J Korean Neurosurg Soc.  2015 Sep;58(3):225-230. 10.3340/jkns.2015.58.3.225.

The Clinical and Radiological Effect of Abnormal Axis after Cervical Arthroplasty

• Jang HJ
• Oh CH
• Yoon SH
• Kim JY
• Park HC
• Kim YH

• KMID: 2191369
• DOI: http://doi.org/10.3340/jkns.2015.58.3.225

Abstract

OBJECTIVE
The clinical outcomes according to the radiological results after cervical total disc replacement (TDR) are not well established. Here, the authors reviewed the clinical results according to the asymmetry in radiographs.
METHODS
This retrospective analysis included patients after TDR (Mobi-C(R) disc) with at least 12 months follow up, and the clinical and radiological data were obtained preoperatively and postoperatively for 12 months. Clinical outcome measures numerical rating scale (NRS) score for neck pain, visual analog scale (VAS) for arm pain, and the Oswestry disability index (ODI) value. The asymmetries of TDRs were evaluated on the anterior-posterior (AP) and the lateral radiographs, and the radiographic adjacent segment degenerations were evaluated for 12 months.
RESULTS
A total of 24 patients (one level cervical TDR; 10 male and 14 female; aged 41.50+/-8.35 years) were included in this study. The clinical results including NRS for neck pain, VAS for arm pain, and ODIs were similar between the normal and asymmetrized TDRs in AP and lateral radiographs. The radiographic adjacent segment degenerations were significantly increased in deviated TDRs (AP>10 mm asymmetry and lateral>10 mm asymmetry).
CONCLUSION
Asymmetrical location of TDR is not related to the clinical outcomes, but related to the risk of radiographic adjacent disc segment degeneration.

Keyword

Cervical arthroplasty; Malposition; Mobi-c; Fusion; Total disc replacement

MeSH Terms

Arm
Arthroplasty*
Axis, Cervical Vertebra*
Female
Follow-Up Studies
Humans
Male
Neck Pain
Outcome Assessment (Health Care)
Retrospective Studies
Total Disc Replacement
Visual Analog Scale

Figure

• 

  Fig. 1 Normal position and anterior-posterior (AP)/lateral (LAT) asymmetry of total disc replacement (TDR). A : AP asymmetry was measured as the distance between the midline of cervical spine and the midline of implant on AP radiographs. B : LAT asymmetry was measured as the distance between the midline of cervical spine and the midline of implant on lateral radiographs.

Reference

1. Amevo B, Worth D, Bogduk N. Instantaneous axes of rotation of the typical cervical motion segments : a study in normal volunteers. Clin Biomech (Bristol, Avon). 1991; 6:111–117.

2. Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W. Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J. 2012; 21:1648–1659. PMID: 22331142.

3. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993; 75:1298–1307. PMID: 8408151.

4. Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain : the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010; 10:469–474. PMID: 20359958.

5. Chen J, Wang X, Bai W, Shen X, Yuan W. Prevalence of heterotopic ossification after cervical total disc arthroplasty : a meta-analysis. Eur Spine J. 2012; 21:674–680. PMID: 22134486.

6. Cloward RB. Cervical diskography; technique, indications and use in diagnosis of ruptured cervical disks. Am J Roentgenol Radium Ther Nucl Med. 1958; 79:563–574.

7. Davis RJ, Kim KD, Hisey MS, Hoffman GA, Bae HW, Gaede SE, et al. Cervical total disc replacement with the Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease : a prospective, randomized, controlled multicenter clinical tria l : clinical article. J Neurosurg Spine. 2013; 19:532–545. PMID: 24010901.

8. Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002; 27:2431–2434. PMID: 12435970.

9. Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up. J Spinal Disord Tech. 2010; 23:367–371. PMID: 20087223.

10. Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004; 17:79–85. PMID: 15260088.

11. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999; 81:519–528. PMID: 10225797.

12. Ipsen BJ, Kim DH, Jenis LG, Tromanhauser SG, Banco RJ. Effect of plate position on clinical outcome after anterior cervical spine surgery. Spine J. 2007; 7:637–642. PMID: 17998122.

13. Matsunaga S, Kabayama S, Yamamoto T, Yone K, Sakou T, Nakanishi K. Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976). 1999; 24:670–675. PMID: 10209796.

14. Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion : a randomized controlled clinical trial. J Neurosurg Spine. 2007; 6:198–209. PMID: 17355018.

15. Park JH, Roh KH, Cho JY, Ra YS, Rhim SC, Noh SW. Comparative analysis of cervical arthroplasty using mobi-c(r) and anterior cervical discectomy and fusion using the solis(r) -cage. J Korean Neurosurg Soc. 2008; 44:217–221. PMID: 19096680.

16. Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty : a prospective 2-year study. J Neurosurg Spine. 2005; 3:417–423. PMID: 16381202.

17. Rong X, Gong Q, Liu H, Hong Y, Lou J, Wu W, et al. The effect of deviated center of rotation on flexion-extension range of motion after single-level cervical arthroplasty : an in vivo study. Spine (Phila Pa 1976). 2014; 39(26 Spec No.):B12–B18. PMID: 25271518.

18. Vital JM, Guérin P, Gille O, Pointillart V, Aurouer N, Obeid I. The Mobi-C® cervical disc prosthesis : indications, technique and results. Interact Surg. 2008; 3:181–186.

19. Yamagata T, Takami T, Uda T, Ikeda H, Nagata T, Sakamoto S, et al. Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment. J Clin Neurosci. 2012; 19:1673–1678. PMID: 23084624.

20. Yue JJ, Bertagnoli R, McAfee PC, An HS. Motion preservation surgery of the spine : advanced techniques and controversies. Philadelphia: Saunders Elsevier;2008. p. 231–237.