1
|
Ma Y, Yu X, Li C, Xiong Y, Zhao H, Yang Y, Zhao D, Wang F, Qu Y, Yang J, Bi L, Yue X. Changes in the centre of rotation and the anterior bone loss of the vertebral body in Mobi-C artificial disc replacement segments after cervical hybrid surgery: a retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1265-1274. [PMID: 38015272 DOI: 10.1007/s00586-023-08047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To examine the short-term efficacy and imaging results of using the Mobi-C in cervical hybrid surgery on 2-level cervical spondylolisthesis. To observe post-operative changes in the flexion-extension centre of rotation (FE-COR) and anterior bone loss (ABL) of the anterior cervical disc replacement (ACDR) segment. METHODS Forty-two patients (20 males and 22 females, aged 42‒67 years) who underwent cervical hybrid surgery were retrospectively analysed. Their ACDR segment used Mobi-C, and the fusion segment used ROI-C, with a follow-up of 25‒42 months (31.1 ± 4.8 months). The modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and visual analogue scale (VAS) were used to assess clinical outcomes. Pre-operative, 6-month post-operative, and final follow-up radiographs were collected to compare total cervical spine curvature (C2-C7), curvature of the operated segments, range of motion (ROM) in the total cervical spine, operated segmental ROM, ACDR segmental ROM, and operated adjacent segmental ROM. The height of the superior articular process (HSAP), the orientation of zygapophyseal joint spaces (OZJS), and the length of the superior articular surface (LSAS) were measured. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The translation distance of the Mobi-C was measured. The degree of disc degeneration in the adjacent segment, bony fusion of the ACDF segment, and ABL of the upper and lower vertebra of the ACDR segment were observed. RESULTS In our group, all patients have shown improvements in their postoperative mJOA, NDI, and VAS scores. Overall cervical ROM and surgical segmental ROM decreased (P < 0.05). However, there was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with pre-operatively (P > 0.05). For FE-COR-X, only the last follow-up compared with pre-surgery showed statistical significance (46.74 ± 7.71% vs. 50.74 ± 6.92%, P < 0.05). For FE-COR-Y, the change was statistically significant at both 6 months post-operation and the final follow-up compared to pre-operation (45.37% ± 21.11% vs. 33.82% ± 10.87%, 45. 37% ± 21.11% vs. 27.48% ± 13.58%, P < 0.05). No significant difference in the Mobi-C translation distance was observed (P > 0.05). Moreover, the difference in HSAP was not statistically significant at each node (P > 0.05). The OZJS and LSAS were significantly different at the final follow-up compared to the pre-operative period (P < 0.05). All the ACDF segments were observed in a stable condition at the final follow-up. Furthermore, 9 of the adjacent segments showed imaging ASD (9/82, 10.98%), and all were present at the last follow-up, of which 6 were mild, and 3 were moderate. Twenty of the 42 Mobi-C segments had no significant ABL (grade 0) 6 months post-operatively (47.62%). Sixteen cases (38.10%) showed mild ABL (grade 1), and 6 cases (14.28%) showed moderate ABL (grade 2). No severe ABL occurred. CONCLUSION The cervical hybrid surgery using Mobi-C artificial cervical discs can achieve satisfactory results. The Mobi-C segmental FE-COR-X shows a slow forward shift trend, and FE-COR-Y drops noticeably within 6 months post-surgery before stabilizing. It's common to see mild to moderate ABL after cervical hybrid surgery using Mobi-C, and significant progression is unlikely in the short term. Furthermore, changes in the FE-COR after hybrid surgery in the Mobi-C segment might not affect clinical outcomes.
Collapse
Affiliation(s)
- Yukun Ma
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Chuanhong Li
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Yang Xiong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - He Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yongdong Yang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Dingyan Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Fengxian Wang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yi Qu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jizhou Yang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Lianyong Bi
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xinliang Yue
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| |
Collapse
|
2
|
Fleck S, Lang A, Lehmberg J, Landscheidt JF, Gerlach R, Rathert J, Ulrich C, Schär RT, Hartmann S, Mueller JU, Thome C. Prospective Multicenter Trial of Cervical Arthroplasty with the ROTAIO® Cervical Disc Prosthesis. Global Spine J 2024; 14:429-437. [PMID: 35929409 PMCID: PMC10802525 DOI: 10.1177/21925682221109563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Clinical observational study. OBJECTIVE The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. MATERIAL AND METHODS 120 patients (72 females and 48 males with median age of 43.0 years [23-60 yrs] underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n = 104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months in 100%, 96% and 77% of the cohort by VAS, NDI, WL-26, Patient`s Satisfaction Index (PSI), SF-36, Nurick Score, mJOA, Composite Success Rate, complications, patient`s overall satisfaction and analgesics use. RESULTS Highly significant clinical improvements were observed according to NDI and VAS (P < .0001 (arm); P < .001 (neck); P = .002 (head)) at all time points. Analgetic use could be reduced in 87.1 to 95.2%. Doctor`s visits have been reduced in 93.8% after 24 months. Patient`s overall satisfaction was high with 78.4 to 83.5% of patients. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed resulting in a revision rate of 1.7% in 2 years. CONCLUSION The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating highly significant clinical improvement and high patient`s overall satisfaction with very low revision rates at 2 years.
Collapse
Affiliation(s)
- Steffen Fleck
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Anna Lang
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jens Lehmberg
- Department of Neurosurgery, Klinikum Bogenhausen, Munich, Germany
| | | | - Ruediger Gerlach
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | - Julian Rathert
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | | | - Ralph T. Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Claudius Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Lee JH, Lee JH. The discrepant clinical outcome predictions according to the differentiated centre of rotation shift after multilevel cervical total disc replacement. Br J Neurosurg 2024; 38:23-28. [PMID: 33369503 DOI: 10.1080/02688697.2020.1866162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Cervical total disc replacement (TDR) aims to maintain normal cervical kinematics after surgery. This study investigates the relation between shifted location of centre of rotation (COR) and subsequent surgical outcomes after multilevel cervical TDR (MCTDR) and identifies radiological parameter that corresponded to this change of COR after MCTDR. METHODS The study included a consecutive 24 patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric Rating Scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and location of COR at TDR level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief. RESULTS The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X axis. CONCLUSION The determinant for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR levels, was restoration of COR from ventro-cranial location close to normal coordinates by posterior and inferior shifts. The position of COR along the X axis after MCTDR was important factor to determine maintenance of C2-7 ROM.
Collapse
Affiliation(s)
- Jung Hwan Lee
- Department of Rehabilitation, Namdarun Rehabilitation Clinic, Yong In, Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Centre, Seoul, Korea
| |
Collapse
|
4
|
He J, Chen H, Wu T, Rong X, Ding C, Wang B, Liu H. Is Cervical Disc Arthroplasty an Effective Treatment for Cervical Degenerative Disease With Osteopenia? Global Spine J 2023:21925682231190612. [PMID: 37459175 DOI: 10.1177/21925682231190612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To evaluate postoperative outcomes of single-level cervical disc arthroplasty (CDA) in patients with osteopenia and compare these results with a matched cohort of normal bone mineral density (BMD). METHODS Patients who had undergone single-level CDA were collected and screened. Included patients were divided into the osteopenia group and the normal group. 38 eligible patients with osteopenia were included in the final analysis. Subsequently, a 1:1 match was utilized. Clinical, radiographic data, and complications were recorded. Appropriate statistical methods were applied to conduct analysis using SPSS version 24.0. RESULTS The mean follow-up time was 30.5 ± 27.3 months. The osteopenia group achieved satisfactory clinical outcomes, with no significant intergroup differences. Additionally, there were no significant differences between groups in any of the radiological parameters, either in cervical alignment or segmental height, or range of motion. The radiological incidence rate of adjacent segmental degeneration and heterotopic ossification (HO) was comparable in both groups, respectively, with a similar composition of ROM-limiting HO. However, the osteopenia group had a tendency of more implant subsidence (2.7% vs 15.2%). The logistic regression analysis showed the osteopenia group had a significantly higher incidence rate of anterior bone loss (ABL) (OR = 5.37, 95% CI: 1.50 - 19.22). CONCLUSIONS Single-level CDA for patients with osteopenia achieved similar satisfactory clinical outcomes compared with the normal BMD group. Meanwhile, the osteopenia group maintained adequate sagittal balance and segmental height. Based on this observation, this option may be feasible for selected patients with osteopenia.
Collapse
Affiliation(s)
- Junbo He
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Chen
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Hsieh MK, Tai CL, Li YD, Lee DM, Lin CY, Tsai TT, Lai PL, Chen WP. Finite element analysis of optimized novel additively manufactured non-articulating prostheses for cervical total disc replacement. Front Bioeng Biotechnol 2023; 11:1182265. [PMID: 37324423 PMCID: PMC10267663 DOI: 10.3389/fbioe.2023.1182265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Ball-and-socket designs of cervical total disc replacement (TDR) have been popular in recent years despite the disadvantages of polyethylene wear, heterotrophic ossification, increased facet contact force, and implant subsidence. In this study, a non-articulating, additively manufactured hybrid TDR with an ultra-high molecular weight polyethylene core and polycarbonate urethane (PCU) fiber jacket, was designed to mimic the motion of normal discs. A finite element (FE) study was conducted to optimize the lattice structure and assess the biomechanical performance of this new generation TDR with an intact disc and a commercial ball-and-socket Baguera®C TDR (Spineart SA, Geneva, Switzerland) on an intact C5-6 cervical spinal model. The lattice structure of the PCU fiber was constructed using the Tesseract or the Cross structures from the IntraLattice model in the Rhino software (McNeel North America, Seattle, WA) to create the hybrid I and hybrid II groups, respectively. The circumferential area of the PCU fiber was divided into three regions (anterior, lateral and posterior), and the cellular structures were adjusted. Optimal cellular distributions and structures were A2L5P2 in the hybrid I and A2L7P3 in the hybrid II groups. All but one of the maximum von Mises stresses were within the yield strength of the PCU material. The range of motions, facet joint stress, C6 vertebral superior endplate stress and path of instantaneous center of rotation of the hybrid I and II groups were closer to those of the intact group than those of the Baguera®C group under 100 N follower load and pure moment of 1.5 Nm in four different planar motions. Restoration of normal cervical spinal kinematics and prevention of implant subsidence could be observed from the FE analysis results. Superior stress distribution in the PCU fiber and core in the hybrid II group revealed that the Cross lattice structure of a PCU fiber jacket could be a choice for a next-generation TDR. This promising outcome suggests the feasibility of implanting an additively manufactured multi-material artificial disc that allows for better physiological motion than the current ball-and-socket design.
