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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

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Published on: August 7, 2018

Cervical disc arthroplasty for less-mobile discs.

Tsung-Hsi Tu^1,2,3, Chu-Yi Lee^1,2, Chao-Hung Kuo^1,2

¹1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.

Journal of Neurosurgery. Spine

|May 11, 2019

Summary

This summary is machine-generated.

Cervical disc arthroplasty (CDA) provides similar clinical improvements regardless of preoperative range of motion (ROM). Patients with less preoperative ROM experienced greater increases in motion after CDA but remained less mobile overall.

Keywords:

ACDF = anterior cervical discectomy and fusion ASD = adjacent-segment degeneration CDA CDA = cervical disc arthroplasty HO = heterotopic ossification JOA = Japanese Orthopaedic Association NDI = Neck Disability Index PLL = posterior longitudinal ligament ROM ROM = range of motion VAS = visual analog scale cervical disc arthroplasty range of motion segmental mobility

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Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Cervical disc arthroplasty (CDA) successfully preserves motion, but outcomes based on preoperative range of motion (ROM) are not well-defined.
Previous trials included patients with adequate preoperative mobility (≥2°).
The impact of lower preoperative ROM on CDA outcomes requires further investigation.

Purpose of the Study:

To compare clinical and radiological outcomes of cervical disc arthroplasty (CDA) in patients with low versus high preoperative C5-6 range of motion (ROM).
To determine if preoperative ROM influences the success of motion preservation after CDA.

Main Methods:

Retrospective review of 60 patients undergoing C5-6 CDA for radiculopathy/myelopathy.
Patients were grouped by preoperative ROM: less-mobile (≤5°) and more-mobile (>5°).
Clinical outcomes (VAS, NDI, JOA) and radiological ROM were assessed over 2 years.

Main Results:

Both groups showed significant clinical improvement with no significant differences.
The less-mobile group had a greater increase in ΔROM (5.5° vs 0.1°, p=0.001) but less final segmental mobility (8.5° vs 11.7°, p=0.04).
Complication rates were similar between groups.

Conclusions:

Preoperative segmental mobility does not affect clinical outcomes after cervical disc arthroplasty (CDA).
Patients with less preoperative ROM achieve similar clinical success and greater motion increase post-CDA.
Despite greater motion increase, less-mobile discs remain less mobile postoperatively.