completed clinical and radiographic follow-up examinations at routine intervals for 2 years after surgery . Analysis of all currently available postoperative 12- and 24-month data indicated a two-point greater improvement in the neck disability index score in the investigational group than the control group . The arthroplasty group also had a statistically significant higher rate of neurological success ( p = 0.005 ) as well as a lower rate of secondary revision surgeries ( p = 0.0277 ) and supplemental fixation ( p = 0.0031 ) . The mean improvement in the 36-Item Short Form Health Survey Physical Component Summary scores was greater in the investigational group at 12 and 24 months , as was relief of neck pain . The patients in the investigational group returned to work 16 days sooner than those in the control group , and the rate of adjacent-segment reoperation was significantly lower in the investigational group as well ( p = 0.0492 , log-rank test ) . The cervical disc implant maintained segmental sagittal angular motion averaging more than 7 degrees . In the investigational group , there were no cases of implant failure or migration . CONCLUSIONS The PRESTIGE ST Cervical Disc System maintained physiological segmental motion at 24 months after implantation and was associated with improved neurological success , improved clinical outcomes , and a reduced rate of secondary surgeries compared with ACDF Study Design Prospect i ve , r and omized , controlled . Level 1 evidence . Objective To report functional outcomes at 48 months follow-up on prospect ively r and omized patients to either the Bryan cervical disc prosthesis or anterior cervical discectomy and fusion ( ACDF ) at a single site . Summary of Background Data Surgical treatment of cervical disc pathology can involve discectomy and fusion ( ACDF ) , the gold st and ard technique . The safety and effectiveness of this procedure has been established and demonstrated in the literature , however , limitations have evolved and alternatives such as disc replacement are being investigated . Intervertebral disc replacement is design ed to preserve motion , both at affected and adjacent levels avoiding limitations of fusion such as adjacent level degeneration . New onset degenerative changes and possible recurring neurologic symptoms may be deferred or eliminated with cervical disc replacement . A recent multicenter trial with 24 months follow-up has shown the Bryan disc to compare favorably with ACDF . Continued follow-up is needed to further evaluate and compare functional outcomes in both these cohorts . Methods A total of 47 patients were enrolled at our site as part of an ongoing multicenter prospect ively r and omized study investigating ACDF versus Bryan cervical disc prosthesis . Functional outcomes are now reported at 48 months follow-up for our cohort of participants . Neck disability index score ( NDI ) , VAS neck and arm and SF-36 both physical and mental as well as complications and reoperations will be reported . Results Functional outcome data collected at routine follow-up for 48-months has favorably demonstrated improved functional outcomes for NDI , neck/arm pain VAS scores , and the SF-36 physical/mental health component scores for the Bryan arthroplasty and ACDF cohorts . The NDI scores for the Bryan arthroplasty preoperatively was 51 and at 48 months 10 . For ACDF preoperative NDI score was also 51 and at 48 months 16.7 . At 48 months NDI success , measured by ≥15 points NDI improvement demonstrated a 93.3 % success for Bryan arthroplasty and an 82.4 % success for ACDF . VAS neck pain scores for the Bryan arthroplasty preoperatively was 76.2 and at 48 months was 13.6 . VAS neck pain scores for ACDF preoperatively was 80.6 and at 48 months was 28.1 . Arm Pain scores were also measured and for the Bryan arthroplasty preoperatively measured 78.8 and at 48 months 10.8 . For ACDF arm 
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C-ADR was also noninferior to  fusion  for perioperative outcomes ( e.g. , operative time , blood loss ) , patient satisfaction , and health-related quality of life ( GRADE : Moderate ) .
C-ADR was superior to  fusion  for recovery and return to work , had higher technical success , and had lower rates of re-operation at the index site ( GRADE : Moderate ) .
C-ADR also maintained motion at the index-treated cervical level ( GRADE : Moderate ) , but evidence was insufficient to determine if adjacent-level surgery rates differed between C-ADR and fusion .
People with cervical degenerative disc disease reported that symptoms of pain and numbness can have a negative impact on their quality of life .
People with whom we spoke had tried a variety of treatments with minor success ; surgery was perceived as the most effective and permanent solution .
Those who had undergone C-ADR spoke positively of its impact on their quality of life and ability to move their neck after surgery .
The limited availability of C-ADR in Ontario was viewed as a barrier to receiving this treatment .
Conclusions For carefully selected patients with cervical degenerative disc disease , C-ADR provides patient-important and statistically significant reductions in pain and disability .
Further , unlike fusion , C-ADR allows people to maintain relatively normal cervical spine motion .
Compared with fusion , C-ADR appears to represent good value for money for adults with one-level cervical degenerative disc disease ( $ 11,607/QALY ) and for adults with two-level disease ( $ 16,782/QALY ) .
People with whom we spoke who had undergone C-ADR surgery spoke positively of its impact on their quality of life and ability to move their neck after surgery .
The limited availability of C-ADR in Ontario was viewed as a barrier to receiving this treatment