Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years

Clinical article

Restricted access

Object

This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc.

Methods

Eighteen patients who underwent C5–6 total disc replacement were followed for an average of 27 months. Cervical neutral and flexion-extension lateral radiographs were obtained before and at 1 and 3 months after surgery for early-phase observations and at the last follow-up for late-phase observation. Segmental ROM values in the treated, superior, and inferior adjacent segments were measured. For whole-neck motion, C2–7 ROM was also measured. The percentage contributions of ROM at functional and adjacent segments to whole-neck motion were calculated. For evaluating sagittal alignment, C2–7 and C5–6 Cobb angles were measured. All data from ProDisc-C arthroplasty were compared with the results obtained in 22 patients who underwent C5–6 interbody fusion in which a Solis cage was used and who were followed for an average of 25 months

Results

In the ProDisc-C group, C2–7 and C5–6 ROM significantly decreased in the early phase after surgery and returned to preoperative levels in the late phase. Both superior and inferior adjacent segments showed significantly decreased ROM in the acute phase after surgery and returned to the preoperative values in the late phase. In terms of contributions to whole-neck motion, the ROM of the functional and adjacent segments did not change significantly compared with the preoperative ROM. In the cage group, C2–7 ROM was also significantly decreased in the early phase after surgery and returned to preoperative levels at the late phase. Both superior and inferior adjacent segments exhibited significantly increased ROM and percentage contributions to whole-neck motion in the early and late phases. Sagittal alignment of the whole cervical spine became significantly more lordotic in the late phase in the ProDisc-C group. The C5–6 Cobb angle became significantly lordotic in the ProDisc-C group, whereas there was no significant change in C5–6 Cobb angle in the cage group.

Conclusions

In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.

Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; FSU = functional spinal unit; ROM = range of motion; TDR = total disc replacement.
Article Information

Contributor Notes

Address correspondence to: Keun Su Kim, M.D., Ph.D., Department of Neurosurgery, Spine and Spinal Cord Institute, Yongdong Severance Hospital, 146-92 Dogok-dong, Gangnamgu 135-720 Seoul, South Korea. email: spinekks@yuhs.ac.
Headings
References
  • 1

    Abd-Alrahman NDokmak ASAbou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:108910921999

    • Search Google Scholar
    • Export Citation
  • 2

    Anderson PARouleau JP: Intervertebral disc arthroplasty. Spine 29:277927862004

  • 3

    Baba HFurusawa NImura SKawahara NTsuchiya HTomita K: Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine 18:216721731993

    • Search Google Scholar
    • Export Citation
  • 4

    Bertagnoli RDuggal NPickett GEWigfield CCGill SSKarg A: Cervical total disc replacement, part two: clinical results. Orthop Clin North Am 36:3553622005

    • Search Google Scholar
    • Export Citation
  • 5

    Bertagnoli RYue JJPfeiffer FFenk-Mayer ALawrence JPKershaw T: Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:4034102005

    • Search Google Scholar
    • Export Citation
  • 6

    Bohlman HHEmery SEGoodfellow DBJones 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 75:129813071993

    • Search Google Scholar
    • Export Citation
  • 7

    Bose B: Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol 49:25311998

  • 8

    Chang UKKim DHLee MCWillenberg RKim SHLim J: Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine 7:40462007

    • Search Google Scholar
    • Export Citation
  • 9

    Clements DHO'Leary PF: Anterior cervical discectomy and fusion. Spine 15:102310251990

  • 10

    DiAngelo DJFoley KTMorrow BRSchwab JSSong JGerman JW: In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant. Neurosurg Focus 17:E72004

    • Search Google Scholar
    • Export Citation
  • 11

    DiAngelo DJRoberston JTMetcalf NHMcVay BJDavis RC: Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:3143232003

    • Search Google Scholar
    • Export Citation
  • 12

    Dohler JRKahn MRHughes SP: Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients. Arch Orthop Trauma Surg 104:2472501985

    • Search Google Scholar
    • Export Citation
  • 13

    Dvorak JFroehlich DPenning LBaumgartner HPanjabi MM: Functional radiographic diagnosis of the cervical spine: flexion-extension. Spine 13:7487551988

    • Search Google Scholar
    • Export Citation
  • 14

    Fuller DAKirkpatrick JSEmery SEWilber RGDavy DT: A kinematic study of the cervical spine before and after segmental arthrodesis. Spine 23:164916561998

    • Search Google Scholar
    • Export Citation
  • 15

    Goffin JCasey AKehr PLiebig KLind BLogroscino C: Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery 51:8408472002

    • Search Google Scholar
    • Export Citation
  • 16

    Goffin Jvan Loon JVan Calenbergh FPlets C: Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord 8:4995081995

    • Search Google Scholar
    • Export Citation
  • 17

    Hilibrand ASCarlson GDPalumbo MAJones PKBohlman HH: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:5195281999

    • Search Google Scholar
    • Export Citation
  • 18

    Hilibrand ASRobbins M: Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?. Spine J 4:190S194S2004

    • Search Google Scholar
    • Export Citation
  • 19

    Hilibrand ASYoo JUCarlson GDBohlman HH: The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine 22:157415791997

    • Search Google Scholar
    • Export Citation
  • 20

    Katsuura AHukuda SSaruhashi YMori K: Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:3203242001

    • Search Google Scholar
    • Export Citation
  • 21

    Kim SWShin JHArbatin JJPark MSChung YKMcAfee PC: Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine. Eur Spine J 17:20292008

    • Search Google Scholar
    • Export Citation
  • 22

    Lind BSihlbom HNordwall AMalchau H: Normal range of motion of the cervical spine. Arch Phys Med Rehabil 70:6926951989

  • 23

    Miyazaki MHong SWYoon SHZou JTow BAlanay A: Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine. Spine 33:1871932008

    • Search Google Scholar
    • Export Citation
  • 24

    Murrey DJanssen MDelamarter RGoldstein JZigler JTay B: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:2752862009

    • Search Google Scholar
    • Export Citation
  • 25

    Nabhan AAhlhelm FShariat KPitzen TSteimer OSteudel WI: The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine 32:193519412007

    • Search Google Scholar
    • Export Citation
  • 26

    Pickett GEMitsis DKSekhon LHSears WRDuggal N: Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 17:E52004

    • Search Google Scholar
    • Export Citation
  • 27

    Pickett GESekhon LHSears WRDuggal N: Complications with cervical arthroplasty. J Neurosurg Spine 4:981052006

  • 28

    Rabin DBertagnoli RWharton NPickett GEDuggal N: Sagittal balance influences range of motion: an in vivo study with the ProDisc-C. Spine J 9:1281332009

    • Search Google Scholar
    • Export Citation
  • 29

    Rousseau MACottin PLevante SNogier ALazennec JYSkalli W: In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine 33:E6E92008

    • Search Google Scholar
    • Export Citation
  • 30

    Shim CSLee SHPark HJKang HSHwang JH: Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech 19:4654702006

    • Search Google Scholar
    • Export Citation
  • 31

    Wigfield CCSkrzypiec DJackowski AAdams MA: Internal stress distribution in cervical intervertebral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech 16:4414492003

    • Search Google Scholar
    • Export Citation
  • 32

    Wu WThuomas KAHedlund RLeszniewski WVavruch L: Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging. Acta Radiol 37:6146171996

    • Search Google Scholar
    • Export Citation
  • 33

    Yoon DHYi SShin HCKim KNKim SH: Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148:9439502006

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 216 169 20
Full Text Views 154 33 1
PDF Downloads 102 23 2
EPUB Downloads 0 0 0
PubMed
Google Scholar