The effects of pathology and one-level versus two-level arthrodesis on cervical spine intervertebral helical axis of motion.
The effects of pathology and one-level versus two-level arthrodesis on cervical spine intervertebral helical axis of motion.
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DOI：
10.1016/j.jbiomech.2022.110960
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发表时间：
2022-01
影响因子：
2.4
通讯作者：
Clarissa M. LeVasseur;Samuel W. Pitcairn;Jeremy D. Shaw;W. Donaldson;J. Lee;W. Anderst
中科院分区：
文献类型：
--
作者：
Clarissa M. LeVasseur;Samuel W. Pitcairn;Jeremy D. Shaw;W. Donaldson;J. Lee;W. Anderst
颈椎前路椎间盘切除术和融合（ACDF）后邻近节段疾病的病因仍有争议。活动度（ROM）通常用于推断关节融合术对ACDF后相邻节段活动的影响，然而，ROM仅测量活动总量。相反，螺旋运动轴（HAM）量化运动是如何发生的，并可能为相邻节段病理的病因提供额外的见解。在62名ACDF患者和38名对照参与者进行动态颈部屈伸时，以每秒30张的速度获得同步颈椎双翼x线片。经过验证的跟踪过程将从特定主题骨模型创建的数字重建x线照片与亚毫米精度的x线照片相匹配。然后使用线性混合效应分析计算并比较患者术前和术后1年的椎间HAM，以及患者和对照组在相应运动节段的HAM。术前有症状的运动节段与对照组相应的运动节段在HAM的前后位置上存在微小差异。从术前到术后1年，关节融合术附近运动节段的HAM未见变化。相邻节段HAM在单节段和双节段关节融合术患者之间没有差异。在一节段或两节段关节融合术后一年内，症状性病理和关节融合术似乎都不能改变颈椎屈伸时的运动方式。这些结果表明，ACDF不会在短期内改变邻近节段的运动学，从而导致邻近节段疾病的发展。
The etiology of adjacent segment disease after anterior cervical discectomy and fusion (ACDF) remains controversial. Range of motion (ROM) is typically used to infer the effects of arthrodesis on adjacent segment motion following ACDF, however, ROM only measures the total amount of motion. In contrast, the helical axis of motion (HAM) quantifies how the motion occurs and may provide additional insight into the etiology of adjacent segment pathology. Synchronized biplane radiographs of the cervical spine were acquired at 30 images per second while 62 ACDF patients and 38 control participants performed dynamic neck flexion/extension. A validated tracking process matched digitally reconstructed radiographs created from subject-specific bone models to the radiographs with sub-millimeter accuracy. The intervertebral HAM was then calculated and compared between pre and 1 year post surgery in patients, and between patients and controls at corresponding motion segments using linear mixed-effects analysis. Small differences in the anterior/posterior location of the HAM were found between the symptomatic motion segments before surgery and corresponding motion segments in controls. No changes in the HAM of motion segments adjacent to the arthrodesis were observed from pre to 1-year post-surgery. No differences in adjacent segment HAM were found between patients with one- versus two-level arthrodesis. Neither symptomatic pathology nor arthrodesis appear to change the way motion occurs in the cervical spine during flexion/extension one year after one or two-level arthrodesis. These results suggest ACDF does not alter short-term adjacent segment kinematics in a way that would contribute to the development of adjacent segment disease.