Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.
METHODS
Retrospective study of patients enrolled in a prospective randomized Food and Drug Administration trial with single level cervical disc replacement (CDR) with the ProDisc-C (Synthes, Paoli, PA).


OBJECTIVE
Evaluate the segmental range of motion (ROM) in the cervical spine pre- and postoperative after CDR.


BACKGROUND
Each cervical level is believed to have its own biomechanical characteristics, ultimately leading to different sagittal and lateral ROM. Our understanding of the factors that influence motion after CDR continues to change and expand.


METHODS
One hundred sixty-four patients with single level ProDisc-C arthroplasty were evaluated radiographically using Medical Metrics (QMATM, Medical Metrics, Inc., Houston, TX). Pre- and postoperative disc height and ROM were measured from standing lateral and flexion-extension radiographs. Of these 164 patients, 44 had a CDR at C6/C7, 96 at C5/C6, 18 at C4/C5, and 6 at C3/C4. The mean follow-up was of 24 months. Statistical analysis evaluated the difference in mean ROM between the groups.


RESULTS
Before surgery, C4/C5 had more sagittal ROM compared with C3/C4, C5/C6, and C6/C7 (P < 0.001.) Before surgery, C4/C5 also had more lateral ROM compared with C3/C4, C5/C6, and C6/C7 (P = 0.015). After surgery, there were no significant differences in sagittal and lateral ROM between C3/C4, C4/C5, C5/C6, and C6/C7. The delta (difference between pre- and postoperative) proved that the C4/C5 CDR actually lost sagittal ROM (-2.5 degrees ) compared with the other levels, which gained sagittal ROM, C3/C4 (0.9 degrees ), C5/C6 (1.8 degrees ), and C6/C7 (1.6 degrees ); P = 0.037. There was no significant difference in the delta lateral ROM between the segments: C3/C4, C4/C5, C5/C6, and C6/C7.


CONCLUSIONS
CDR approximates the different segmental sagittal and lateral ROM. Although C4/C5 had negative delta ROM in the sagittal and lateral planes, it provided a satisfactory final ROM. Long-term clinical outcome studies are needed to properly evaluate if these differences could ultimately affect the patients everyday life.
Park
Justin J
JJ
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E. 17th Street, New York, NY 10003, USA. justin.park@nyumc.org
Quirno
Martin
M
Cunningham
Mary R
MR
Schwarzkopf
Ran
R
Bendo
John A
JA
Spivak
Jeffrey M
JM
Goldstein
Jeffrey A
JA
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000502:physiology* / Q000601:surgery*; D015331:Cohort Studies; D017586:Diskectomy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000592:standards / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery