Anderst William J, West Tyler, Donaldson William F, Lee Joon Y, Kang James D
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
Spine (Phila Pa 1976). 2016 Nov 15;41(22):E1319-E1327. doi: 10.1097/BRS.0000000000001629.
A longitudinal study using biplane radiography to measure in vivo intervertebral range of motion (ROM) during dynamic flexion/extension, and rotation.
To longitudinally compare intervertebral maximal ROM and midrange motion in asymptomatic control subjects and single-level arthrodesis patients.
In vitro studies consistently report that adjacent segment maximal ROM increases superior and inferior to cervical arthrodesis. Previous in vivo results have been conflicting, indicating that maximal ROM may or may not increase superior and/or inferior to the arthrodesis. There are no previous reports of midrange motion in arthrodesis patients and similar-aged controls.
Eight single-level (C5/C6) anterior arthrodesis patients (tested 7 ± 1 months and 28 ± 6 months postsurgery) and six asymptomatic control subjects (tested twice, 58 ± 6 months apart) performed dynamic full ROM flexion/extension and axial rotation whereas biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral position from each pair of radiographs with submillimeter accuracy. The intervertebral maximal ROM and midrange motion in flexion/extension, rotation, lateral bending, and anterior-posterior translation were compared between test dates and between groups.
Adjacent segment maximal ROM did not increase over time during flexion/extension, or rotation movements. Adjacent segment maximal rotational ROM was not significantly greater in arthrodesis patients than in corresponding motion segments of similar-aged controls. C4/C5 adjacent segment rotation during the midrange of head motion and maximal anterior-posterior translation were significantly greater in arthrodesis patients than in the corresponding motion segment in controls on the second test date.
C5/C6 arthrodesis appears to significantly affect midrange, but not end-range, adjacent segment motions. The effects of arthrodesis on adjacent segment motion may be best evaluated by longitudinal studies that compare maximal and midrange adjacent segment motion to corresponding motion segments of similar-aged controls to determine if the adjacent segment motion is truly excessive.
一项纵向研究，使用双平面X线摄影术测量动态屈伸和旋转过程中的体内椎间活动范围（ROM）。
纵向比较无症状对照受试者和单节段融合术患者的椎间最大ROM和中间范围运动。
体外研究一致报告，颈椎融合术上下相邻节段的最大ROM增加。先前的体内研究结果相互矛盾，表明融合术上下的最大ROM可能增加，也可能不增加。以前没有关于融合术患者和年龄相仿的对照者中间范围运动的报道。
8名单节段（C5/C6）前路融合术患者（分别在术后7±1个月和28±6个月进行测试）和6名无症状对照受试者（进行两次测试，间隔58±6个月）进行动态全ROM屈伸和轴向旋转，同时以每秒采集30张双平面X线片。一个先前经过验证的跟踪程序从每对X线片中确定三维椎体位置，精度达到亚毫米级。比较测试日期之间和组间在屈伸、旋转、侧屈和前后平移方面的椎间最大ROM和中间范围运动。
在屈伸或旋转运动过程中，相邻节段的最大ROM没有随时间增加。融合术患者相邻节段的最大旋转ROM并不显著大于年龄相仿对照者的相应运动节段。在第二次测试日期，融合术患者在头部运动中间范围时C4/C5相邻节段的旋转以及最大前后平移显著大于对照者的相应运动节段。
C5/C6融合术似乎显著影响中间范围，但不影响终末范围的相邻节段运动。融合术对相邻节段运动的影响可能最好通过纵向研究来评估，该研究将相邻节段的最大和中间范围运动与年龄相仿对照者的相应运动节段进行比较，以确定相邻节段运动是否真的过度。
3级。
