Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E. 17th Street, New York, NY 10003, USA.
Spine (Phila Pa 1976). 2010 Apr 15;35(8):E285-9. doi: 10.1097/BRS.0b013e3181c88165.
STUDY DESIGN: Retrospective study of patients enrolled in a prospective randomized Food and Drug Administration trial with single level cervical disc replacement (CDR) with the ProDisc-C (Synthes, Paoli, PA). OBJECTIVE: Evaluate the segmental range of motion (ROM) in the cervical spine pre- and postoperative after CDR. SUMMARY OF BACKGROUND INFORMATION: Each cervical level is believed to have its own biomechanical characteristics, ultimately leading to different sagittal and lateral ROM. Our understanding of the factors that influence motion after CDR continues to change and expand. METHODS: One hundred sixty-four patients with single level ProDisc-C arthroplasty were evaluated radiographically using Medical Metrics (QMATM, Medical Metrics, Inc., Houston, TX). Pre- and postoperative disc height and ROM were measured from standing lateral and flexion-extension radiographs. Of these 164 patients, 44 had a CDR at C6/C7, 96 at C5/C6, 18 at C4/C5, and 6 at C3/C4. The mean follow-up was of 24 months. Statistical analysis evaluated the difference in mean ROM between the groups. RESULTS: Before surgery, C4/C5 had more sagittal ROM compared with C3/C4, C5/C6, and C6/C7 (P < 0.001.) Before surgery, C4/C5 also had more lateral ROM compared with C3/C4, C5/C6, and C6/C7 (P = 0.015). After surgery, there were no significant differences in sagittal and lateral ROM between C3/C4, C4/C5, C5/C6, and C6/C7. The delta (difference between pre- and postoperative) proved that the C4/C5 CDR actually lost sagittal ROM (-2.5 degrees ) compared with the other levels, which gained sagittal ROM, C3/C4 (0.9 degrees ), C5/C6 (1.8 degrees ), and C6/C7 (1.6 degrees ); P = 0.037. There was no significant difference in the delta lateral ROM between the segments: C3/C4, C4/C5, C5/C6, and C6/C7. CONCLUSION: CDR approximates the different segmental sagittal and lateral ROM. Although C4/C5 had negative delta ROM in the sagittal and lateral planes, it provided a satisfactory final ROM. Long-term clinical outcome studies are needed to properly evaluate if these differences could ultimately affect the patients everyday life.
研究设计：回顾性研究前瞻性随机食品和药物管理局试验中接受单节段颈椎间盘置换术（CDR）的患者，使用 ProDisc-C（Synthes，宾夕法尼亚州波利）。 目的：评估 CDR 前后颈椎的节段活动范围（ROM）。 背景信息摘要：每个颈椎水平都被认为具有自己的生物力学特性，最终导致矢状面和侧面 ROM 不同。我们对影响 CDR 后运动的因素的理解还在不断变化和扩展。 方法：使用 Medical Metrics（QMATM，Medical Metrics，Inc.，休斯顿，TX）对 164 例接受单节段 ProDisc-C 关节置换术的患者进行影像学评估。从站立侧位和屈伸位 X 线片测量术前和术后的椎间盘高度和 ROM。在这 164 例患者中，44 例在 C6/C7 行 CDR，96 例在 C5/C6 行 CDR，18 例在 C4/C5 行 CDR，6 例在 C3/C4 行 CDR。平均随访时间为 24 个月。统计分析评估了各组间 ROM 平均值的差异。 结果：术前，C4/C5 的矢状面 ROM 大于 C3/C4、C5/C6 和 C6/C7（P < 0.001）。术前，C4/C5 的侧方 ROM 也大于 C3/C4、C5/C6 和 C6/C7（P = 0.015）。术后，C3/C4、C4/C5、C5/C6 和 C6/C7 之间的矢状面和侧方 ROM 无显著差异。差值（术前与术后差值）表明 C4/C5 CDR 实际上比其他节段丧失了矢状面 ROM（-2.5 度），而 C3/C4、C5/C6 和 C6/C7 则增加了矢状面 ROM（分别为 0.9 度、1.8 度和 1.6 度）；P = 0.037。节段间的差值侧 ROM 无显著差异：C3/C4、C4/C5、C5/C6 和 C6/C7。 结论：CDR 接近不同节段的矢状面和侧面 ROM。尽管 C4/C5 在矢状面和冠状面的差值 ROM 为负，但它提供了满意的终末 ROM。需要进行长期的临床结果研究，以正确评估这些差异是否最终会影响患者的日常生活。
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