Skip to main content
SpringerLink
Log in

Changes in cervical motion after cervical spinal motion preservation surgery

  • Original Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

For patients with single-level cervical radiculopathy, various types of motion preservation surgeries, such as total disc replacement (TDR), posterior cervical foraminotomy (PCF) and posterior percutaneous endoscopic foraminotomy and discectomy (PECF), are available. In addition to motion preservation, the quality of motion is an important issue. The aim of the present study was to evaluate the influence of these surgeries on cervical motion by comparing the instantaneous axis of rotation (IAR) among PECF, TDR and PCF at the index and superior/inferior adjacent segments.

Methods

A retrospective review was performed of patients who underwent index surgery at C5–6 for cervical single-level foraminal disc herniation or foraminal stenosis. Patients with minimal degeneration at the index and other cervical spinal levels and flexion/extension cervical lateral radiographs both preoperatively and 6 months postoperatively were included (PECF, 11 patients; TDR, 11 patients; PCF, 12 patients). The IARs were calculated at the index segment and segments above and below the index segment from the flexion and extension cervical lateral radiographs, which were obtained preoperatively and 6 months postoperatively. A standardized cervical normogram was referenced to qualify shifts in the IAR.

Results

Postoperatively, neck pain was significantly decreased, with no difference among the surgical methods. The IARs were not significantly changed after the PECF. Although significant inferior shift occurred at C6–7 after TDR (p = 0.02), the shift occurred within the normal range in the cervical normogram. However, significant inferior shifts in the IARs occurred after PCF at C5–6 (p = 0.02) and C6–7 (p = 0.02), and the IARs moved out of the normal range.

Conclusions

The IARs were significantly changed after PCF at either the index segment or the adjacent segment below. The shifts in IAR at the index and adjacent segments were not significant after PECF and TDR. The sample size was too small to allow definitive conclusions, but the present study showed that PECF may be another alternative to motion preservation surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Alvin MD, Qureshi S, Klineberg E, Riew KD, Fischer DJ, Norvell DC, Mroz TE (2014) Cervical degenerative disease: systematic review of economic analyses. Spine (Phila Pa 1976) 39:S53–S64

    Article  Google Scholar 

  2. Amevo B, Aprill C, Bogduk N (1992) Abnormal instantaneous axes of rotation in patients with neck pain. Spine (Phila Pa 1976) 17:748–756

    Article  CAS  Google Scholar 

  3. Amevo B, Macintosh JE, Worth D, Bogduk N (1991) Instantaneous axes of rotation of the typical cervical motion segments: I. An empirical study of technical errors. Clin Biomech (Bristol, Avon) 6:31–37

    Article  CAS  Google Scholar 

  4. Amevo B, Worth D, Bogduk N (1991) Instantaneous axes of rotation of the typical cervical motion segments: a study in normal volunteers. Clin Biomech (Bristol, Avon) 6:111–117

    Article  CAS  Google Scholar 

  5. Amevo B, Worth D, Bogduk N (1991) Instantaneous axes of rotation of the typical cervical motion segments: II. Optimization of technical errors. Clin Biomech (Bristol, Avon) 6:38–46

    Article  CAS  Google Scholar 

  6. Anderst W, Baillargeon E, Donaldson W, Lee J, Kang J (2013) Motion path of the instant center of rotation in the cervical spine during in vivo dynamic flexion-extension: implications for artificial disc design and evaluation of motion quality after arthrodesis. Spine (Phila Pa 1976) 38:E594–E601

    Article  Google Scholar 

  7. Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W (2012) Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J 21:1648–1659

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bogduk N, Amevo B, Pearcy M (1995) A biological basis for instantaneous centres of rotation of the vertebral column. Proc Inst Mech Eng H 209:177–183

    Article  CAS  PubMed  Google Scholar 

  9. Bogduk N, Mercer S (2000) Biomechanics of the cervical spine. I: normal kinematics. Clin Biomech 15:633–648

    Article  CAS  Google Scholar 

  10. Chin-See-Chong TC, Gadjradj PS, Boelen RJ, Harhangi BS (2017) Current practice of cervical disc arthroplasty: a survey among 383 AOSpine international members. Neurosurg Focus 42:E8

