Postoperative segmental hypermobility after cervical arthroplasty: A possible pathomechanism for outcome failure

Gautschi, Oliver; Corniola, Marco Vincenzo; Stienen, Martin N.; Smoll, Nicolas R.; Cadosch, Dieter

doi:10.1016/j.jocn.2014.12.025

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…However, on the other hand, excessive disc height increment might contribute to the facet joint subluxation, which could subsequently result in hypermobility or instability at the surgical level. [15] In this study, the disc height increment in group A and group B was 1.3 and 2.3 mm, respectively. No overstretching of the disc space or the facet joint space was recorded.…”

Section: Discussionmentioning

confidence: 57%

How to choose when implants of adjacent height both fit the disc space properly in single-level cervical artificial disc replacement

Xiao

Lou²,

Li³

et al. 2017

Medicine

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In cervical artificial disc replacement (C-ADR), sometimes we encountered with such cases that implants of adjacent height both fit the target disc space properly. No study was available discussing the choice of implant height and the clinical outcomes under such circumstance. The purpose of this study was to evaluate the impact of different implant heights on the clinical outcomes and radiographic results when the implants of adjacent height both fit the disc space properly. This retrospective study included 34 patients underwent single-level C-ADR at the C5–C6 level at our institution. In these 34 patients, implant with either 5 mm height or 6 mm height fit the surgical level properly without overstretching the disc space or the facet joint space. Clinical outcomes were evaluated using the Japanese Orthopedic Association score, visual analog scale (VAS), and Neck Disability Index. Radiographic assessments were conducted on static and dynamic radiographs for the determination of the disc space height, intersegmental range of motion (ROM), and the ROM of the functional spinal unit (FSU) at the surgical level. The baseline information of the patients, such as age, gender, weight, follow-up time, and diagnosis, was similar between the 2 groups (P > .05). Postoperative mean VAS in group B was significantly lower than that in group A (2.1 ± 0.7 vs. 2.7 ± 1.0, P < .05). The mean VAS decrease in group B was significantly larger than that in group A (5.3 ± 0.8 vs. 4.6 ± 1.1, P < .05). Significant difference was found in the postoperative disc height of the surgical segment between the 2 groups (6.4 ± 0.4 mm vs. 7.5 ± 0.5 mm, P < .05). No significant differences were noted in the intersegmental ROM and ROM of the FSU between the 2 groups both before the surgery and at the last follow-up (P > .05). No hypermobility or instability was observed in these patients. Our results suggested that when implants of adjacent height both fit the disc space properly, using the larger implant could result in better pain relief without the risk of segmental hypermobility in patients underwent single-level C-ADR at the C5–C6 level.

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Section: Discussionmentioning

confidence: 57%

How to choose when implants of adjacent height both fit the disc space properly in single-level cervical artificial disc replacement

Xiao

Lou²,

Li³

et al. 2017

Medicine

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“…There are few reported cases of hypermobility in the literature. Case reports exist outlining cases of hypermobility with the M6-C and PCM devices (7,8). To our knowledge, this is the first reported instance of focal hypermobility with the LDR Mobi-C cervical artificial disc.…”

Section: A B Discussionmentioning

confidence: 99%

Focal hypermobility observed in cervical arthroplasty with Mobi-C

Kerferd¹,

Abi–Hanna²,

Phan³

et al. 2017

J. Spine Surg.

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In recent decades cervical arthroplasty, or cervical disc replacement, has been steadily increasing in popularity as a procedure for the treatment of degenerative pathologies of the cervical spine. This is based on an evolving body of literature that documents superior outcomes in cervical disc replacement over fusion, for both single and double level pathologies, in well selected patients. One of the more recent and popular implants currently on the market is the Mobi-C cervical artificial disc (LDR Medical; Troyes, France). In this paper we report on two cases where focal hypermobility was observed following total disc replacement using the Mobi-C cervical artificial disc. This is followed by a discussion as to potential contributing factors to this hypermobility in relation to both implant design, and operative technique, suggesting potential changes that might prevent this in future patients.

