In Vivo Changes in Dynamic Adjacent Segment Motion 1 Year After One and Two-Level Cervical Arthrodesis.
In Vivo Changes in Dynamic Adjacent Segment Motion 1 Year After One and Two-Level Cervical Arthrodesis.
复制标题
一级和二级颈椎融合术一年后动态相邻节段运动的体内变化。
DOI：
10.1007/s10439-022-02964-7
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发表时间：
2022
影响因子：
3.8
通讯作者：
Anderst,WilliamJ
中科院分区：
文献类型：
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作者：
LeVasseur,ClarissaM;Pitcairn,SamuelW;Okonkwo,DavidO;Kanter,AdamS;Shaw,JeremyD;Donaldson,WilliamF;Lee,JoonY;Anderst,WilliamJ
生物力学尸体测试表明单节段颈椎前路融合术后相邻节段活动增加，双节段融合术加剧了这些影响。几乎没有活体证据支持这些生物力学研究。本研究的目的是评估单节段和两节段颈椎关节融合术对相邻节段运动的影响。50例患者接受了单节段C56关节融合术或双节段C456或C567关节融合术，并与23例无症状对照组沿着接受了术前（PRE）和术后1年（1年-POST）测试。一种经验证的基于CT模型的跟踪技术被用于测量颈椎动态屈伸和轴向旋转过程中收集的双平面X线片的3D椎体运动。比较单节段和双节段关节融合术患者和对照组的头部和相邻节段椎间活动度（ROM）的终末范围和中端范围。从术前到术后1年，观察到相邻节段末端ROM小幅（2.3°或更小）但无显著性增加。从术前到术后1年，关节融合术下方C67运动节段的中等屈曲-伸展ROM和关节融合术上方上级C45运动节段的中等轴向旋转ROM增加（所有p < 0.022）。这项研究提供了体内证据，与长期以来的观点相矛盾，即颈椎前路融合术后相邻节段末端活动度明显增加，双节段融合术加剧了这些影响。在检测颈椎融合术后相邻节段运动的早期变化方面，中程ROM似乎比末端ROM更有用。
Biomechanical cadaver testing indicates adjacent segment motion increases after one-level anterior cervical spine arthrodesis, and two-level arthrodesis exacerbates these effects. There is littlein vivoevidence to support those biomechanical studies. The purpose of this study was to assess the effects of one- and two-level cervical arthrodesis on adjacent segment motion. Fifty patients received either one-level C56 arthrodesis or two-level C456 or C567 arthrodesis and were tested preoperatively (PRE) and 1 year postoperatively (1YR-POST) along with 23 asymptomatic controls. A validated CT model-based tracking technique was used to measure 3D vertebral motion from biplane radiographs collected during dynamic flexion-extension and axial rotation of the cervical spine. Head and adjacent segment intervertebral end-range range of motion (ROM) and mid-range ROM were compared between one-level and two-level arthrodesis patients and controls. Small (2.3° or less) but non-significant increases in adjacent segment end-range ROM were observed from PRE to 1YR-POST. Mid-range flexion-extension ROM in the C67 motion segment inferior to the arthrodesis and mid-range axial rotation ROM in the C45 motion segment superior to the arthrodesis increased from PRE to 1YR-POST (allp< 0.022). This study providesin vivoevidence that contradicts long-held beliefs that adjacent segment end-range ROM increases appreciably after anterior cervical arthrodesis and that two-level arthrodesis exacerbates these effects. Mid-range ROM appears to be more useful than end-range ROM for detecting early changes in adjacent segment motion after cervical spine arthrodesis.