Patwardhan Avinash G, Carandang Gerard, Voronov Leonard I, Havey Robert M, Paul Gary A, Lauryssen Carl, Coric Domagoj, Dimmig Thomas, Musante David
Edward Hines Jr. VA Hospital, Hines, IL.
Loyola University Stritch School of Medicine, Maywood, IL.
Spine (Phila Pa 1976). 2016 Dec 15;41(24):1866-1875. doi: 10.1097/BRS.0000000000001793.
Analysis of prospectively collected radiographic data.
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.
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.
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.
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).
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.
对前瞻性收集的影像学数据进行分析。
探讨使用可压缩椎间盘假体进行颈椎全椎间盘置换术（TDA）时，术前节段活动度（ROM）和椎间盘高度对术后ROM的影响。
临床研究表明保留活动度优于融合术；然而，关于哪些术前因素能够识别出最有可能获得良好术后活动度的患者这一问题仍未得到解答，而这正是TDA的主要理论依据。
我们分析了一项单臂多中心研究中前瞻性收集的数据，该研究对30例患者的48个植入节段进行了2年随访。所有患者均接受了6毫米高的可压缩颈椎间盘假体（M6C，Spinal Kinetics，加利福尼亚州桑尼维尔）。使用2×2方差分析来分析术前节段椎间盘高度和ROM（各分为两个水平：中位数以下和中位数以上）对术后ROM的影响。我们还进一步分析了术前高度小于3毫米的一部分椎间盘（即所谓的“塌陷”椎间盘）的影像学结果。
术前较短（3.0±0.4毫米）的椎间盘活动度明显低于较高（4.4±0.5毫米）的椎间盘（6.7°对10.5°，P = 0.01）。较短和较高椎间盘的术后ROM没有差异（5.6°对5.0°，P = 0.63）。术前活动度较小的高椎间盘术后ROM明显小于术前活动度中位数以上的短椎间盘（P < 0.05）。与所有椎间盘合并计算相比，“塌陷椎间盘”（n = 8）术前活动度较小（5.1°对8.6°，P < 0.01）。这些椎间盘被撑开至术前高度的两倍多，从2.6毫米增加到5.7毫米，并且术后ROM明显大于所有椎间盘合并计算的结果（7.6°对5.3°，P < 0.05）。
我们观察到术前节段椎间盘高度和ROM在影响术后ROM方面存在显著相互作用。尽管受样本量小的限制，但结果表明术前高度小于3毫米的椎间盘可能适合使用可压缩椎间盘假体进行椎间盘置换术。
2级。