Collapse
Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - De-Mei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yi Lin
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Weng-Pin Chen
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| |
Collapse
|
6
|
Yan K, Shi Z, He D, Liu B, Xiao B, Wang Q, Tian W. Influence of the deviated center of rotation on the range of motion after cervical disc arthroplasty -an in vivo study with a minimum of 10-year follow-up. BMC Musculoskelet Disord 2023; 24:88. [PMID: 36726119 PMCID: PMC9890835 DOI: 10.1186/s12891-022-06041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Short-term researches have studied the change of the center of rotation (COR) after the Bryan Cervical disc arthroplasty (CDA). But there is a lack of long-term studies focusing on the location of COR and its influence after surgery. METHODS Clinical and radiographic materials of patients who received CDA were retrospectively reviewed. Written informed consents were obtained. Clinical outcome was accessed by Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and Odom's scale. Radiographic evaluation underwent before surgery, at early (3 months) follow-up and final (minimal 10 years) follow-up. The ROM of the global cervical spine and index level, the functional spine unit (FSU) angle and C2-C7 angle were measured. COR was identified and its coordinates were calculated. The absolute change of COR-x and COR-y were compared in subgroup analysis. RESULTS Sixty patients were included, with an average age of 55.9 ± 8.1 years old. The mean duration of follow up was 135.1 ± 16.1 (120-155) months. JOA, NDI and Odom's scale showed significant improvements at 10 years after surgery. The COR of index level was located in the posterior superior half of the caudal vertebral body. Following the implant of Bryan Disc, the COR shifted forward and downward. During the 10-year follow-up, the location of COR remained stable. ROM at the index level decreased from 10.6 ± 4.0° preoperatively to 9.3 ± 4.0° at the early follow-up (p = 0.03). The ROM at the index level remained unchanged from early follow-up to the final follow-up (9.3 ± 4.0° vs 9.5 ± 5.2°, p = 0.80). In subgroup analysis, larger changes of both COR-x and COR-y were related with decreased ROM. CONCLUSIONS Our study illustrated that Bryan CDA could achieved favorable clinical and radiographic outcome over a minimal 10-year follow-up. The reduction of the flexion-extension ROM may be correlated with a more deviated postoperative COR. More attention should be paid to preoperative design and intraoperative technique to obtain a more native COR.
Collapse
Affiliation(s)
- Kai Yan
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Zhan Shi
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Da He
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Bo Liu
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Bin Xiao
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Qilong Wang
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| | - Wei Tian
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035 China
| |
Collapse
|
7
|
Lang A, Lener S, Grassner L, Abramovic A, Thomé C, Päsler D, Lehmberg J, Schär R, Hartmann S. Clinical and radiological outcome 1-year after cervical total disc replacement using the Signus ROTAIO - Prosthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3477-3483. [PMID: 36219329 DOI: 10.1007/s00586-022-07416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The instantaneous center of rotation (iCOR) of a motion segment has been shown to correlate with its total range of motion (ROM). Importantly, a correlation of the correct placement of cervical total disc replacement (cTDR) to preserve a physiological iCOR has been previously identified. However, changes of these parameters and the corresponding clinical relevance have hardly been analyzed. This study assesses the radiological and clinical correlation of iCOR and ROM following cTDR. MATERIALS/METHODS A retrospective multi-center observational study was conducted and radiological as well as clinical parameters were evaluated preoperatively and 1 year after cTDR with an unconstrained device. Radiographic parameters including flexion/extension X-rays (flex/ex), ROM, iCOR and the implant position in anterior-posterior direction (IP ap), as well as corresponding clinical parameters [(Neck Disability Index (NDI) and the visual analogue scale (VAS)] were assessed. RESULTS 57 index segments of 53 patients treated with cTDR were analyzed. Pre- and post-operative ROM showed no significant changes (8.0° vs. 10.9°; p > 0.05). Significant correlations between iCOR and IP (Pearson's R: 0.6; p < 0.01) as well as between ROM and IP ap (Pearson's R: - 0.3; p = 0.04) were identified. NDI and VAS improved significantly (p < 0.01). A significant correlation between NDI and IP ap after 12 months (Pearson's R: - 0.39; p < 0.01) was found. CONCLUSION Implantation of the tested prosthesis maintains the ROM and results in a physiological iCOR. The exact position of the device correlates with the clinical outcome and emphasize the importance of implant design and precise implant positioning.
Collapse
Affiliation(s)
- Anna Lang
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Grassner
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dennis Päsler
- Department of Neurosurgery, University of Greifswald, Greifswald, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Academic Hospital Bogenhausen Munich, Munich, Germany
| | - Ralph Schär
- Department of Neurosurgery, University of Bern, Bern, Switzerland
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
8
|
Liu Z, Rong X, Liu H, Ding C, Hong Y, Wang B. Effect of Facet Tropism on Postoperative Cervical Range of Motion After Single-Level Cervical Disc Arthroplasty. Global Spine J 2022; 12:1696-1707. [PMID: 33511887 PMCID: PMC9609535 DOI: 10.1177/2192568220986144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES Cervical disc arthroplasty (CDA) was designed to replace the degenerated disc with the prosthesis to preserve cervical motion. The commonly used artificial discs are designed symmetric, whereas the facet joints were reported to be asymmetric in many people. This study aimed to evaluate the effect of facet tropism on the cervical range of motion (ROM) after single-level CDA using Prestige LP. METHODS A total of 90 patients who underwent single-level CDA using Prestige LP from 2012 to 2017 were retrospectively reviewed. Radiographs were taken at each time point to measure the C2-C7 ROM and the ROM at the surgical segment. The pre-operation CT scans were utilized to reconstruct and calculate the angular direction of facet joints with respect to transverse, coronal, and sagittal reference planes. Facet tropism above 7° was defined as facet joint asymmetry. RESULTS No significant difference was found in flexion-extension C2-C7 ROM or ROM at the surgical segment between patients with symmetric and asymmetric fact joints regarding the sagittal plane. Patients with coronal asymmetric facet joints had lower flexion-extension ROM at the surgical level. Patients with transverse asymmetric facet joints had both lower flexion-extension C2-C7 ROM and ROM at the surgical level. After CDA surgery, patients obtained good clinical outcomes including increased Japanese Orthopedic Association (JOA) and decreased Neck Disability Index (NDI) as well as Visual Analogue Scale (VAS). CONCLUSION The coronal and transverse tropism seemed to be correlated with decreased flexion-extension ROM after CDA using Prestige LP.
Collapse
Affiliation(s)
- Ziyang Liu
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China,Department of Orthopedics, Tianjin
Hospital, Tianjin Province, China
| | - Xin Rong
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China,Hao Liu, Department of Orthopedic Surgery,
West China Hospital, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province,
China.
| | - Chen Ding
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ying Hong
- Department of Operating Room, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Beiyu Wang
- Department of Orthopedics, West China
Hospital, Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
9
|
Li C, Yu X, Xiong Y, Yang Y, Wang F, Zhao H. Mid-long-term follow-up of operated level kinematics after single-level artificial cervical disc replacement with Bryan disc. J Orthop Surg Res 2022; 17:149. [PMID: 35264233 PMCID: PMC8905739 DOI: 10.1186/s13018-022-03051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluation of the mid-long-term kinematics of single-level Bryan artificial cervical disc replacement (ACDR) in vivo by analyzing the center of rotation (COR) at the operated level. METHODS A retrospective analysis was conducted using data collected from 38 patients who underwent single-level Bryan ACDR from January 2010 to March 2013. Radiological parameters including range of motion (ROM), lordosis angle, translation, and COR were obtained. Clinical outcomes were assessed based on Odom Criteria, modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores. Correlations between COR and other follow-up data were discussed at the last follow-up. RESULTS Compared with preoperative values, the last follow-up data showed that 86.84% of cases achieved good-or-excellent outcomes based on Odom criteria; Significant improvements were observed across all scales assessed for clinical outcomes (P < 0.05); Lordosis angle was significantly increased in both the overall cervical spine and the operated level (P < 0.05); ROM of the overall cervical spine, operated level, and adjacent levels was preserved (P > 0.05); There was no significant change in COR at the operated level (P > 0.05). At the last follow-up and at the operated level, COR (Y) showed negative correlations with ROM and translation (P < 0.05), but no follow-up data correlated with COR (X) were found (P > 0.05). CONCLUSIONS Satisfactory clinical and radiological outcomes were achieved 7 years or more after single-level Bryan ACDR. At the operated level, preoperative COR was maintained, probably due to replicating the physiological interrelations of COR (Y), translation, and ROM.
