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首页> 外文期刊>The spine journal: official journal of the North American Spine Society >Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation
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Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation

机译：人工颈椎间盘置换术与颈前路椎间盘摘除融合术治疗颈椎间盘突出症患者的颈椎运动学比较

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Background context Although anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments. In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR. However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional motion and coupled movement during motion of one axis. Purpose The purpose of this study was to compare the clinical parameters and cervical motion by three-dimensional motion analysis between ACDF and ADR and to investigate the ability of ADR to maintain cervical kinematics. Study design This was a prospective case control study. Patient sample Patients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation. Outcome measures Visual analog scale (VAS), Korean version of Neck Disability Index (NDI, %), and three-dimensional motion analysis were used. Methods The patients were evaluated by VAS and the Korean version of the NDI (%) to assess pain degree and functional status. Cervical motions were assessed by three-dimensional motion analysis in terms of sagittal, coronal, and horizontal planes. Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10-20 system of electroencephalography, C7 spinous process, and both acromions. These evaluations were performed preoperatively and 1 month and 6 months after surgery. Results The ACDF and ADR groups revealed no significant difference in VAS, NDI (%), and cervical range of motion preoperatively. After surgery, both groups showed no significant difference in VAS and NDI (%). In motion analysis, significantly more range of motion was retained in flexion and extension in the ADR group than the ACDF group at 1 month and 6 months. There was no significant difference in lateral tilt and rotation angle. In terms of coupled motion, ADR group exhibited significantly more preserved sagittal plane motion during right and left rotation and also showed significantly more preserved right lateral bending angle during right rotation than ACDF group at 1 month and 6 months. There was no significant difference in other coupled motions. Conclusion Three-dimensional motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes. ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF. ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.
机译：背景技术尽管颈椎前路椎间盘切除术和融合术（ACDF）对于颈椎间盘突出症患者是一种有效的治疗选择，但它限制了颈椎的运动范围，有时会引起不适并导致邻近节段的生物力学应力。相反，与ACDF相比，宫颈人工椎间盘置换术（ADR）可以保持正常的宫颈运动范围。为了确定ADR的优势和临床意义，必须进行生物力学测量。但是，关于该主题的文献很少，在那些可用的研究中，作者使用了静态放射学方法，该方法无法识别三维运动和单轴运动期间的耦合运动。目的本研究的目的是通过ACDF和ADR之间的三维运动分析来比较临床参数和宫颈运动，并研究ADR保持宫颈运动学的能力。研究设计这是一项前瞻性病例对照研究。患者样本接受ADR或ACDF治疗单级颈椎间盘突出症的患者。结果测量使用了视觉模拟量表（VAS），韩文版的颈部残疾指数（NDI，％）和三维运动分析。方法采用VAS和韩文版NDI（％）对患者进行评估，以评估疼痛程度和功能状态。通过三维运动分析评估矢状，冠状和水平面的颈椎运动。直径为2.5 cm的标记附着在10-20脑电图系统，C7棘突和两个肩峰的额极（Fpz），中心（Cz）和枕骨（Oz）处。这些评估是在术前以及术后1个月和6个月进行的。结果ACDF和ADR组术前VAS，NDI（％）和颈椎活动范围无明显差异。手术后，两组的VAS和NDI均无明显差异（％）。在运动分析中，与ACDF组相比，在1个月和6个月时，ADR组的屈伸运动保留的运动范围明显更多。横向倾斜度和旋转角度无明显差异。在耦合运动方面，与ACDF组相比，在1个月和6个月时，ADR组在左右旋转时表现出明显更多的矢状面运动，并且在右旋过程中也表现出更多的保留右侧弯角。其他耦合运动没有显着差异。结论三维运动分析可以客观，定量地提供有关术后颈椎运动的有用信息。此外，它不仅使我们能够测量主运动，而且还能测量三个平面中的耦合运动。与ACDF相比，ADR表现出主要在矢状平面（屈伸）中更好的保留颈椎运动，在横断面运动期间更好地保留了矢状和冠状耦合运动。 ADR的优势在于，与ACDF相比，它具有在手术后保留更多宫颈运动的能力。

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