Are Collapsed Cervical Discs Amenable to Total Disc Arthroplasty?: Analysis of Prospective Clinical Data With 2-Year Follow Up.
Are Collapsed Cervical Discs Amenable to Total Disc Arthroplasty?: Analysis of Prospective Clinical Data With 2-Year Follow Up.
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颈椎间盘塌陷是否适合全椎间盘置换术？：2 年随访的前瞻性临床数据分析。
DOI：
10.1097/brs.0000000000001793
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发表时间：
2016
期刊：
影响因子：
3
通讯作者：
Musante,David
中科院分区：
文献类型：
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作者：
Patwardhan,AvinashG;Carandang,Gerard;Voronov,LeonardI;Havey,RobertM;Paul,GaryA;Lauryssen,Carl;Coric,Domagoj;Dimmig,Thomas;Musante,David
研究设计：分析前瞻性收集的影像学数据。目的：研究术前指数水平活动度（ROM）和椎间盘高度对使用可压缩椎间盘假体的颈椎全椎间盘置换术（TDA）后ROM的影响。背景资料摘要：临床研究表明，与融合相比，保留运动的益处;然而，关于哪些术前因素有能力识别最有可能具有良好术后活动的患者，方法：我们前瞻性地分析了从一项单臂、多中心研究中收集的数据，该研究对30例患者48个植入节段进行了2年随访。所有患者均接受高度为6 mm的可压缩颈椎间盘假体（M6 C，Spinal Kinetics，桑尼维尔，CA）。使用2 x 2 ANOVA分析指数级术前椎间盘高度和ROM（各有两个级别：低于中位数和高于中位数）对术后ROM的影响。我们进一步分析了术前高度小于3 mm的椎间盘亚组的影像学结果，即所谓的“塌陷”disc.Results.Shorter（3.0±0.4 mm）椎间盘术前移动的明显少于较高（4.4±0.5 mm）椎间盘（6.7 vs. 10.5，P= 0.01）。较短和较高椎间盘的术后ROM无差异（5.6 vs. 5.0，P= 0.63）。术前移动的较少的高椎间盘的术后ROM明显小于术前活动度高于中位数的短椎间盘（P< 0.05）。“塌陷椎间盘”（n= 8）术前移动的少于所有椎间盘（5.1 vs. 8.6，P< 0.01）。这些椎间盘被牵引到术前高度的两倍以上，从2.6到5.7 mm，术后ROM明显大于所有椎间盘的总和（7.6 vs. 5.3，P< 0.05）。结论：我们观察到术前指数级椎间盘高度和ROM之间在影响术后ROM方面存在显著的相互作用。尽管受样本量小的限制，结果表明，术前高度小于3 mm的椎间盘可能适用于使用可压缩椎间盘假体的椎间盘成形术。证据等级：2历史上，颈椎前路椎间盘切除融合术（ACDF）已被广泛用于治疗症状性颈椎病。临床研究表明，颈椎融合术易使剩余的移动的节段发生退变。1-5生物力学研究报告融合后相邻节段的运动和应力增加，这被认为会加速其退变。6-8颈椎全椎间盘置换术（TDA）的长期研究建议将其作为ACDF的替代选择，用于单节段和两节段颈椎疾病的神经根病和脊髓神经根病的手术治疗。9-14这些研究证明了活动度保留优于融合;然而，关于哪些术前因素能够识别最有可能获得良好术后活动度的患者（这是TDA的主要依据），仍有几个问题尚未得到解答。
Study Design.Analysis of prospectively collected radiographic data.Objective.To investigate the influence of preoperative index-level range of motion (ROM) and disc height on postoperative ROM after cervical total disc arthroplasty (TDA) using compressible disc prostheses.Summary of Background Data.Clinical studies demonstrate benefits of motion preservation over fusion; however, questions remain unanswered as to which preoperative factors have the ability to identify patients who are most likely to have good postoperative motion, which is the primary rationale for TDA.Methods.We analyzed prospectively collected data from a single-arm, multicenter study with 2-year follow up of 30 patients with 48 implanted levels. All received compressible cervical disc prostheses of 6 mm-height (M6C, Spinal Kinetics, Sunnyvale, CA). The influence of index-level preoperative disc height and ROM (each with two levels: below-median and above-median) on postoperative ROM was analyzed using 2 x 2 ANOVA. We further analyzed the radiographic outcomes of a subset of discs with preoperative height less than 3 mm, the so-called “collapsed” discs.Results.Shorter (3.0±0.4 mm) discs were significantly less mobile preoperatively than taller (4.4±0.5 mm) discs (6.7 vs. 10.5, P= 0.01). The postoperative ROM did not differ between the shorter and taller discs (5.6 vs. 5.0, P= 0.63). Tall discs that were less mobile preoperatively had significantly smaller postoperative ROM than short discs with above-median preoperative mobility (P< 0.05). The “collapsed discs”(n= 8) were less mobile preoperatively compared with all discs combined (5.1 vs. 8.6, P< 0.01). These discs were distracted to more than two times the preoperative height, from 2.6 to 5.7 mm, and had significantly greater postoperative ROM than all discs combined (7.6 vs. 5.3, P< 0.05).Conclusion.We observed a significant interaction between preoperative index-level disc height and ROM in influencing postoperative ROM. Although limited by small sample size, the results suggest discs with preoperative height less than 3 mm may be amenable to disc arthroplasty using compressible disc prostheses.Level of Evidence: 2Historically, anterior cervical discectomy and fusion (ACDF) has been widely used to treat symptomatic cervical spondylosis. Clinical studies suggest that cervical fusion predisposes the remaining mobile segments to degeneration. 1–5 Biomechanical studies report increased motion and stresses in adjacent segments after fusion, which are thought to accelerate their degeneration. 6–8 Long-term studies of cervical total disc arthroplasty (TDA) have recommended it as an alternative option to ACDF for the surgical treatment of radiculopathy and myeloradiculopathy in one-and two-level cervical disease. 9–14 These studies demonstrate benefits of motion preservation over fusion; however, several questions still remain unanswered as to which preoperative factors have the ability to identify patients who are most likely to have good postoperative motion, which is the primary rationale for TDA.