Collapse
Affiliation(s)
- Chuanhong Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China.
| | - Yang Xiong
- School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Yongdong Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Fengxian Wang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - He Zhao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| |
Collapse
|
10
|
Muhlbauer MK, Tomasch E, Sinz W, Trattnig S, Steffan H. Cervical disc prostheses need a variable center of rotation for flexion / extension below disc level, plus a separate COR for lateral bending above disc level to more closely replicate in-vivo motion: MRI-based biomechanical in-vivo study. BMC Musculoskelet Disord 2022; 23:227. [PMID: 35260131 PMCID: PMC8905756 DOI: 10.1186/s12891-022-05121-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cervical disc prostheses are used to preserve motion after discectomy, but they should also provide a near-physiological qualitative motion pattern. Nevertheless, they come in many completely different biomechanical concepts. This caused us to perform an in-vivo MR-based biomechanical study to further investigate cervical spine motion with the aim to gain new information for improving the design of future cervical arthroplasty devices. Methods Fifteen healthy volunteers underwent MRI-investigation (in order to avoid radiation exposure) of their cervical spines from C3 to C7; for each segment centers of rotation (COR) for flexion / extension were determined from 5 different positions, and CORs for lateral bending from 3 different positions. The motion path of the COR is then described and illustrated in relation to the respective COR for maximum flexion / extension or lateral bending, respectively, and the findings are translated into implications for a better biomechanical prosthesis-design. Results The COR for flexion / extension does not remain constant during motion. The CORs for the respective motion intervals were always found at different positions than the COR for maximum flexion /extension showing that the COR moves both along the x- and the y-axis throughout flexion / extension. For lateral bending a completely independent COR was found above disc-level. Conclusion Flexion / extension is not a simple circular motion. Disc prostheses need a variable COR for flexion / extension below disc level with the capability to move both along the x- and the y-axis during motion, plus a second completely independent COR for lateral bending above disc level to closely replicate in-vivo motion. These findings are important for improving the biomechanical design of such devices in the future.
Collapse
Affiliation(s)
- Manfred K Muhlbauer
- Neurosurgical Department, Klinik Donaustadt, Langobardenstrasse 122, 1220, Vienna, Austria.
| | - Ernst Tomasch
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Wolfgang Sinz
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Hermann Steffan
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| |
Collapse
|
11
|
Biswas JK, Malas A, Majumdar S, Rana M. A comparative finite element analysis of artificial intervertebral disc replacement and pedicle screw fixation of the lumbar spine. Comput Methods Biomech Biomed Engin 2022; 25:1812-1820. [PMID: 35152795 DOI: 10.1080/10255842.2022.2039130] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Titanium alloy-based Pedicle screw-rod fusion is a very common technique to provide higher fusion regularity than other methods. In recent times, Carbon-fibre-reinforced (CFR)-PEEK rod is used to better reduce the fusion rate. Alternatively, total disc replacement (TDR) is also very common for the non-fusion treatment method for degenerative disc disease (DDD). This study aims to investigate flexibility (ROM), stability, stress condition in implant, implant adjacent bone of the implanted lumbar spine during different physiological movements and loading environments. The finite element (FE) intact model of the lumbar spine (L2-L5) with two-level pedicle screw-rod fusion at L3-L4-L5 and two-level artificial disc replacement was developed. CFR-PEEK was taken for rod for semi-rigid fusion. UHMWPE was taken as core part of the artificial disc. The FE models were simulated under 6, 8 and 10 Nm moments in left right lateral bending, flexion and extension movements. The total ROM was reduced for two-level pedicle screw fixation and increased for the artificial disc replacement model during flexion extension compared to the intact spine. The total ROM was reduced by around 54% and 25% for two-level fixation and increased by 30% and 19.5% for artificial disc replacement spine, under flexion-extension and left-right lateral bending respectively. For screw fixation, the ROM increased by 15% and 18% reduced by 4.5% and 14% for disc replacement at the adjacent segments for flexion-extension and left-right lateral bending.
Collapse
Affiliation(s)
- Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Anindya Malas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Sourav Majumdar
- Department of Applied Science & Humanities, Guru Nanak Institute of Technology, Kolkata, West Bengal, India
| | - Masud Rana
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, West Bengal, India
| |
Collapse
|
12
|
Wo J, Lv Z, Wang J, Shen K, Zhu H, Liu Y, Huang Y, Sun G, Li Z. Biomechanical Analysis of Cervical Artificial Disc Replacement Using Cervical Subtotal Discectomy Prosthesis. Front Bioeng Biotechnol 2021; 9:680769. [PMID: 34336799 PMCID: PMC8317600 DOI: 10.3389/fbioe.2021.680769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) sacrifices segmental mobility, which can lead to the acceleration of adjacent segment degeneration. The challenge has promoted cervical artificial disc replacement (CADR) as a substitute for ACDF. However, CADR has revealed a series of new issues that are not found in ACDF, such as hypermobility, subsidence, and wear phenomenon. This study designed a cervical subtotal discectomy prosthesis (CSDP) consisting of a cervical disc prosthesis structure (CDP structure), cervical vertebra fixation structure (CVF structure), link structure, and locking screw, aiming to facilitate motion control and reduce subsidence. The aim of this study was to assess the biomechanics of the CSDP using finite element (FE) analysis, friction-wear test, and non-human primates implantation study. Study Design: For the FE analysis, based on an intact FE C2-C7 spinal model, a CSDP was implanted at C5-C6 to establish the CSDP FE model and compare it with the Prestige LP prosthesis (Medtronic Sofamor Danek, Minneapolis, MN, United States). The range of motion (ROM), bone-implant interface stress, and facet joint force were calculated under flexion extension, lateral bending, and axial rotation. In addition, CSDP was elevated 1 mm to mimic an improper implantation technique to analyze the biomechanics of CSDP errors in the FE model. Moreover, the friction-wear test was conducted in vitro to research CSDP durability and observe surface wear morphology and total wear volume. Finally, the CSDP was implanted into non-human primates, and its properties were evaluated and verified by radiology. Results: In the FE analysis, the ROM of the CSDP FE model was close to that of the intact FE model in the operative and adjacent segments. In the operative segment, the CSDP error FE model increased ROM in flexion extension, lateral bending, and axial rotation. The maximum stress in the CSDP FE model was similar to that of the intact FE model and was located in the peripheral cortical bone region. The facet joint force changes were minimal in extension, lateral bending, and axial rotation loads in CSDP. In the friction-wear test, after the 150-W movement simulation, both the CVF-link-junction and the CDP-link-junction had slight wear. In the CSDP non-human primate implantation study, no subsidence, dislocation, or loosening was observed. Conclusion: In the FE analysis, the biomechanical parameters of the CSDP FE model were relatively close to those of the intact FE model when compared with the Prestige LP FE model. In terms of CSDP error FE models, we demonstrated that the implantation position influences CSDP performance, such as ROM, bone-implant interface stress, and facet joint force. In addition, we performed a friction-wear test on the CSDP to prove its durability. Finally, CSDP studies with non-human primates have shown that the CSDP is effective.
Collapse
Affiliation(s)
- Jin Wo
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhenjing Lv
- Department of Spine Orthopedics, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
| | - Jing Wang
- Department of Neurosurgery, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Kui Shen
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Haoran Zhu
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yang Liu
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yuen Huang
- Department of Rehabilitation, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Guodong Sun
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Orthopedics, Fifth Affiliated Hospital, Heyuan Shenhe People's Hospital, Jinan University, Heyuan, China
| | - Zhizhong Li
- Department of Orthopedics, First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Orthopedics, Fifth Affiliated Hospital, Heyuan Shenhe People's Hospital, Jinan University, Heyuan, China.,Department of Orthopedics, Heyuan People's Hospital, Heyuan Affiliated Hospital of Jinan University, Heyuan, China
| |
Collapse
|
13
|
Hui N, Phan K, Lee MY, Kerferd J, Singh T, Mobbs RJ. The Changes in Cervical Biomechanics After CTDR and Its Association With Heterotopic Ossification: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:565-574. [PMID: 32677512 PMCID: PMC8119929 DOI: 10.1177/2192568220922949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES Cervical total disc replacement (CTDR) can preserve range of motion (ROM) of the operated spinal segment in cadaver studies. Evidence is less clear in clinical trials. The present study aims to investigate the differences in cervical biomechanics before and after CTDR and its association with heterotopic ossification (HO) development. METHOD Articles that reported the rate of HO and ≥1 difference in cervical biomechanics were included in quantitative analyses. We pooled the mean difference (MD) of cervical biomechanics before and after CTDR. Subgroup analyses and metaregression analyses were conducted to identify potential contributors to heterogeneity. RESULTS Of the 599 studies screened, 35 studies were included in the final analysis. In comparison with preoperative values, ROM of the spinal segment inferior (MD: 0.38; 95% CI: 0.02 to 0.74) and superior (MD: 0.43; 95% CI: 0.12 to 0.75) to the surgical spinal segment, functional spinal unit (FSU) angle (MD: 2.23; 95% CI: 1.11 to 3.35), and C2/C7 Cobb angle (MD: 3.49; 95% CI: 1.73 to 5.25) significantly increased after CTDR. In contrast, FSU and cervical ROM at baseline were no different from follow-up. On multivariable meta-regression analyses, HO and ROM-limiting HO were not associated with changes in cervical biomechanics. Single-level CTDR and duration of follow-up were associated with changes in cervical biomechanics. CONCLUSION Our study reported the pooled mean of biomechanics at baseline and final follow-up and their differences. The changes in biomechanics were not associated with the rates of HO and ROM-limiting HO.
