Highlights
- •The cervical spine compensates for operative loss of ROM in ACDF patients.
- •TDR-C patients have greater improvement in total cervical ROM than ACDF patients.
- •TDR-C maintains a better physiologic distribution of ROM than ACDF.
Abstract
This study was a retrospective radiographic evaluation of patients after cervical
total disc replacement (TDR-C) or anterior cervical discectomy and fusion (ACDF) for
one-level cervical disc disease. Our objective was to evaluate (1) total cervical
(C1–C7) range of motion (ROM) during dynamic imaging, and (2) relative contribution
to total cervical ROM from operative and adjacent levels. Radiographic review of 64
patients who underwent TDR-C (n = 30) or ACDF (n = 34) for one-level cervical disc
disease. ROM measurements were performed independently using a vertebral motion analysis
system to evaluate total cervical ROM and relative contribution to total ROM from
each level (C1–C7) preoperatively and at 12-month follow-up. At follow-up, TDR-C patients
had significantly greater improvement in total cervical ROM (+5.67°, 1.15 mm) than
ACDF patients (−0.96°, 0.12 mm) (P = 0.001). In TDR-C patients, relative contributions to total cervical ROM from operative
and adjacent caudal and cranial levels were statistically equivalent to baseline values.
ACDF patients had a significantly reduced contribution to total cervical ROM from
the operative level (−22.5%, P < 0.001) and significantly elevated contributions from the adjacent caudal level
(+16.5%–21.3%, P < 0.001) and from the adjacent first (20.6% vs. 34.6%, P < 0.001), second (22.9% vs. 30.4%, P < 0.001), and third cranial levels (17.5% vs. 25.6%, P < 0.001). The cervical spine compensates for loss of ROM at the operative level in
ACDF patients. However, total cervical ROM increases with TDR-C and maintains physiologic
distribution of ROM throughout the cervical spine at 12-month follow-up, potentially
reducing the risk for adjacent segment breakdown.
Abbreviations:
ACDF (anterior cervical discectomy and fusion), ASD (adjacent segment disease), CSM (cervical spondylotic myeloradiculopathy), ROM (range of motion), TDR-C (cervical total disc replacement), VMA (vertebral motion analysis)Keywords
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Article info
Publication history
Published online: September 06, 2018
Accepted:
August 21,
2018
Received:
February 8,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