    Article  PubMed  Google Scholar 

  11. Harrod CC, Hilibrand AS, Fischer DJ, Skelly AC (2012) Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine (Phila Pa 1976) 37:S96–S112

    Article  Google Scholar 

  12. Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA (2009) The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine 10:347–356

    Article  PubMed  Google Scholar 

  13. Jho HD, Kim WK, Kim MH (2002) Anterior microforaminotomy for treatment of cervical radiculopathy: part 1—disc-preserving “functional cervical disc surgery”. Neurosurgery 51:S46–S53

    PubMed  Google Scholar 

  14. Kim CH, Kim KT, Chung CK, Park SB, Yang SH, Kim SM, Sung JK (2015) Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation. Eur Spine J 24:3005–3012

    Article  PubMed  Google Scholar 

  15. Kim CH, Shin KH, Chung CK, Park SB, Kim JH (2015) Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy. Global Spine J 5:31–38

    Article  PubMed  Google Scholar 

  16. Kim HJ, Nemani VM, Piyaskulkaew C, Vargas SR, Riew KD (2016) Cervical Radiculopathy: incidence and treatment of 1,420 consecutive cases. Asian Spine J 10:231–237

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim KT, Cho DC, Sung JK, Kim YB, Kim DH (2017) Comparative analysis between total disc replacement and posterior foraminotomy for posterolateral soft disc herniation with unilateral radiculopathy: clinical and biomechanical results of a minimum 5 years follow-up. J Korean Neurosurg Soc 60:30–39

    Article  PubMed  Google Scholar 

  18. Kong L, Ma Q, Meng F, Cao J, Yu K, Shen Y (2017) The prevalence of heterotopic ossification among patients after cervical artificial disc replacement: a systematic review and meta-analysis. Medicine (Baltimore) 96:e7163

    Article  Google Scholar 

  19. Lee H, Nicholson LL, Adams RD, Maher CG, Halaki M, Bae SS (2006) Development and psychometric testing of Korean language versions of 4 neck pain and disability questionnaires. Spine (Phila Pa 1976) 31:1841–1845

    Article  Google Scholar 

  20. Lee SE, Chung CK, Jahng TA (2012) Early development and progression of heterotopic ossification in cervical total disc replacement. J Neurosurg Spine 16:31–36

    Article  PubMed  Google Scholar 

  21. Lind B, Zoega B, Anderson PA (2007) A radiostereometric analysis of the Bryan cervical disc prosthesis. Spine (Phila Pa 1976) 32:885–890 discussion 891

    Article  Google Scholar 

  22. Liu B, Liu Z, VanHoof T, Kalala J, Zeng Z, Lin X (2014) Kinematic study of the relation between the instantaneous center of rotation and degenerative changes in the cervical intervertebral disc. Eur Spine J 23:2307–2313

    Article  PubMed  Google Scholar 

  23. Liu B, Zeng Z, Hoof TV, Kalala JP, Liu Z, Wu B (2015) Comparison of hybrid constructs with 2-level artificial disc replacement and 2-level anterior cervical discectomy and fusion for surgical reconstruction of the cervical spine: a kinematic study in whole cadavers. Med Sci Monit 21:1031–1037

    Article  PubMed  PubMed Central  Google Scholar 

  24. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC (2008) Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech 21:288–292

    Article  PubMed  Google Scholar 

  25. Ohnmeiss DD, Guyer RD (2009) Twenty-four month follow-up for reporting results of spinal implant studies: is this guideline supported by the literature? SAS J 3:100–107

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park DK, Lin EL, Phillips FM (2011) Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976) 36:721–730

    Article  Google Scholar 

  27. Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD (2014) Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 14:1228–1234