Collapse
Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Mei-Yi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia,85120Hong Kong Polytechnic
University, Hong Kong
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Telvinderjit Singh
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia,NeuroSpineClinic, Sydney, Australia,Ralph J. Mobbs, NeuroSpineClinic, Suite 7,
Level 7, Prince of Wales Private Hospital, Randwick, New South Wales 2031,
Australia.
| |
Collapse
|
14
|
Muhlbauer M, Tomasch E, Sinz W, Trattnig S, Steffan H. In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern. J Orthop Surg Res 2020; 15:391. [PMID: 32907606 PMCID: PMC7488089 DOI: 10.1186/s13018-020-01908-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background In cervical arthroplasty, qualitative motion analysis generally investigates the position of the center of rotation (COR) before and after surgery. But is the pre-op COR suitable as reference? We believe that only a comparison against healthy individuals can answer whether a physiological motion pattern has been achieved. The aim of our study was to examine how the COR for flexion/extension after insertion of 3 biomechanically completely different types of disc prostheses compares to healthy volunteers, and whether and how prosthesis design contributes to a more natural or maybe even worse motion pattern. Methods In 15 healthy volunteers, MRI in flexion and in extension was taken, and the coordinates for the CORs (COR-HV) from C3 to C7 were determined. Then pre- and post-op flexion/extension x-rays from 30 patients with a one-level disc prosthesis underwent analysis for determination of COR from C3 to C7; 10 patients who received a Bryan, a Prestige STLP, or a Discover prosthesis were chosen, respectively. Change of post-op COR position was investigated in relation to the COR-HV. Results The pre-operative COR is not congruent with the COR found in healthy subjects and therefore cannot be used as reference for investigation whether a disc prosthesis resembles natural motion. However, the comparison with healthy individuals shows that prosthesis insertion can change the coordinates of the COR to any direction in all levels from C3/4 to C6/7 regardless of the operated segment. Prostheses with flexible biomechanical properties can contribute to shift the COR toward normal, but devices with unphysiological biomechanical design, like fixed ball socket designs, for instance, can make the motion pattern even worse. Conclusions Even if the small cohorts in our study do not allow strong conclusions, it seems that in cervical arthroplasty, the biomechanical concept of the prosthesis has a significant impact whether a near-physiological motion pattern can be achieved or not. As it is a rumor but not scientifically proven that prosthesis design has no influence on clinical outcome, surgeons should only choose devices with flexible biomechanical properties for disc replacement.
Collapse
Affiliation(s)
- Manfred Muhlbauer
- Neurosurgical Department, Donauspital SMZ-Ost, Langobardenstrasse 122, 1220, Vienna, Austria.
| | - Ernst Tomasch
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Wolfgang Sinz
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Hermann Steffan
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| |
Collapse
|
15
|
Sang H, Cui W, Sang D, Guo Z, Liu B. How Center of Rotation Changes and What Affects These After Cervical Arthroplasty: A Systematic Review and Meta-analysis. World Neurosurg 2020; 135:e702-e709. [DOI: 10.1016/j.wneu.2019.12.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
|
16
|
Lee JH, Lee JH. The Feasibility of Optimal Surgical Result Prediction according to the Center of Rotation Shift after Multilevel Cervical Total Disc Replacement. Asian Spine J 2020; 14:445-452. [PMID: 31940714 PMCID: PMC7435305 DOI: 10.31616/asj.2019.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective design/spine clinic and tertiary referral hospital. PURPOSE This study investigated the association between shifted location of center of rotation (COR) and subsequent surgical outcomes and identified radiological parameters that corresponded to COR change after multilevel cervical total disc replacement (MCTDR). OVERVIEW OF LITERATURE Cervical total disc replacement (TDR) maintains normal cervical kinematics after surgery. However, there is a paucity of literature analyzing the relationship between radiological shifts of COR and subsequent clinical success, especially when it comes to the issue of MCTDR switch. METHODS This study included 24 consecutive patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale, range of motion (ROM) at both C2-7 segment and TDR implanted levels, and location of COR at TDR level were evaluated pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief. RESULTS The inherent CORs relatively at ventrocranial coordinates demonstrated significant migrations to dorsocaudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 segment and MCTDR level compared with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the x-axis. CONCLUSIONS Aside from ROM preservation at both C2-7 and TDR levels, COR restoration from ventrocranial location close to normal coordinates by posterior and inferior shifts was marked as a clinical success after MCTDR. The COR position along the x-axis after MCTDR was an important factor to determine maintenance of C2-7 ROM.
Collapse
Affiliation(s)
- Jung Hwan Lee
- Department of Rehabilitation, Namdarun Rehabilitation Clinic, Seoul, Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea
| |
Collapse
|
17
|
Sang D, Cui W, Guo Z, Sang H, Liu B. The Differences Among Kinematic Parameters for Evaluating the Quality of Intervertebral Motion of the Cervical Spine in Clinical and Experimental Studies: Concepts, Research and Measurement Techniques. A Literature Review. World Neurosurg 2020; 133:343-357.e1. [DOI: 10.1016/j.wneu.2019.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
|
18
|
Kim KJ, Gang MS, Bae JS, Jang JS, Jang IT. Cervical instability following artificial disc replacement. Surg Neurol Int 2019; 10:183. [PMID: 31637084 PMCID: PMC6778327 DOI: 10.25259/sni_431_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Although there has been increased interest in utilizing artificial disc replacement (ADR) techniques to treat cervical degenerative disease, few reports have focused on their postoperative complication and reoperation rates. Case Description: A 52-year-old male underwent the uneventful placement of a C5-C6 cervical ADR for disc disease and foraminal stenosis. One year later, he experienced the onset of severe neck pain attributed to instability of the ADR construct. This required removal of the C5-6 ADR and subsequent fusion. Conclusion: Strict adherence to appropriate criteria is critical for choosing when to place a cervical ADR. This requires documenting; adequate surgical indications, careful selection of the appropriate ADR device, meticulous surgical technique, proper preservation of the supporting structures, and sufficient neural decompression.
Collapse
Affiliation(s)
- Ki Joon Kim
- Department of Neurosurgery, Nanoori Hospital Suwon, Suwon-si, Gyeonggi-do
| | - Mun Soo Gang
- Department of Neurosurgery, Nanoori Hospital Gangseo
| | - Jung-Sik Bae
- Department of Neurosurgery, Nanoori Hospital Gangseo
| | - Jee Soo Jang
- Department of Neurosurgery, Nanoori Hospital Suwon, Suwon-si, Gyeonggi-do
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, South Korea
| |
Collapse
|
19
|
Tu TH, Lee CY, Kuo CH, Wu JC, Chang HK, Fay LY, Huang WC, Cheng H. Cervical disc arthroplasty for less-mobile discs. J Neurosurg Spine 2019; 31:310-316. [PMID: 31075765 DOI: 10.3171/2019.2.spine181472] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°-9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM. METHODS A series of consecutive patients who underwent CDA at the level of C5-6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5-6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5-6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed. RESULTS A total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups. CONCLUSIONS Preoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.
Collapse
Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica; and
| | - Chu-Yi Lee
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
20
|
Hu L, Wu T, Liu H, Wang B, Zhang J, Meng Y, Ding C, Gao X, Hong Y. Influence of Fusion on the Behavior of Adjacent Disc Arthroplasty in Contiguous 2-Level Hybrid Surgery In Vivo. World Neurosurg 2019; 132:e929-e940. [PMID: 31323402 DOI: 10.1016/j.wneu.2019.07.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate whether the behavior of disc arthroplasty in 2-level hybrid surgery (HS) was affected by adjacent fusion in vivo compared with cervical disc arthroplasty (CDA) alone. METHODS Seventy-nine patients undergoing either a 1-level CDA or contiguous 2-level HS were retrospectively reviewed. Radiologic assessments included segmental lordosis (SL), intervertebral disc height (IDH), changes in SL and IDH, range of motion (ROM) of the disc replacement and its adjacent segments, migration and subsidence of the prosthesis, heterotopic ossification (HO), and adjacent segment degeneration (ASD) adjacent to the arthroplasty level. Clinical features and outcome scores were also recorded. RESULTS Compared with 1-level CDA, the increased SL and IDH immediately after surgery in 2-level HS were more likely to be lost throughout the follow-up period. However, both groups generally maintained the SL and IDH of the arthroplasty segment postoperatively. Two-level HS did not exhibit hypermobility of the disc prosthesis and preserved preoperative ROM of the adjacent segment of the device. The HS group showed adverse effects on the prosthesis stability, but there was no significant difference in the number of cases of obvious migration or subsidence between the groups. The differences in HO, ASD, and clinical outcomes between the groups were not significant at the final follow-up. CONCLUSIONS Although the fusion in 2-level HS partially affected the behavior of adjacent disc arthroplasty compared with CDA alone, it did not cause severe complications and adverse clinical outcomes. However, large-scale and long follow-up trials are warranted.
