Sagittal Cervical Alignment After Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion

Anakwenze, Okechukwu A.; Auerbach, Joshua D.; Milby, Andrew H.; Lonner, Baron; Balderston, Richard A.

doi:10.1097/brs.0b013e3181b03fe6

Cited by 86 publications

(59 citation statements)

References 44 publications

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“…Usually, the shell angle depends on the physiologic shape of the segment, trimming of the endplates by the surgeon and is modulated by the design and the size of the CDR. In the current study, shell angle was -78 postoperatively and did not change significantly during follow-up, echoing data of Anakwenze et al [1] where the disc angle was -68 at 2-year follow-up. Hence, implant dimensions and positioning, both of which may impact the shell angle, can influence the amount of translation seen by affecting the COR-X and the COR-Y location.…”

Section: Discussionsupporting

confidence: 89%

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

et al. 2012

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Introduction To better understand cervical kinematics following cervical disc replacement (CDR), the in vivo behavior of a minimally constrained CDR was assessed. Methods Radiographic analysis of 19 patients undergoing a 1-level CDR from C4-5 to C6-7 (DISCOVER, DepuySpine, USA) was performed. Neutral-lateral and flexionextension radiographs obtained at preop, postop and late follow-up were analyzed for segmental angle and global angle (GA C2-7). Flexion-extension range of motion was analyzed using validated quantitative motion analysis software (QMAÒ, Medical Metrics, USA). The FSU motion parameters measured at the index and adjacent levels were angular range of motion (ROM), translation and center of rotation (COR). Translation and COR were normalized to the AP dimension of the inferior endplate of the caudal vertebra. All motion parameters, including COR, were compared with normative reference data. Results The average patient age was 43.5 ± 7.3 years. The mean follow-up was 15.3 ± 7.2 months. C2-7 ROM was 35.9°± 15.7°at preop and 45.4°± 13.6°at follow-up (Dp\ .01). Based on the QMA at follow-up, angular ROM at the CDR level measured 9.8°± 5.9°and translation was 10.1 ± 7.8 %. Individuals with higher ROM at the CDR level had increased translation at that level (p \ .001, r = 0.97), increased translation and ROM at the supra-adjacent level (p \ .001, r = .8; p = .005, r = .6). There was a strong interrelation between angular ROM and translation at the supra-adjacent level (p \ .001, r = .9) and caudal-adjacent level (p\.001, r = .9). The location of the COR at the CDRand supra-adjacent levels was significantly different for the COR-X (p \ .001). Notably, the COR-Y at the CDR level was significantly correlated with the extent of CDR-level translation (p = .02, r = .6). Shell angle, which may be influenced by implant size and positioning had no impact on angular ROM but was correlated with COR-X (p = .05, r = -.6) and COR-Y (p = .04, r = -.5). Conclusion The COR is an important parameter for assessing the ability of non-constrained CDRs to replicate the normal kinematics of a FSU. CDR size and location, both of which can impact shell angle, may influence the amount of translation by affecting the location of the COR. Future research is needed to show how much translation is beneficial concerning clinical outcomes and facet loading.

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Section: Discussionsupporting

confidence: 89%

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

et al. 2012

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“…Some prostheses have shown increased ROM postoperatively [1][2][3][4], while others have shown no change [5][6][7] or decreased ROM [8][9][10]. Interestingly, some prostheses have been shown to aid in restoration of cervical lordosis postoperatively [11][12][13][14], while others have shown no change [2,4] or trend toward kyphosis [5,15,16]. As a newly developed device, few reports about the Discover artificial cervical disc (DePuy Spine, Raynham, MA, USA) arthroplasty have been published.…”

Section: Introductionmentioning

confidence: 99%

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

Liang

et al. 2013

Eur Spine J

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Purpose The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed. Method 27 men and 28 women with a mean age of 46.4 ± 8.7 years were prospectively followed up for 2 years. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), visual analog scale (VAS) and Odom's criteria. Radiographic information including segment and overall alignment, functional spinal unit (FSU) and overall ROM, and disc heights were prospectively collected during the follow-up. The correlations between the postoperative FSU ROM at last follow-up and influencing factors were analyzed. Results Mean NDI, JOA and VAS scores showed statistical improvements at last follow-up. Anterior migration of the prosthesis was detected in six cases. Heterotopic ossification was observed in ten patients. Mean FSU angle, endplate angle of the treated level and mean overall cervical alignment were all improved significantly at last follow-up (P \ 0.001). However, mean FSU ROM of the treated segment significantly decreased postoperatively (P = 0.008), while mean overall ROM showed no significant differences. A significant correlation was found between preoperative FSU ROM and postoperative FSU ROM by the Pearson correlation coefficient (r = 0.325, P = 0.034). Multiple linear regression analysis confirmed that preoperative FSU ROM contributed independently to a model with a coefficient of determination of 0.37 (P = 0.034). Conclusions In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM.

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“…The majority of prospective assessments in the spine literature are industry-sponsored device trials that limit their assessment to specific spinal implants in carefully selected surgical patients. 1,12,21 Prospective studies using an easily replicated complication definition while focusing on the complication incidence after spine surgery are limited.…”

mentioning

confidence: 99%

Complications related to instrumentation in spine surgery: a prospective analysis

Campbell

Yadla²,

Malone³

et al. 2011

FOC

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Object Prospective examination of perioperative complications in spine surgery is limited in the literature. The authors prospectively collected data on patients who underwent spinal fusion at a tertiary care center and evaluated the effect of spinal fusion and comorbidities on perioperative complications. Methods Between May and December 2008 data were collected prospectively in 248 patients admitted to the authors' institution for spine surgery. The 202 patients undergoing spine surgery with instrumentation were further analyzed in this report. Perioperative complications occurring within the initial 30 days after surgery were included. All adverse occurrences, whether directly related to surgery, were included in the analysis. Results Overall, 114 (56.4%) of 202 patients experienced at least one perioperative complication. Instrumented fusions were associated with more minor complications (p = 0.001) and more overall complications (0.0024). Furthermore, in the thoracic and lumbar spine, complications increased based on the number of levels fused. Advanced patient age and certain comorbidities such as diabetes, cardiac disease, or a history of malignancy were also associated with an increased incidence of complications. Conclusions Using a prospective methodology with a broad definition of complications, the authors report a significantly higher perioperative incidence of complications than previously indicated after spinal fusion procedures. Given the increased application of instrumentation, especially for degenerative disease, a better estimate of clinically relevant surgical complications could aid spine surgeons and patients in an individualized complication index to facilitate a more thorough risk-benefit analysis prior to surgery.

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Sagittal Cervical Alignment After Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion

Cited by 86 publications

References 44 publications

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

Complications related to instrumentation in spine surgery: a prospective analysis

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