***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 
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    Input: Cervical artificial disc replacement ( ADR ) is indicated for the treatment of severe radiculopathy permitting neural decompression and maintenance of motion . We evaluated the clinical and radiographic outcomes in cervical ADR patients using the ProDisc-C device ( DePuy Synthes , West Chester , PA , USA ) with a 5 - 9 year follow-up . Data were collected through a prospect i ve registry , with retrospective analysis performed on 24 consecutive patients treated with cervical ADR by a single surgeon . All patients underwent single- or two-level ADR with the ProDisc-C device . Outcome measures included neck and arm pain ( visual analogue scale ) , disability ( neck disability index [ NDI ] ) , complications and secondary surgery rates . Flexion-extension cervical radiographs were performed to assess range of motion ( ROM ) of the device and adjacent segment disease ( ASD ) . Average follow-up was 7.7 years . Neck and arm pain improved 60 % and 79 % , respectively , and NDI had an improvement of 58 % . There were no episodes of device migration or subsidence . Mean ROM of the device was 6.4 ° . Heterotopic ossification was present in seven patients ( 37 % ) . Radiographic ASD below the device developed in four patients ( 21 % ) ( one single-level and three two-level ADR ) . No patient required secondary surgery ( repeat operations at the index level or adjacent levels ) . Fourteen out of 19 patients ( 74 % ) were able to return to employment , with a median return to work time of 1.3 months . The ProDisc-C device for cervical ADR is a safe option for patients providing excellent clinical outcomes , satisfactory return to work rates and maintenance of segmental motion despite radiographic evidence of heterotopic ossification and ASD on long-term follow-up Background Neck pain caused by cervical spondylosis has become a common health problem worldwide among > 40-year-old adults .  Acupuncture intervention is one of the most popular treatment measures for this disorder . However , evidence for its efficacy in relieving neck pain and recovering neck physiological function has not been established in r and omized , placebo-controlled trials . The primary aim of this trial is to assess the efficacy and safety of active acupuncture compared with sham acupuncture intervention for neck pain caused by cervical spondylosis . Methods / Design We will conduct a r and omized , double-blind , parallel-group , placebo-controlled trial comparing active acupuncture with placebo ( sham acupuncture ) . A total of 456 patients with neck pain caused by cervical spondylosis who meet the eligibility criteria from outpatient clinics of the Second People ’s Hospital of Fujian Province and the Affiliated Rehabilitation Hospital , Fujian University of Traditional Chinese Medicine will be recruited and r and omized into an active acupuncture or sham acupuncture group . The participants will undergo treatment sessions with either active or sham acupuncture intervention five times a week for 2 weeks . Evaluation by blinded assessors at baseline and at intervention for 1 and 2 weeks will include demographic characteristics , vali date d question naires ( Northwick Park Neck Pain Question naire ( NPQ ) scale , Short-Form 36 ( SF-36 ) scale , and McGill pain scale ) , examination of neck physiological function , and adverse events . All included patients will be followed up and investigated for relapse of neck pain at 4 , 8 , and 12 weeks after intervention . Discussion This paper describes the rationale and design of a r and omized double-blind , placebo-controlled trial that aims to determine the efficacy and safety of acupuncture intervention for neck pain caused by cervical spondylosis . The primary outcomes are changes in the NPQ score and neck physiological function . Secondary outcome measures include quality of life , adverse events , and relapse of neck pain . If successful , this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis . Trial registration Chinese Clinical Trial Registry : ChiCTR-TRC-12002206 . Registration date : 11 May 2012 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 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 pain scores preoperatively measured 77.1 and at 48 months 21.7 . These outcomes have not been associated with any degradation of outcome measures from 2 to 4 years . During the 48 months of follow-up at our institution we also report 6 secondary surgeries in our control group ( ACDF ) and only 1 in our investigational group ( Bryan ) . Of the 6 surgeries in the control group performed , 3 or 12 % to date were for adjacent level degenerative disease and 1 or 4 % for remote level degenerative disc disease . The remaining 2 surgeries were performed on the same patient for a pseudarthrosis . In the investigational group there was only 1 secondary surgery performed to date for adjacent level disease 5 % . Conclusions At 48 months , cervical arthroplasty with the Bryan cervical disc prosthesis continues to compare favorably to ACDF at our institution . There has been no degradation of functional outcomes from 24 to 48 months for NDI , VAS of neck and arm , and SF-36 . There has been a lower incidence of secondary surgeries for the Bryan arthroplasty cohort to date OBJECT The purpose of this study was to determine long-term clinical outcomes in patients undergoing anterior cervical surgery in which a cervical disc prosthesis was used to treat single-level degenerative cervical disc disease . METHODS In this prospect i ve , nonblinded study , 541 patients at 32 investigational sites were r and omly assigned to 1 of 2 treatment groups . The results of the investigational group , in which patients received the Prestige disc prosthesis , were compared with those of the control group , in which patients underwent an instrumented interbody fusion . Data were collected preoperatively , intraoperatively , and at 1.5 , 3 , 6 , 12 , 24 , 36 , and 60 months postoperatively . To date , 271 patients have completed 5 years of clinical follow-up ( 144 investigational and 127 control patients ) . RESULTS Significant improvements in Neck Disability Index ( NDI ) scores , Physical Component Summary scores of the 36-Item Short-Form Health Survey , and neck and arm pain scores were achieved by 1.5 months in both groups and sustained at 5 years . The mean NDI improvements from preoperative scores were 35.4 , 36.3 , and 38.4 at 24 , 36 , and 60 months , respectively , in the investigational group . The corresponding mean NDI improvements were 33.9 , 31.3 , and 34.1 in the control group . The intergroup differences at both 36 and 60 months were significant ( p = 0.008 and 0.022 , respectively ) . The overall rates of maintenance or improvement in neurological status in the investigational group were 91.6 % , 92.8 % , and 95.0 % , respectively , at 24 , 36 , and 60 months compared with 83.6 % , 83.2 % , and 88.9 % in the control group ( p = 0.006 , 0.004 , and 0.051 , respectively ) . The implant effectively maintained angular motion , averaging more than 7.3 degrees at 36 months and 6.5 degrees at 60 months after surgery . No implant migration was observed up to 60 months . There were statistically significant differences between the investigational and control groups with regard to the rate of revision and supplemental fixation surgical procedures performed subsequent to the index procedure . Additional surgical procedures for adjacent-segment disease were observed in both treatment groups . Rates for surgery at adjacent levels trended lower in the investigational group ( 8 patients [ 11 surgeries ] ) compared with those in the control group ( 13 patients [ 16 surger 
    Output:
    
Taken together , these results suggested that CDA and ACDF are efficient and safe methods for dealing with cervical spondylosis .
However , with respect to certain specific indicators , such as the reoperation rate of adjacent levels following surgery , the former has several advantages