Collapse
Affiliation(s)
- Lingyun Hu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopaedic Surgery, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianying Zhang
- Department of Radiology, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinlin Gao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
21
|
Heterotopic ossification is related to change in disc space angle after Prestige-LP cervical disc arthroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2359-2370. [DOI: 10.1007/s00586-019-06053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
|
22
|
BHATTACHARYA SHAMBO, ROY SANDIPAN, RANA MASUD, BANERJEE SREERUP, KARMAKAR SANTANUKUMAR, BISWAS JAYANTAKUMAR. BIOMECHANICAL PERFORMANCE OF A MODIFIED DESIGN OF DYNAMIC CERVICAL IMPLANT COMPARED TO CONVENTIONAL BALL AND SOCKET DESIGN OF AN ARTIFICIAL INTERVERTEBRAL DISC IMPLANT: A FINITE ELEMENT STUDY. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500179] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Most of the implants used for total disc replacement (TDR) surgery are designed as a ball and socket pair aimed at providing a three-dimensional unconstrained motion. However, one of the major concerns with ball and socket design is the wear of the implant which limits its life. In this study the biomechanical performance of two types of implant designs is compared — a conventional ball and socket type (Prodisc-C) and a modified design of dynamic cervical implant (DCI) using FE analysis. A 3-dimensional geometrical model of cervical spine (C1–T1) was developed using CT scan data of a middle-aged healthy male. Subsequently, using FE analysis, the ROM values were validated with the existing literature using a compressive load in combination with different physiological motions of the neck. Furthermore, FE analysis on the two implants, fitted at C5–C6 segment, showed a significant increase in the ROM of implanted segment using Prodisc and decrease in the ROM of inferior segment, but modified-DCI restored the motion of the implanted and adjacent segments. Analysis of average bone strains adjacent to the implant showed a possibility of stress shielding for Prodisc. However, higher stress distribution on the modified-DCI limited its clinical use.
Collapse
Affiliation(s)
- SHAMBO BHATTACHARYA
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, WB, India
| | - SANDIPAN ROY
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamilnadu, India
| | - MASUD RANA
- Department of Aerospace and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, WB, India
| | - SREERUP BANERJEE
- Department of Bio Engineering, National Institute of Technology, Agartala, Barjala, Jirania, West Tripura 799055, India
| | - SANTANU KUMAR KARMAKAR
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, WB, India
| | - JAYANTA KUMAR BISWAS
- Department of Aerospace and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, WB, India
- Department of Mechanical Engineering, JIS College of Engineering, Kalyani, Nadia 741235, West Bengal, India
| |
Collapse
|
23
|
Guo Z, Cui W, Sang DC, Sang HP, Liu BG. Clinical Relevance of Cervical Kinematic Quality Parameters in Planar Movement. Orthop Surg 2019; 11:167-175. [PMID: 30884156 PMCID: PMC6594496 DOI: 10.1111/os.12435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
Comprehending cervical spinal motion underlies the understanding of the mechanisms of cervical disorders. We aimed to better define the clinical relevance of cervical spine kinematics, focusing on quality parameters describing cervical spine planar motion. The most common study focuses were kinematic quality parameters after cervical arthroplasty and in normal subjects, patients with cervical degeneration, and patients with cervical deformities. Kinematic quality parameters are important for cervical degeneration prevention, being detected sooner than differences on imaging examinations and being significantly related to the degree of cervical degeneration. Kinematic quality parameters are effective for evaluating the changes of cervical motion pattern after cervical fusion and non‐fusion, assessing operative and adjacent segments in the early stages, and predicting adjacent segment degeneration. However, owing to current research limitations, and controversy about the changes of kinematic quality parameters after different surgical procedures, current assessments are limited to cervical spine flexion and extension. Different osteotomy methods of cervical deformity have different effects on cervical motion patterns and quality parameters. Choosing the most effective surgical method remains a challenge and kinematic quality parameters in cervical deformity are important future research topics. This review highlights the instantaneous center of rotation, the center of rotation, and the instantaneous axis of rotation as being important kinematic quality parameters of cervical spinal motion. These can be used to detect abnormal cervical mobility, to diagnose cervical degeneration, to design disc protheses, and to evaluate surgical effects earlier than other methods. Owing to limitations of research methods there is variation in the way parameters are defined by various researchers. No uniform standard exists for defining degenerative motion quality parameters in normal asymptomatic, degenerative, and postoperative patients. Therefore, further study is required. New study techniques and defining kinematic quality parameters in normal subjects will clarify the definitions of these parameters, enhancing their future clinical usefulness.
Collapse
Affiliation(s)
- Ze Guo
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Da-Cheng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hong-Peng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bao-Ge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
24
|
Wu TK, Meng Y, Wang BY, Hong Y, Rong X, Ding C, Chen H, Liu H. Is the behavior of disc replacement adjacent to fusion affected by the location of the fused level in hybrid surgery? Spine J 2018; 18:2171-2180. [PMID: 29709550 DOI: 10.1016/j.spinee.2018.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND CONTEXT Hybrid surgery (HS), consisting of cervical disc arthroplasty (CDA) at the mobile level, along with anterior cervical discectomy and fusion at the spondylotic level, could be a promising treatment for patients with multilevel cervical degenerative disc disease (DDD). An advantage of this technique is that it uses an optimal procedure according to the status of each level. However, information is lacking regarding the influence of the relative location of the replacement and the fusion segment in vivo. PURPOSE We conducted the present study to investigate whether the location of the fusion affected the behavior of the disc replacement and adjacent segments in HS in vivo. STUDY DESIGN This is an observational study. PATIENT SAMPLE The numbers of patients in the arthroplasty-fusion (AF) and fusion-arthroplasty (FA) groups were 51 and 24, respectively. OUTCOME MEASURES The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores were evaluated. Global and segmental lordosis, the range of motion (ROM) of C2-C7, and the operated and adjacent segments were measured. Fusion rate and radiological changes at adjacent levels were observed. METHODS Between January 2010 and July 2016, 75 patients with cervical DDD at two contiguous levels undergoing a two-level HS were retrospectively reviewed. The patients were divided into AF and FA groups according to the locations of the disc replacement. Clinical outcomes were evaluated according to the JOA, NDI, and VAS scores. Radiological parameters, including global and segmental lordosis, the ROM of C2-C7, the operated and adjacent segments, and complications, were also evaluated. RESULTS Although the JOA, NDI, and VAS scores were improved in both the AF and the FA groups, no significant differences were found between the two groups at any follow-up point. Both groups maintained cervical lordosis, but no difference was found between the groups. Segmental lordosis at the fusion segment was significantly improved postoperatively (p<.001), whereas it was maintained at the arthroplasty segment. The ROM of C2-C7 was significantly decreased in both groups postoperatively (AF p=.001, FA p=.014), but no difference was found between the groups. The FA group exhibited a non-significant improvement in ROM at the arthroplasty segment. The ROM adjacent to the arthroplasty segment was increased, although not significantly, whereas the ROM adjacent to the fusion segment was significantly improved after surgery in both groups (p<.001). Fusion was achieved in all patients. No significant difference in complications was found between the groups. CONCLUSIONS In HS, cephalic or caudal fusion segments to the arthroplasty segment did not affect the clinical outcomes and the behavior of CDA. However, the ROM of adjacent segments was affected by the location of the fusion segment; segments adjacent to fusion segments had greater ROMs than segments adjacent to arthroplasty segments.
Collapse
Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| |
Collapse
|
25
|
Staudt MD, Rabin D, Baaj AA, Crawford NR, Duggal N. Biomechanical evaluation of the ProDisc-C stability following graded posterior cervical injury. J Neurosurg Spine 2018; 29:515-524. [PMID: 30168784 DOI: 10.3171/2018.3.spine171248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere are limited data regarding the implications of revision posterior surgery in the setting of previous cervical arthroplasty (CA). The purpose of this study was to analyze segmental biomechanics in human cadaveric specimens with and without CA, in the context of graded posterior resection.METHODSFourteen human cadaveric cervical spines (C3-T1 or C2-7) were divided into arthroplasty (ProDisc-C, n = 7) and control (intact disc, n = 7) groups. Both groups underwent sequential posterior element resections: unilateral foraminotomy, laminoplasty, and finally laminectomy. Specimens were studied sequentially in two different loading apparatuses during the induction of flexion-extension, lateral bending, and axial rotation.RESULTSRange of motion (ROM) after artificial disc insertion was reduced relative to that in the control group during axial rotation and lateral bending (13% and 28%, respectively; p < 0.05) but was similar during flexion and extension. With sequential resections, ROM increased by a similar magnitude following foraminotomy and laminoplasty in both groups. Laminectomy had a much greater effect: mean (aggregate) ROM during flexion-extension, lateral bending, and axial rotation was increased by a magnitude of 52% following laminectomy in the setting of CA, compared to an 8% increase without arthroplasty. In particular, laminectomy in the setting of CA introduced significant instability in flexion-extension, characterized by a 90% increase in ROM from laminoplasty to laminectomy, compared to a 16% increase in ROM from laminoplasty to laminectomy without arthroplasty (p < 0.05).CONCLUSIONSForaminotomy and laminoplasty did not result in significant instability in the setting of CA, compared to controls. Laminectomy alone, however, resulted in a significant change in biomechanics, allowing for significantly increased flexion and extension. Laminectomy alone should be used with caution in the setting of previous CA.
Collapse
Affiliation(s)
- Michael D Staudt
- 1Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Doron Rabin
- 2St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Ali A Baaj
- 3Department of Neurological Surgery, Weill Cornell Medical College, New York, New York; and
| | - Neil R Crawford
- 4Barrow Neurological Institute, Spinal Biomechanics Laboratory, Phoenix, Arizona
| | - Neil Duggal
- 1Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| |
Collapse
|
26
|
Cervical disc arthroplasty for the treatment of adjacent segment disease: A systematic review of clinical evidence. Clin Neurol Neurosurg 2017; 162:1-11. [DOI: 10.1016/j.clineuro.2017.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 12/27/2022]
|
27
|
Tasiou A, Giannis T, Brotis AG, Siasios I, Georgiadis I, Gatos H, Tsianaka E, Vagkopoulos K, Paterakis K, Fountas KN. Anterior cervical spine surgery-associated complications in a retrospective case-control study. JOURNAL OF SPINE SURGERY 2017; 3:444-459. [PMID: 29057356 DOI: 10.21037/jss.2017.08.03] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.
