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Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis

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Abstract

Purpose

Recent studies describe significant rates of heterotopic ossification (HO) after cervical total disc replacement (CTDR). Little is known about the reasons, and one aspect that requires further in vivo investigation is the biomechanical alteration after CTDR and the role of the implant-related centre of rotation (CORi) in particular. The role of the sagittal position of the CORi on functional outcome in two versions of a semi-constrained disc prosthesis with sagittally different CORi is the topic of this study.

Methods

Patients were candidates for single-level CTDR between C3 and C7 who suffered from CDDD and received a standard or flat version of activ C™ (Aesculap AG, Tuttlingen). Clinical and radiographic assessments were determined preoperatively, intraoperatively, at discharge and again at 6 weeks, 6 months, 1 and 2 years. Radiographic examinations were performed independently using specialized quantitative motion analysis software.

Results

Clinical outcome improved significantly regarding NDI as well as VAS on neck and arm pain with no differences in mean improvement by study group. Segmental angle measures show a significantly better lordotic alignment for both groups after surgery, but the degree of correction achieved is higher in the flat group. Correlation analysis proves that the more anterior the CORi is positioned, the higher the lordotic correction is achieved (Pearson rho −0.385). Segmental ROM decreased in the standard group but was maintained for flat implants. At present, our data do not demonstrate a correlation between CORi and ROM at 2 years. Two years after surgery, severe HO grade III–IV was present in 31.6 % standard and 13.1 % flat cases with significant differences. Grouping according to HO severity showed comparable sagittal positions of CORi for flat implants but a more posterior position in the severe HO group for standard implants.

Conclusions

Our results confirm the influence of CORi location on segmental alignment, kinematics and HO for a semi-constrained CTDR, but it also indicates a multifactorial process.

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Acknowledgments

The authors wish to thank Mrs Nele Borm, frictionless GmbH, Kiel, Germany for her contributions to this study, especially in monitoring data collection, performing statistical analyses, supervising the conduct of the study and writing the final draft of the article. Funding for the study was received from Aesculap AG (Tuttlingen, Germany). Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but will be directed solely to research funds, foundations, educational institutions, or other non-profit organizations with which one or more of the authors are associated. PS, SS, HJM, CW and BB are consultants of Aesculap AG (Tuttlingen, Germany).

Conflict of interest

None of the authors has any potential conflict of interest.

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Authors and Affiliations

  1. Neurocentre, Regional Hospital Liberec, Husova 10, 46063, Liberec, Czech Republic

    P. Suchomel & L. Jurák

  2. Department of Neurosurgery, University of Helsinki, Helsinki, Finland

    J. Antinheimo & J. Pohjola

  3. Spinal Surgery, University Hospital Motol, Prague, Czech Republic

    J. Stulik

  4. Department of Neurosurgery, BG Clinic Bergmannstrost, Halle, Germany

    H.-J. Meisel

  5. Department of Neurosurgery, Charité University Hospital and School of Medicine, Berlin, Germany

    M. Čabraja

  6. Neurosurgery and Spine Surgery in Orthopaedic Practice, Berlin, Germany

    C. Woiciechowsky

  7. Spinal Surgery, Katholisches Klinikum Koblenz, Koblenz, Germany

    B. Bruchmann

  8. Department of Orthopaedics and Trauma, Warrington District General Hospital, Warrington, UK

    I. Shackleford

  9. Neurosurgical Department, Hospital Maz, Zaragoza, Spain

    R. Arregui

  10. Department of Neurosurgery, University of Rostock, Rostock, Germany

    S. Sola

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  1. P. Suchomel
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  2. L. Jurák
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Correspondence to P. Suchomel.

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Suchomel, P., Jurák, L., Antinheimo, J. et al. Does sagittal position of the CTDR-related centre of rotation influence functional outcome? Prospective 2-year follow-up analysis. Eur Spine J 23, 1124–1134 (2014). https://doi.org/10.1007/s00586-014-3223-0

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  • DOI: https://doi.org/10.1007/s00586-014-3223-0

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