Abstract
BackgroundCervical disc arthroplasty (CDA) has been demonstrated, in clinical trials, as an effective and safe treatment for patients diagnosed with radiculopathy and/or myelopathy. However, the current CDA indication criteria, based on the preoperative segmental range of motion (ROM), comprises a wide range of variability. Although the arthroplasty level preserved ROM averages 7°-9° after CDA, there are no clear guidelines on preoperatively limited or excessive ROM at the index level, which could be considered as suitable for CDA.MethodsThis was a retrospective study of patients who underwent CDA between January 2008 and October 2018 using Prestige-LP discs in our hospital. They were divided into the small-ROM (≤5.5°) and the large-ROM (> 12.5°) groups according to preoperatively index-level ROM. Clinical outcomes, including the Japanese Orthopedics Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores, were evaluated. Radiological parameters, including cervical lordosis, disc angle (DA), global and segmental ROM, disc height (DH), and complications were measured.ResultsOne hundred and twenty six patients, with a total of 132 arthroplasty segments were analyzed. There were 64 patients in the small-ROM and 62 in the large-ROM group. There were more patients diagnosed with cervical spondylosis in the small-ROM than in the large-ROM group (P = 0.046). Patients in both groups had significantly improved JOA, NDI, and VAS scores after surgery, but the intergroup difference was not significant. Patients in the small-ROM group had dramatic postoperative increase in cervical lordosis, global and segmental ROM (P < 0.001). However, there was a paradoxical postoperative decrease in global and segmental ROM in the large-ROM group postoperatively (P < 0.001). Patients in the small-ROM group had lower preoperative DH (P = 0.012), and a higher rate of postoperative heterotopic ossification (HO) (P = 0.037).ConclusionPatients with preoperatively limited segmental ROM had severe HO, and achieved similar postoperative clinical outcomes as patients with preoperatively excessive segmental ROM. Patients with preoperatively limited segmental ROM showed a postoperative increase in segmental mobility, which decreased in patients with preoperatively excessive segmental ROM.
Highlights
In recent decades, cervical disc arthroplasty (CDA) has been studied in many clinical trials as an alternative surgical treatment to anterior cervical discectomy and fusion (ACDF), due to a paradigm shift towards preserving motion and avoiding adjacent segment disease [1,2,3,4,5,6,7]
This study aims to investigate the influence of preoperative index-level range of motion (ROM) on postoperative ROM after Cervical disc arthroplasty (CDA), and whether the patients with preoperatively limited or excessive segmental ROM are suitable candidates for arthroplasty
We found that there was no significant difference in postoperative segmental ROM at the arthroplasty level among the three surgical types
Summary
Cervical disc arthroplasty (CDA) has been studied in many clinical trials as an alternative surgical treatment to anterior cervical discectomy and fusion (ACDF), due to a paradigm shift towards preserving motion and avoiding adjacent segment disease [1,2,3,4,5,6,7]. There are no clear guidelines as to the optimal preoperative indexlevel ROM; the preoperative ROM at the index level averaged 7°-9°, and a similar motion was successfully preserved after surgery [10,11,12,13,14]. These observations raise a question for surgeons; whether limited or excessive preoperative ROM, other than the average one at the index level, could achieve satisfactory clinical or kinematic outcomes?. The arthroplasty level preserved ROM averages 7°-9° after CDA, there are no clear guidelines on preoperatively limited or excessive ROM at the index level, which could be considered as suitable for CDA
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