Abstract
OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM) of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r) for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that.
Highlights
Cervical disc arthroplasty (CDA) was developed to treat the symptoms of degenerative disease of the cervical intervertebral discs, and began to be widely used in 1990 as an alternative to anterior approach discectomies with intersomatic fusion.[1,2,3,4]
It can be seen that there was a loss of 12% of the preoperative range of motion (ROM) in flexion, 21% in extension, and 23% in right and left lateral bending of the lower cervical spine in the seventh postoperative year
The big advantage is in the conservation of the spinal ROM and the spinal biomechanics, which reduces the overload on the adjacent level and results in a lower rate of recurring symptoms.[2,3,4,5,10]
Summary
Cervical disc arthroplasty (CDA) was developed to treat the symptoms of degenerative disease of the cervical intervertebral discs, and began to be widely used in 1990 as an alternative to anterior approach discectomies with intersomatic fusion.[1,2,3,4] The advantage offered by CDA was that it maintained the range of motion (ROM) of the spine in combination with the treatment of pain and nerve-related symptoms of the degenerative disease of the cervical spine.[4,5] Using CDA preserves the spinal biomechanics and integrity of the adjacent levels, while intersomatic fusion imposes new biomechanics on the spine that restrict the ROM of the treated levels, leading to hypermobility of the adjacent levels by increasing intradisc pressure. In 2013, a comparison between intersomatic fusion and CDA of two levels showed evidence of superiority in the short term.[7,8,9,10] The purpose of this study is the evaluate the evolution of the range of motion of the lower cervical spine seven years following CDA of two levels in the lower cervical spine
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