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Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

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Abstract

Background

The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels.

Materials and methods

Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv™ implant, Scient’x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview™, Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects.

Results

Both local and C3–C7 lordosis significantly increased postoperatively (+8° and +13° at 2 years, respectively). At instrumented level ROM in flexion–extension (FE) was measured to 10.2° preoperatively versus 7.5° at 1 year and 6.1° at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels.

Conclusion

Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.

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Conflict of interest

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Authors and Affiliations

  1. Department of Spine Surgery, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel, 69394, Lyon, France

    Cédric Barrey & Gilles Perrin

  2. University Claude bernard LYON 1, Lyon, France

    Cédric Barrey & Gilles Perrin

  3. Laboratory of Biomechanics, ENSAM, Arts et Metiers PARISTECH, 151 boulevard de l’Hôpital, 75640, Paris, France

    Cédric Barrey, Sabina Champain, Sophie Campana & Wafa Skalli

  4. Department of Neurosurgery, Clinique Beausoleil, Geneva, Switzerland

    Aymen Ramadan

  5. 11 ter rue Saint-Gervais, 69008, Lyon, France

    Cédric Barrey

Authors
  1. Cédric Barrey
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  2. Sabina Champain
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  3. Sophie Campana
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  4. Aymen Ramadan
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  5. Gilles Perrin
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  6. Wafa Skalli
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Correspondence to Cédric Barrey.

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Barrey, C., Champain, S., Campana, S. et al. Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J 21, 1648–1659 (2012). https://doi.org/10.1007/s00586-012-2180-8

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  • DOI: https://doi.org/10.1007/s00586-012-2180-8

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