Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis

Suchomel, Petr; Jurák, Lubomír; Antinheimo, Jussi; Pohjola, Juha; Štulík, J; Meisel, Hans-Joerg; Čabraja, Mario; Woiciechowsky, Christian; Bruchmann, Bernhard; Shackleford, Ian; Arregui, Ricardo; Sola, Steffen

doi:10.1007/s00586-014-3223-0

Cited by 15 publications

(10 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…51 The clinical relevance of HO is controversial, indicating that HO does not affect clinical improvement 5,33,38,51,52,57 and is less relevant in the absence of clinical symptoms, 6,28 while challenging the principle of motion preservation. On the other hand, most studies show that in the majority of patients segmental mobility was sustained 4 to 6 years after cTDR.…”

Section: Discussionmentioning

confidence: 99%

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Meisel

Jurák

Antinheimo

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from −2.4° preoperatively to −6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 (clinicaltrials.gov)

show abstract

Section: Discussionmentioning

confidence: 99%

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Meisel

Jurák

Antinheimo

et al. 2016

SPI

View full text Add to dashboard Cite

show abstract

“…However, in longer term follow-up, ROM became comparable to preoperative values [30,58,[64][65][66][67]. Other studies have reported preserved segmental ROM compared with preoperative ROM at 1-2year [14,20,55,[69][70][71][72], 3-5-year [73][74][75][76][77][78][79][80], 7-year [81], and 8-year follow-up [82]. Interestingly, some studies even reported significantly more mobile segments over 1-year follow-up [48] than at 5-year follow-up [83].…”

Section: Does Heterotopic Ossification Really Matter To Patients In Cmentioning

confidence: 80%

“…Significant changes in postoperative COR-X and COR-Y have been reported in another study examining ProDisc-C and Synergy prostheses [35]. Indeed, a more posterior COR was correlated with a higher rate of HO [20]. Tu et al [2] suggested that surgeons should place implants at the center of the disc space, with symmetrical disc space from the sides.…”

Section: Center Of Rotationmentioning

confidence: 94%

See 1 more Smart Citation

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

Hui¹,

Phan²,

Kerferd³

et al. 2021

Asian Spine J

View full text Add to dashboard Cite

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.

show abstract

“…However, even patients with a physiological cervical alignment and adequate decompression can display certain amounts of persisting neck pain and neurological dysfunction, as evidenced even in patients undergoing total disc arthroplasty that display only slight degenerative changes [32]. Kyphotic patients can be asymptomatic, as well [26].…”

Section: Discussionmentioning

confidence: 99%

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Koeppen¹,

Piepenbrock²,

Kroppenstedt³

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

PurposeDecompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery.MethodsThis is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom’s criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1–7° and ≥8°) and final lordosis (4 Omega-groups: 0–7°, 8–14°, 15–21°, ≥22°).Results219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom’s criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome.ConclusionsDecompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms “balance” and “physiologic lordosis” remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful.

show abstract

Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis

Abstract: Our results confirm the influence of CORi location on segmental alignment, kinematics and HO for a semi-constrained CTDR, but it also indicates a multifactorial process.

Cited by 15 publications

References 48 publications

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

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

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Contact Info

Product

Resources

About