Collapse
Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Theofanis Giannis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Iordanis Georgiadis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Haralampos Gatos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Vagkopoulos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| |
Collapse
|
28
|
Analysis of the Factors That Could Predict Segmental Range of Motion After Cervical Artificial Disk Replacement: A 7-Year Follow-up Study. Clin Spine Surg 2017; 30:E603-E608. [PMID: 28525485 DOI: 10.1097/bsd.0000000000000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify the potential preoperative factors and surgical technique factors that are associated with long-term range of motion (ROM) after surgery. Further, this article aimed to guide selection of patients with cervical artificial disk replacement and a fine surgical technique. SUMMARY OF BACKGROUND DATA Segmental ROM is the most important parameter concerning cervical kinematics after a cervical artificial disk replacement. There are few researches regarding the influencing factors on postoperative ROM, and consistent results have not yet been reported. METHODS The cohort comprised a total of 68 disks implanted into 57 patients who were retrospectively analyzed. The mean follow-up period was 84.1 months. Segmental ROM and other useful parameters were measured using lateral neutral, extension, and flexion radiographs, which were obtained preoperatively, 3 months after surgery, and at last follow-up. Preoperative CT and clinical assessment were also used. To find out associated factors, the patients were divided into 2 groups according to the segmental ROM at last follow-up. RESULTS After surgery, the clinical outcomes were satisfactory. The segmental ROM at last follow-up (7.8±4.3 degrees) was preserved without significant change from preoperative ROM (8.8±3.8 degrees). The patients who had a better segmental ROM after surgery were found to have a higher preoperative segmental ROM, a younger age, a better disk insertion angle, and disk insertion depth. These 4 factors were identified as independent risk factors (P=0.027, 0.017, 0.036, and 0.046, respectively) for long-term ROM. CONCLUSIONS The postoperative long-term, segmental ROM was well preserved and found to be affected by the preoperative segmental ROM, patient's age, disk insertion angle, and disk insertion depth.
Collapse
|
29
|
Cervical facet force analysis after disc replacement versus fusion. Clin Biomech (Bristol, Avon) 2017; 44:52-58. [PMID: 28340364 DOI: 10.1016/j.clinbiomech.2017.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/31/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical total disc replacement was developed to preserve motion and reduce adjacent-level degeneration relative to fusion, yet concerns remain that total disc replacement will lead to altered facet joint loading and long-term facet joint arthrosis. This study is intended to evaluate changes in facet contact force, pressure and surface area at the treated and superior adjacent levels before and after discectomy, disc replacement, and fusion. METHODS Ten fresh-frozen human cadaveric cervical spines were potted from C2 to C7 with pressure sensors placed into the facet joints of C3-C4 and C4-C5 via slits in the facet capsules. Moments were applied to the specimens to produce axial rotation, lateral bending and extension. Facet contact force and pressure were measured at both levels for intact, discectomy at C4-C5, disc replacement with ProDisc-C (Synthes Spine, West Chester, Pennsylvania, USA) at C4-C5, and anterior discectomy and fusion with Cervical Spine Locking Plate (Synthes Spine, West Chester, Pennsylvania, USA) at C4-C5. Facet contact area was calculated from the force and pressure measurements. An analysis of variance was used to determine significant differences with P-values <0.05 indicating significance. FINDINGS Facet contact force was elevated at the treated level under extension following both discectomy and disc replacement, while facet contact pressure and area were relatively unchanged. Facet contact force and area were decreased at the treated level following fusion for all three loading conditions. INTERPRETATION Total disc replacement preserved facet contact force for all scenarios except extension at the treated level, highlighting the importance of the anterior disco-ligamentous complex. This could promote treated-level facet joint disease.
Collapse
|
30
|
Feasibility and Biomechanics of Multilevel Arthroplasty and Combined Cervical Arthrodesis and Arthroplasty. Clin Spine Surg 2016; 29:E522-E531. [PMID: 23698102 DOI: 10.1097/bsd.0b013e31829920f0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A new experimental protocol was applied utilizing a simplified postural control model. Multiple constructs were tested nondestructively by interconnecting segmental rods to screws. OBJECTIVE To investigate how posture and distribution of segmental angles under physiological loads are affected by combined cervical arthroplasty and fusion. SUMMARY OF BACKGROUND DATA Previous studies of biomechanics of multilevel arthroplasty have focused on range of motion and intradiscal pressure. No previous study has investigated postural changes and segmental angle distribution. METHODS In 7 human cadaveric C3-T1 specimens, C4-C5, C5-C6, and C6-C7 disks were replaced with ProDisc-C (Synthes). Combinations of fusion (f) adjacent to arthroplasty (A) were simulated at C4-C5, C5-C6, and C6-C7, respectively: fAA, AfA, AAf, ffA, fAf, Aff, fff. C3-C4 and C7-T1 remained intact. A compressive belt apparatus simulated normal muscle cocontraction and gravitational preload; C3-C4, C4-C5, C5-C6, C6-C7, and C7-T1 motions were tracked independently. Parameters studied were segmental postural compensation, neutral buckling, and shift in sagittal plane instantaneous axis of rotation (IAR). RESULTS With one or more levels unfused, the arthroplasty levels preferentially moved toward upright posture before the intact levels. Neutral buckling was greatest for 3-level arthroplasty, less for 2-level arthroplasty, and least for 1-level arthroplasty. Among the three 1-level arthroplasty groups (ffA, fAf, Aff), arthroplasty at the caudalmost level resulted in significantly greater buckling than with arthroplasty rostralmost or at mid-segment (P<0.04, analysis of variance/Holm-Sidak). Although IAR location was related to buckling, this correlation did not reach significance (P=0.112). CONCLUSIONS Arthroplasty levels provide the "path of least resistance," through which the initial motion is more likely to occur. The tendency for specimens to buckle under vertical compression became greater with more arthroplasty levels. Buckling appeared more severe with arthroplasty more caudal. Buckling only moderately correlated to shifts in IAR, meaning slight malpositioning of the devices would not necessarily cause buckling.
Collapse
|
31
|
König SA, Ranguis S, Spetzger U. Hybrid Solutions for the Surgical Treatment of Multilevel Degenerative Cervical Disk Disease. Surg J (N Y) 2015; 1:e16-e22. [PMID: 28824965 DOI: 10.1055/s-0035-1567876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022] Open
Abstract
Background In different stages of cervical degenerative disk disease, the combination of dynamic and nondynamic implants may be considered. The aim of this study was to investigate the applicability of criteria to assist decision making in these cases. Methods Thirty patients with spondylotic cervical radiculopathy and a coincidence of soft disk and hard disk herniation were surgically treated with a hybrid solution (combination of total disk replacement and cage fusion). The control group included 32 patients who underwent two-level cage fusion. Pre- and postoperative Japanese Orthopaedic Association (JOA) scores and range of motion (ROM) were compared. Results Twenty-three patients underwent two-level hybrid solution and 7 underwent three-level treatment. The most frequent solution (n = 13) was a combination of a dynamic implant at C5-C6 and a nondynamic implant at C6-C7. The mean JOA score improved from 13.9 to 15.6 points after surgery (mean deviation [MD] 1.6, 95% confidence interval [CI] 2.1 to 1.2, p < 0.001). ROM showed a slight trend to increase (MD 0.8, 95% CI -0.9 to 2.6, p = 0.193). In the control group, the mean JOA score improved from 13.3 to 15.1 points after surgery (MD 1.4, 95% CI 2.1 to 1.2, p < 0.001). The comparison of the postoperative JOA scores and recovery rates between the hybrid treatment group and the control group did not show significant differences. Conclusions In cases of coincident soft and hard degenerative cervical disk disease at adjacent levels, the combination of a disk prosthesis and a nondynamic implant is a safe and effective treatment option and an alternative to multilevel fusion.
Collapse
Affiliation(s)
| | - Sebastian Ranguis
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Uwe Spetzger
- Neurochirurgische Klinik, Klinikum Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
32
|
Cervical spine alignment in disc arthroplasty: should we change our perspective? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 7:810-25. [PMID: 26441258 DOI: 10.1007/s00586-015-4258-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE The alignment at the cervical spine has been considered a determinant of degeneration at the adjacent disc, but this issue in cervical disc replacement surgery is poorly explored and discussed in this patient population. The aim of this systematic review is to compare anterior cervical fusion and total disc replacement (TDR) in terms of preservation of the overall cervical alignment and complications. METHODS A systematic review of the current literature was performed, together with the evaluation of the methodological quality of all the retrieved studies. RESULTS In most of the retrieved studies, a tendency towards a more postoperative kyphotic alignment in TDR was reported. The reported mean complication rate was of 12.5 % (0-66.2 %). Complications associated with cervical prosthesis included heterotopic ossification, device migration, mechanical instability, failure, implant removal, reoperations and revision. CONCLUSIONS Even though cervical disc arthroplasty leads to similar outcomes compared to arthrodesis in the middle term follow-up, no evidence of superiority of cervical TDR is available up to date. We understand that the overall cervical alignment after TDR tends towards the loss of lordosis, but only longer follow-up can determine its influence on the clinical results.
Collapse
|
33
|
Aragonés M, Hevia E, Barrios C. Polyurethane on titanium unconstrained disc arthroplasty versus anterior discectomy and fusion for the treatment of cervical disc disease: a review of level I-II randomized clinical trials including clinical outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2735-45. [PMID: 26363559 DOI: 10.1007/s00586-015-4228-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To contrast the clinical and radiologic outcomes and adverse events of anterior cervical discectomy and fusion (ACDF) with a single cervical disc arthroplasty design, the polyurethane on titanium unconstrained cervical disc (PTUCD). METHODS This is a systematic review of randomized clinical trials (RCT) with evidence level I-II reporting clinical outcomes. After a search on different databases including PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE, a total of 10 RCTs out of 51 studies found were entered in the study. RTCs were searched from the earliest available records in 2005 to November 2014. RESULTS Out of a total of 1101 patients, 562 were randomly assigned into the PTUCD arthroplasty group and 539 into the ACDF group. The mean follow-up was 30.9 months. Patients undergoing arthroplasty had lower Neck Disability Index, and better SF-36 Physical component scores than ACDF patients. Patients with PTUCD arthroplasty had also less radiological degenerative changes at the upper adjacent level. Overall adverse events were twice more frequent in patients with ACDF. The rate of revision surgery including both adjacent and index level was slightly higher in patients with ACDF, showing no statistically significant difference. CONCLUSIONS According to this review, PTUCD arthroplasty showed a global superiority to ACDF in clinical outcomes. The impact of both surgical techniques on the cervical spine (radiological spine deterioration and/or complications) was more severe in patients undergoing ACDF. However, the rate of revision surgeries at any cervical level was equivalent for ACDF and PTUCD arthroplasty.
Collapse
Affiliation(s)
- María Aragonés
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain
| | - Eduardo Hevia
- Spine Surgery Unit, Hospital La Fraternidad, Paseo de la Habana 83-85, 28036, Madrid, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
| |
Collapse
|
34
|
Dong L, Tan MS, Yan QH, Yi P, Yang F, Tang XS, Hao QY. Footprint mismatch of cervical disc prostheses with Chinese cervical anatomic dimensions. Chin Med J (Engl) 2015; 128:197-202. [PMID: 25591562 PMCID: PMC4837838 DOI: 10.4103/0366-6999.149200] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The footprint of most prostheses is designed according to Caucasian data. Total disc replacement (TDR) has been performed widely for cervical degenerative diseases in China. It is essential to analyze the match sizes of prostheses footprints and Chinese cervical anatomic dimensions in our study. Methods: The anatomic dimensions of the C4–C7 segments of 138 patients (age range 16–77 years) in a Chinese population were measured by computed tomography scans. We compared the footprints of the most commonly used cervical disc prostheses (Bryan: Medtronic, Minneapolis, MN, USA; Prestige LP: Medtronic, Fridley, Minnesota, USA; Discover: DePuy, Raynham, MA, USA; Prodisc-C: Synthes, West Chester, PA, USA) in China with Chinese cervical anatomic dimensions and assessed the match of their size. Results: The mismatch of available dimensions of prostheses and anatomic data of cervical endplates ranged from 17.03% (C4/C5, Prestige LP, Prodisc-C) to 57.61% (C6/C7, Discover) in the anterior-posterior (AP) diameter, and 35.51% (C4/C5, Prodisc-C, Prestige LP) to 94.93% (C6/C7, Bryan) in the center mediolateral (CML) diameter. About 21.01% of endplates were larger than the largest prostheses in the AP diameter and 57.25% in the CML diameter. All available footprints of prostheses expect the Bryan with an unfixed height, can accommodate the disc height (DH), however, 36.23% of the middle DH was less than the smallest height of the prostheses. The average disc sagittal angles (DSAs) of C4–C7 junctions were 5.04°, 5.15°, and 4.13° respectively. Only the Discover brand had a built-in 7° lordotic angle, roughly matching with the DSA. Conclusions: There is a large discrepancy between footprints of prostheses and Chinese cervical anatomic data. In recent years, possible complications of TDR related with mismatch sizes are increasing, such as subsidence, displacement, and heterotopic ossification. Manufacturers of prostheses should introduce or produce additional footprints of prostheses for Chinese TDR.
Collapse
Affiliation(s)
| | - Ming-Sheng Tan
- Department of Orthopedics Surgery, China Japan Friendship Hospital, Beijing 100029; Graduate School of Peking Union Medical College, Beijing 100730, China
| | | | | | | | | | | |
Collapse
|
35
|
The effect of deviated center of rotation on flexion-extension range of motion after single-level cervical arthroplasty: an in vivo study. Spine (Phila Pa 1976) 2014; 39:B12-8. [PMID: 25271518 DOI: 10.1097/brs.0000000000000634] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To report the clinical outcomes and sagittal kinematics after cervical total disc replacement (TDR). To evaluate the in vivo effect of deviated center of rotation (COR) on flexion-extension range of motion (ROM) at the instrumented level. SUMMARY OF BACKGROUND DATA A few studies showed that the location of COR after cervical TDR deviated from its preoperative location or inherent location in healthy subjects. However, little is known about the effect of deviated COR on ROM at the instrumented level. METHODS A total of 24 patients who underwent C5-C6 single-level TDR with Prestige LP (Medtronic Sofamor Danek) were retrospectively included. Japanese Orthopedic Association score and visual analogue scale were used to assess the clinical outcomes. ROM and COR were measured for radiographical analysis. Patients were categorized into 2 groups according to the change of ROM for further evaluation. Group 1, characterized by decreased postoperative ROM, consisted of 16 patients; group 2, characterized by increased postoperative ROM, consisted of 8 patients. RESULTS Ten males and 14 females comprised the study cohort. The mean age was 45.05 years, and the mean follow-up time was 15.5 months. The Japanese Orthopedic Association score increased significantly and the neck and arm visual analogue scale decreased significantly after cervical TDR. On average, ROM was preserved after cervical TDR. The postoperative COR had a significant cranial shift from its preoperative location. The COR shift in anterior-posterior direction was larger in group 2 than that in group 1. No difference was observed in the COR shift in cranial-caudal direction between the 2 groups. CONCLUSION Single-level cervical TDR with Prestige LP obtained satisfactory clinical outcomes and partially restored the natural cervical kinematics. At instrumented level, the deviated COR had a negative correlation with the flexion-extension ROM.
Collapse
|
36
|
McDonald CP, Chang V, McDonald M, Ramo N, Bey MJ, Bartol S. Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients. J Neurosurg Spine 2014; 20:245-55. [DOI: 10.3171/2013.11.spine13392] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Object
Cervical arthroplasty with an artificial disc (AD) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis. This study aims to provide 3D motion analysis data comparing patients after ACDF and AD replacement.
Methods
Ten patients who underwent C5–6 ACDF and 7 who underwent C5–6 AD replacement were enrolled. Using biplanar fluoroscopy and a model-based track technique (accurate up to 0.6 mm and 0.6°), motion analysis of axial rotation and flexion-extension of the neck was performed. Three nonoperative segments (C3–4, C4–5, and C6–7) were assessed for both intervertebral rotation (coronal, sagittal, and axial planes) and facet shear (anteroposterior and mediolateral).
Results
There was no difference in total neck motion comparing ACDF and AD replacement for neck extension (43.3° ± 10.2° vs 44.3° ± 12.6°, p = 0.866) and rotation (36.0° ± 6.5° vs 38.2° ± 9.3°, p = 0.576). For extension, when measured as a percentage of total neck motion, there was a greater amount of rotation at the nonoperated segments in the ACDF group than in the AD group (p = 0.003). When comparing specific motion segments, greater normalized rotation was seen in the ACDF group at C3–4 (33.2% ± 4.9% vs 26.8% ± 6.6%, p = 0.036) and C6–7 (28.5% ± 6.7% vs 20.5% ± 5.5%, p = 0.009) but not at C4–5 (33.5% ± 6.4% vs 31.8% ± 4.0%, p = 0.562). For neck rotation, greater rotation was observed at the nonoperative segments in the ACDF group than in the AD group (p = 0.024), but the differences between individual segments did not reach significance (p ≥ 0.146). Increased mediolateral facet shear was seen on neck extension with ACDF versus AD replacement (p = 0.008). Comparing each segment, C3–4 (0.9 ± 0.5 mm vs 0.4 ± 0.1 mm, p = 0.039) and C4–5 (1.0 ± 0.4 mm vs 0.5 ± 0.2 mm, p = 0.022) showed increased shear while C6–7 (1.0 ± 0.4 mm vs 1.0 ± 0.5 mm, p = 0.767) did not.
Conclusions
This study illustrates increased motion at nonoperative segments in patients who have undergone ACDF compared with those who have undergone AD replacement. Further studies will be required to examine whether these changes contribute to adjacent-segment disease.
Collapse
Affiliation(s)
- Colin P. McDonald
- 1Department of Orthopedics, Herrick Davis Motion Analysis Laboratory, and
| | - Victor Chang
- 2Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Michael McDonald
- 1Department of Orthopedics, Herrick Davis Motion Analysis Laboratory, and
| | - Nicole Ramo
- 1Department of Orthopedics, Herrick Davis Motion Analysis Laboratory, and
| | - Michael J. Bey
- 1Department of Orthopedics, Herrick Davis Motion Analysis Laboratory, and
| | - Stephen Bartol
- 1Department of Orthopedics, Herrick Davis Motion Analysis Laboratory, and
| |
Collapse
|
37
|
Shi R, Li J, Liu H, Ding C, Hu T, Li T, Gong Q. Clinical comparison of 2 implantation systems for single-level cervical disk replacement. Orthopedics 2014; 37:e161-8. [PMID: 24679203 DOI: 10.3928/01477447-20140124-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/05/2013] [Indexed: 02/03/2023]
Abstract
The safety and effectiveness of 2 implantation systems for single-segment cervical disk replacement-the Bryan Cervical Disc System (Medtronic Inc, Minneapolis, Minnesota) and the ACCEL system (Medtronic Inc)-have not been clinically compared. A prospective, nonrandomized controlled study in consecutive patients with a minimum 2-year follow-up was performed. Fifty patients with single-level cervical disk degeneration who responded poorly to conservative treatment and underwent Bryan Cervical Disc replacement were involved. Fifty patients were included (24 in group A [Bryan Cervical Disc System] and 26 in group B [ACCEL system]).The patients' visual analog scale scores, Neck Disability Index (NDI) scores, Short Form 36 (SF-36) scores, Odom scores, operative time, blood loss, and complications were compared. Patients' baseline statuses were similar (P>.05). Visual analog scale for neck and arm pain, NDI, and SF-36 were significantly improved postoperatively (P<.05) in both groups, and no clinical differences were found between the groups (P>.05). All Odom scores were better than good. Mean operative time and average blood loss in group A (173±42.5 minutes and 250±159.8 mL, respectively), were both significantly higher than the values in group B (137.5±19.3 minutes and 138.1±86.7 mL, respectively) (P<.05). Complications included intraoperative bleeding, temporary throat discomfort, and slight migration of the prosthesis; there was no significant difference in the total complication rates between the 2 groups (P>.05). The 2 implantation systems displayed equal clinical effectiveness and safety, but the ACCEL system appears to have the advantages of shorter operative time and less blood loss.