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“…The ALL has been demonstrated to be an important stabilizer of the motion segment during extension and lateral bending but at the same time, is routinely divided during anterior discectomy and prosthesis insertion [ 10 ]. The non-physiological kinematics introduced by current prosthesis designs in conjunction with loss of the ALL is speculated to cause clinically significant hypermobility, especially in extension, of the operated segment and excessive loading of the facet joints and implanted device [ 11 15 27 28 ]. There has been speculation on the use of the lateral approach for TDR, but this has not been well explored and there is the theoretical risk of lumbosacral plexus injury with this approach.…”

Section: Discussionmentioning

confidence: 99%

“…In studies on lumbar TDR failures, Pettine [ 17 ] reported that 50% of failures were attributed to facet pathology while Rosen et al [ 16 ] reported 100% of failures involved a facet aetiology [ 27 ]. In the cervical spine, Gautschi et al [ 11 ] reported a case of failed disc arthroplasty due to segmental hypermobility which resulted in persisting axial neck pain worsening under motion. These studies describe sagittal imbalance and subsequent concentration of stresses to the posterior elements, especially the facet joints, as mechanisms of clinically significant facet degeneration.…”

Section: Discussionmentioning

confidence: 99%

“…This however comes with a risk of hypermobility in the motion segment, which combined with the inherent iatrogenic damage to the anterior longitudinal ligament (ALL) during insertion, disturbs the physiological kinematics of the spine [ 8 9 10 ]. These factors have been speculated to cause clinically significant secondary consequences to the operated spinal motion segment and adjacent segments in the short and long term [ 11 12 13 14 15 16 17 ]. Indeed, there have been several reports of anterior prosthesis migration following TDR, speculated to be a direct consequence of the disrupted ligamentous structures [ 12 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Anterior Longitudinal Ligament Reconstruction to Reduce Hypermobility of Cervical and Lumbar Disc Arthroplasty

Mobbs

Phan

2017

Asian Spine J

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Study DesignRetrospective case seriesPurposeThis study aims to present the early clinical and radiological outcomes of anterior longitudinal ligament (ALL) reconstruction following disc arthroplasty.Overview of LiteratureAlthough cervical and lumbar disc arthroplasty have entered the clinical setting, there are still concerns regarding the short and long term complications arising from hypermobility of current prosthesis designs. Reconstruction of the ALL is a potential solution to disc arthroplasty hypermobility.MethodsALL reconstruction following disc arthroplasty have been performed by the senior author over a 24 month period. Ligament replacements used include allograft and synthetic, ligament advanced reinforcement system (LARS) ligaments. Methods of fixation used include titanium staples, bone anchors and suture fixation. Radiological follow-up pre- and postoperative Oswestry disability index, Neck Disability Index, Patient Satisfaction index scores were recorded on all patients.ResultsA total of 18 ALL reconstructions were performed. There have been no cases of early complications, revision surgery for recurrent symptoms or implant failure. Of the 6 patients receiving a minimum of 15 months follow-up, 4 patients received an allograft, 2 patients received the LARS ligament. Favourable, postoperative clinical and radiographic outcomes have been demonstrated.ConclusionsALL reconstruction following cervical and lumbar disc arthroplasty is a promising solution to addressing non-physiological kinematics of current disc arthroplasty devices. Randomized, controlled studies with larger study samples and long-term follow-up are required to establish these conclusions.

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Postoperative segmental hypermobility after cervical arthroplasty: A possible pathomechanism for outcome failure

Cited by 6 publications

References 16 publications

How to choose when implants of adjacent height both fit the disc space properly in single-level cervical artificial disc replacement

How to choose when implants of adjacent height both fit the disc space properly in single-level cervical artificial disc replacement

Focal hypermobility observed in cervical arthroplasty with Mobi-C

Anterior Longitudinal Ligament Reconstruction to Reduce Hypermobility of Cervical and Lumbar Disc Arthroplasty

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