Can segmental mobility be increased by cervical arthroplasty?

Chang, Hsuan Kan; Chang, Chia Chin; Tu, Tsung Hsi; Wu, Jau Ching; Huang, Wen Cheng; Fay, Li Yu; Chang, Po-Ya; Wu, Chih-Cheng; Cheng, Henrich

doi:10.3171/2016.10.focus16411

Cited by 41 publications

(27 citation statements)

References 42 publications

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“…21,29 In selected patients, CDA may even be capable of increasing segmental ROM. 4 In a study by Chang et al, it was not clear why some of the CDA segments gradually lost motion, but HO seemed to have played a role. Limited segmental ROM at the index level was correlated with HO formation, and vice versa.…”

Section: Discussionmentioning

confidence: 98%

Effects of smoking on cervical disc arthroplasty

Kuo

Huang

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO).RESULTSA total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43).CONCLUSIONSDuring an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked.

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Section: Discussionmentioning

confidence: 98%

Effects of smoking on cervical disc arthroplasty

Kuo

Huang

et al. 2019

Journal of Neurosurgery: Spine

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“…Aunque aún existe discusión respecto a los beneficios obte-nidos por el tratamiento con esta técnica para dos o tres espacios discales simultáneamente (15,19) . Se sabe incluso que no es la técnica más utilizada por grupos de neurocirujanos en el mundo, principalmente debido a los elevados costos, aunque se tiene proyección que esta situación se revertirá en los próximos años, ante la evidencia de los buenos resultados en el corto, mediano y largo plazo (20,21) . Por otro lado, la motilidad segmentaria o el alineamiento cervical general es afectado por la artroplastía de un nivel, por ende, los implantes discales cervicales deben tener la característica de simular la fisiología del movimiento cervical, lo que justifica la realización de pruebas de movimientos de flexión antero-posterior, extensión antero-posterior, flexión lateral, así como de tolerancia a la sobrecarga axial (22,23) .…”

Section: Discussionunclassified

Desarrollo mecánico y experimental de un implante discal cervical flexible

Álvarez¹,

Lean

Rodrı́guez³

et al. 2019

An Fac med

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Introducción: La artroplastía cervical es una cirugía que implica el uso de implantes discales con la capacidad de conservar el movimiento del segmento. Constituye un reto para paises como el nuestro desarrollar alternativas a los altos costos de los mencionados implantes, con diseños patentado, elaborado viables de manufacturar, con biocompatibilidad, seguridad, y que simule lo máximo posible los movimientos cervicales fisiológicos. Objetivo: Desarrollar la geometría y mecánica de un diseño discal patentado, elaborado, sea por manufactura aditiva de titanio ELI, así como verificar su compatibilidad con la fisiología de los movimientos cervicales. Métodos: El diseño del estudio tuvo tres etapas iterativas: la primera, el desarrollo de la geometría del implante y el estudio de elementos finitos utilizando como referencia normas internacionales; en segundo lugar, se desarrollaron estudios de metalografía, caracterización del material incluyendo pruebas de fatiga del implante; finalmente, se utilizó un modelo animal cadavérico para confirmar la compatibilidad del implante con los movimientos cervicales. Resultados: Se demostró que el implante elaborado sea por manufactura aditiva o por forja, fue compatible con las normas internacionales. Se realizaron 84 estudios de rayos X en 18 cuellos de porcino. En el 100% de las columnas cervicales de los porcinos, el rango en flexión fue menor que el de extensión. Existió mayor rango de movimiento cuando se utilizaron dos implantes y cuando el implante fue más grande. Conclusiones: El implante cervical flexible elaborado por forja o por manufactura aditiva de titanio ELI presentó resultados prometedores, por lo que podría postularse su uso experimental en pacientes tributarios de artroplastía cervical.

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“…As the follow-up time increases, there will be an increased rate of ROM-limiting HO, which is functionally similar, if not identical, to the fused segments in ACDF [43]. While HO is gradually fusing the spinal segments, the formation of ROM-limiting HO is preceded by years of preservation of segmental mobility [14,20,30,55,58,[64][65][66][67][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. The years of preserved segmental mobility may serve, in theory, as a "grace period" to delay the formation of ASD in CTDR, compared with ACDF ( Fig.…”

Section: Does Heterotopic Ossification Really Matter To Patients In Cmentioning

confidence: 99%

Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics

Hui¹,

Phan²,

Kerferd³

et al. 2021

Asian Spine J

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Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.

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Can segmental mobility be increased by cervical arthroplasty?

Cited by 41 publications

References 42 publications

Effects of smoking on cervical disc arthroplasty

Effects of smoking on cervical disc arthroplasty

Desarrollo mecánico y experimental de un implante discal cervical flexible

Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics

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