Clinical and radiological findings after multilevel cervical total disc replacement: defining radiological changes to predict surgical outcomes.

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Clinical and radiological findings after multilevel cervical total disc replacement: defining radiological changes to predict surgical outcomes.

World Neurosurg. 2017 Jan 17;:

Authors: Lee JH, Lee SH, Lee JH

Abstract
OBJECTIVE: This study compared the radiological parameters between preoperation and postoperation for patients who underwent multilevel cervical total disc replacement (MCTDR) and assessed which parameters were related to successful clinical outcomes after MCTDR.
METHODS: The study included a consecutive series of 24 patients who were treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric Rating Scale (NRS), C2-7 sagittal vertical axis (SVA), range of motion (ROM) of C2-7 segment and TDR implanted levels were evaluated at pre- and post-TDR. These parameters were compared between patients who experienced successful (S) and unsuccessful (US) pain relief.
RESULTS: NRS scores were reduced while C2-7 SVA improved significantly after MCTDR. C2-7 flexion was significantly decreased (p<0.05), while its extension showed trends toward considerable (P=0.088) increase, thereby maintaining original C2-7 ROM without statistical significance. TDR flexion was decreased (p<0.05), while its extension changes were stationary, consequently resulting in a significant decrease in TDR ROM. (p<0.05) The US group showed markedly reduced ROM and lack of ROM angular change maintenance both at the C2-7 and MCTDR levels (p<0.05) compared to the S group.
CONCLUSIONS: MCTDR was effective in reducing pain as well as improving cervical lordosis in patients with multilevel cervical disc herniation or stenosis. Despite a significant decrease in the flexion angle, it could maintain C2-7 ROM presumably by compensating with C2-7 extension angle increase. Clinical success after MCTDR was crucially related to retaining original C2-7 ROM and minimizing ROM angular changes both at the C2-7 and MCTDR levels.

PMID: 28108424 [PubMed - as supplied by publisher]

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