Collapse
|
38
|
Mo ZJ, Zhao YB, Wang LZ, Sun Y, Zhang M, Fan YB. Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:613-21. [PMID: 24154828 DOI: 10.1007/s00586-013-3070-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/09/2013] [Accepted: 10/09/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Various design concepts have been adopted in cervical disc prostheses, including sliding articulation and standalone configuration. This study aimed to evaluate the biomechanical effects of the standalone U-shaped configuration on the cervical spine. METHODS Based on an intact finite element model of C3-C7, a standalone U-shaped implant (DCI) was installed at C5-C6 and compared with a sliding articulation design (Prodisc-C) and an anterior fusion system. The range of motion (ROM), adjacent intradiscal pressure (IDP) and capsular ligament strain were calculated under different spinal motions. RESULTS Compared to the intact configuration, the ROM at C5-C6 was reduced by 90% after fusion, but increased by 70% in the Prodisc-C model, while the maximum percentage change in the DCI model was 30% decrease. At the adjacent segments, up to 32% increase in ROM happened after fusion, while up to 34% decrease occurred in Prodisc-C model and 17% decrease in DCI model. The IDP increased by 11.6% after fusion, but decreased by 5.6 and 6.3% in the DCI and Prodisc-C model, respectively. The capsular ligament strain increased by 147% in Prodisc-C and by 13% in the DCI model. The DCI implant exhibited a high stress distribution. CONCLUSIONS Spinal fusion resulted in compensatory increase of ROM at the adjacent sites, thereby elevating the IDP. Prodisc-C resulted in hyper-mobility at the operative site that led to an increase of ligament force and strain. The U-shaped implant could maintain the spinal kinematics and impose minimum influence on the adjacent soft tissues, despite the standalone configuration encountering the disadvantages of high stress distribution.
Collapse
Affiliation(s)
- Zhong Jun Mo
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Key Laboratory for Optimal Design and Evaluation Technology of Implantable & Interventional Medical Devices, International Joint Research Center of Aerospace Biotechnology and Medical Engineering of Ministry of Science and Technology, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No.37, HaiDian District, Beijing, 100191, People's Republic of China
| | | | | | | | | | | |
Collapse
|
39
|
Bydon M, Xu R, Macki M, De la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion in a Large Series. Neurosurgery 2013; 74:139-46 discussion 146. [DOI: 10.1227/neu.0000000000000204] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Adjacent segment disease (ASD) development is known to occur after anterior cervical discectomy and fusion (ACDF).
OBJECTIVE:
To study the relationship between index ACDF levels and the location of ASD development (above/below), as well as the effect of fusion length on ASD development.
METHODS:
We report 888 patients who underwent ACDF for cervical spondylosis over a twenty-year period at a single institution. Of these patients, 108 had re-do surgery due to symptomatic ASD. Patients were followed for an average of 92.4 ± 52.6 months after the index ACDF.
RESULTS:
In agreement with previous ACDF case series, we found the highest rates of cervical spinal degenerative disease requiring surgery at C5/C6, followed by C6/C7. Interestingly, neither the inherent location of index ACDF nor the length of instrumented arthrodesis appeared to correlate with the propensity to develop ASD. However, patients were more likely to develop ASD above the index level of fusion. This was true even for patients undergoing a second revision surgery due to recurrent ASD. Importantly, our data are consistent with existing in vitro biomechanical data in cadaveric spines.
CONCLUSION:
We describe in detail the location and length of arthrodesis for index ACDFs, as well as first and second revision fusion surgeries in one of the largest Western cohorts in the literature. Our findings support the theory that iatrogenically introduced stress and instability at adjacent spinal segments contribute to the pathogenesis of ASD.
Collapse
Affiliation(s)
- Mohamad Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamed Macki
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Rafael De la Garza-Ramos
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Timothy F. Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine
- Johns Hopkins Biomechanics and Surgical Outcomes Laboratory
| |
Collapse
|
40
|
ProDisc cervical arthroplasty does not alter facet joint contact pressure during lateral bending or axial torsion. Spine (Phila Pa 1976) 2013; 38:E84-93. [PMID: 23132537 DOI: 10.1097/brs.0b013e31827b8a2d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical study of facet joint pressure after total disc replacement using cadaveric human cervical spines during lateral bending and axial torsion. OBJECTIVE The goal was to measure the contact pressure in the facet joint in cadaveric human cervical spines subjected to physiologic lateral bending and axial torsion before and after implantation of a ProDisc-C implant. SUMMARY OF BACKGROUND DATA Changes in facet biomechanics can damage the articular cartilage in the joint, potentially leading to degeneration and painful arthritis. Few cadaveric and computational studies have evaluated the changes in facet joint loading during spinal loading with an artificial disc implanted. Computational models have predicted that the design and placement of the implant influence facet joint loading, but limited cadaveric studies document changes in facet forces and pressures during nonsagittal bending after implantation of a ProDisc. As such, little is known about the local facet joint mechanics for these complicated loading scenarios in the cervical spine. METHODS Seven osteoligamentous C2-T1 cadaveric cervical spines were instrumented with a transducer to measure the C5-C6 facet pressure profiles during physiological lateral bending and axial torsion, before and after implantation of a ProDisc-C at that level. Rotations at that level and global cervical spine motions and loads were also quantified. RESULT.: Global and segmental rotations were not altered by the disc implantation. Facet contact pressure increased after implantation during ipsilateral lateral bending and contralateral torsion, but that increase was not significant compared with the intact condition. CONCLUSION Implantation of a ProDisc-C does not significantly modify the kinematics and facet pressure at the index level in cadaveric specimens during lateral bending and axial torsion. However, changes in facet contact pressures after disc arthroplasty may have long-term effects on spinal loading and cartilage degeneration and should be monitored in vivo.
Collapse
|
41
|
Coric D, Kim PK, Clemente JD, Boltes MO, Nussbaum M, James S. Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine 2013; 18:36-42. [PMID: 23140129 DOI: 10.3171/2012.9.spine12555] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Object
The purpose of this study was to evaluate the long-term results of cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) in the treatment of single-level cervical radiculopathy.
Methods
The results of 2 separate prospective, randomized, US FDA Investigational Device Exemption pivotal trials (Bryan Disc and Kineflex|C) from a single investigational site were combined to evaluate outcomes at long-term follow-up. The primary clinical outcome measures included the Neck Disability Index (NDI), visual analog scale (VAS), and neurological examination. Patients were randomized to receive cervical TDR in 2 separate prospective, randomized studies using the Bryan Disc or Kineflex|C cervical artificial disc compared with ACDF using structural allograft and an anterior plate. Patients were evaluated preoperatively; at 6 weeks; at 3, 6, and 12 months; and then yearly for a minimum of 48 months. Plain radiographs were obtained at each study visit.
Results
A total of 74 patients were enrolled and randomly assigned to either the cervical TDR (n = 41) or ACDF (n = 33) group. A total of 63 patients (86%) completed a minimum of 4 years follow-up. Average follow-up was 6 years (72 months) with a range from 48 to 108 months. In both the cervical TDR and ACDF groups, mean NDI scores improved significantly by 6 weeks after surgery and remained significantly improved throughout the minimum 48-month follow-up (p < 0.001). Similarly, the median VAS pain scores improved significantly by 6 weeks and remained significantly improved throughout the minimum 48-month follow-up (p < 0.001). There were no significant differences between groups in mean NDI or median VAS scores. The range of motion (ROM) in the cervical TDR group remained significantly greater than the preoperative mean, whereas the ROM in the ACDF group was significantly reduced from the preoperative mean. There was significantly greater ROM in the cervical TDR group compared with the ACDF group. There were 3 reoperations (7.3%) at index or adjacent levels in the cervical TDR group; all were cervical laminoforaminotomies. There were 2 adjacent-level reoperations in the cervical TDR group (4.9%). There was 1 reoperation (3.0%) in the ACDF group at an index or adjacent level (a second ACDF at the adjacent level). There was no statistically significant difference in overall reoperation rate or adjacent-level reoperation rate between groups.
Conclusions
Both cervical TDR and ACDF groups showed excellent clinical outcomes that were maintained over long-term follow-up. Both groups showed low index-level and adjacent-level reoperation rates. Both cervical TDR and ACDF appear to be viable options for the treatment of single-level cervical radiculopathy.
Collapse
Affiliation(s)
- Domagoj Coric
- 1Carolina Neurosurgery and Spine Associates
- 2Department of Neurosurgery, Carolinas Medical Center
| | | | | | | | | | - Sara James
- 1Carolina Neurosurgery and Spine Associates
| |
Collapse
|