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Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement

Neurospine 2020년 17권 3호 p.588 ~ 602
목정기, Vaishnav Avani S., Chaudhary Chirag, Alluri R. Kiran, Lee Ryan, Urakawa Hikari, Sato Kosuke, Chen Darren A., Gang Catherine Himo, Huang Russel C., Albert Todd J., Qureshi Sheeraz A.,
소속 상세정보
목정기 ( Mok Jung-Kee ) - Weill Cornell Medical College
 ( Vaishnav Avani S. ) - Hospital for Special Surgery
 ( Chaudhary Chirag ) - Hospital for Special Surgery
 ( Alluri R. Kiran ) - Hospital for Special Surgery
 ( Lee Ryan ) - Hospital for Special Surgery
 ( Urakawa Hikari ) - Hospital for Special Surgery
 ( Sato Kosuke ) - Hospital for Special Surgery
 ( Chen Darren A. ) - Weill Cornell Medical College
 ( Gang Catherine Himo ) - Hospital for Special Surgery
 ( Huang Russel C. ) - Weill Cornell Medical College
 ( Albert Todd J. ) - Weill Cornell Medical College
 ( Qureshi Sheeraz A. ) - Hospital for Special Surgery

Abstract


Objective: To evaluate outcomes of cervical disc replacement (CDR) in patients with nonlordotic alignment.

Methods: Patients who underwent CDR were retrospectively reviewed and divided into 3 cohorts: (1) neutral/lordotic segmental and C2?7 Cobb angle (L), (2) nonlordotic segmental Cobb angle, lordotic C2?7 Cobb angle (NL-S), and (3) nonlordotic segmental and C2?7 Cobb angle (NL-SC). Radiographic and patient-reported outcomes (PROMs) were compared.

Results: One-hundred five patients were included (L: 37, NL-S: 30, NL-SC: 38). A significant gain in segmental lordosis was seen in all cohorts at < 6 months (L: -1.90° [p = 0.007]; NL-S: -5.16° [p < 0.0001]; NL-SC: -6.00° [p < 0.0001]) and ≥ 6 months (L: -2.07° [p = 0.031; NL-S: -6.04° [p < 0.0001]; NL-SC: -6.74° [p < 0.0001]), with greater lordosis generated in preoperatively nonlordotic cohorts (p < 0.0001). C2?7 lordosis improved in the preoperatively nonlordotic cohort (NL-SC: 8.04°) at follow-up of < 6 months (-4.15°, p=0.003) and ≥ 6 months (-6.40°, p=0.003), but not enough to create lordotic alignment (< 6 months: 3.89°; ≥ 6 months: 4.06°). All cohorts showed improvement in Neck Disability Index, visual analogue scale (VAS) neck, and VAS arm, without significant difference among groups in the amount of improvement (≥ 6-month PROMs follow-up=69%).

Conclusion: In patients without major kyphotic deformity, CDR has the potential to generate and maintain lordosis and improve PROMs in the short-term, and can be an effective treatment option for patients with nonlordotic alignment.

키워드

Cervical disc replacement; Segmental alignment; Cervical alignment; Nonlordotic alignment

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