    Article  PubMed  Google Scholar 

  28. Park MS, Moon SH, Kim TH, Lee SY, Jo YG, Riew KD (2015) Relationship between modic changes and facet joint degeneration in the cervical spine. Eur Spine J 24:2999–3004

    Article  PubMed  Google Scholar 

  29. Park SB, Jahng TA, Chung CK (2012) Remodeling of adjacent spinal alignments following cervical arthroplasty and anterior discectomy and fusion. Eur Spine J 21:322–327

    Article  PubMed  Google Scholar 

  30. Penning L (1978) Normal movements of the cervical spine. AJR Am J Roentgenol 130:317–326

    Article  CAS  PubMed  Google Scholar 

  31. Powell JW, Sasso RC, Metcalf NH, Anderson PA, Hipp JA (2010) Quality of spinal motion with cervical disk arthroplasty: computer-aided radiographic analysis. J Spinal Disord Tech 23:89–95

    Article  PubMed  Google Scholar 

  32. Riew KD, Cheng I, Pimenta L, Taylor B (2007) Posterior cervical spine surgery for radiculopathy. Neurosurgery 60:S57–S63

    Article  PubMed  Google Scholar 

  33. Riew KD, Schenk-Kisser JM, Skelly AC (2012) Adjacent segment disease and C-ADR: promises fulfilled? Evid Based Spine Care J 3:39–46

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ruetten S, Komp M, Merk H, Godolias G (2007) A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg 50:219–226

    Article  CAS  PubMed  Google Scholar 

  35. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:940–948

    Article  Google Scholar 

  36. Selvik G (1989) Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand Suppl 232:1–51

    Article  CAS  PubMed  Google Scholar 

  37. Singhatanadgige W, Kang DG, Luksanapruksa P, Peters C, Riew KD (2016) Correlation and reliability of cervical sagittal alignment parameters between lateral cervical radiograph and lateral whole-body EOS Stereoradiograph. Global Spine J 6:548–554

    Article  PubMed  Google Scholar 

  38. Skovrlj B, Gologorsky Y, Haque R, Fessler RG, Qureshi SA (2014) Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 14:2405–2411

    Article  PubMed  Google Scholar 

  39. Woltring HJ, Long K, Osterbauer PJ, Fuhr AW (1994) Instantaneous helical axis estimation from 3-D video data in neck kinematics for whiplash diagnostics. J Biomech 27:1415–1432

    Article  CAS  PubMed  Google Scholar 

  40. Won S, Kim CH, Chung CK, Choi Y, Park SB, Moon JH, Heo W, Kim SM (2016) Clinical outcomes of single-level posterior percutaneous endoscopic cervical foraminotomy for patients with less cervical lordosis. J Minim Invasive Spine Surg Tech 1:11–17

    Article  Google Scholar 

  41. Won S, Kim CH, Chung CK, Choi Y, Park SB, Moon JH, Heo W, Kim SM (2017) Comparison of cervical sagittal alignment and kinematics after posterior full-endoscopic cervical foraminotomy and discectomy according to preoperative cervical alignment. Pain Physician 20:77–87

    Article  PubMed  Google Scholar 

Download references

Funding

Seoul National University Hospital provided financial support in the form of a research grant (Grant No. 0320160210; 2016–1062). The sponsor had no role in the design or conduct of this research.

Author information

Author notes

  1. C.H. Kim and T.H. Park contributed equally to this manuscript as joint first authors

Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Chi Heon Kim & Chun Kee Chung

  2. Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Chi Heon Kim & Chun Kee Chung

  3. Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Chi Heon Kim & Chun Kee Chung

  4. R&D Center, Medyssey Co., Ltd, 129, Hanbang expo-ro, Jecheon-si, Chungcheongbuk-do, 27116, South Korea

    Tae Hyun Park

  5. Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea

    Chun Kee Chung

  6. Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea

    Kyoung-Tae Kim

  7. Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Yun Hee Choi

  8. Department of Neurosurgery, Daegu Wooridul Spine Hospital, 648, Gukchaebosang-ro, Jung-gu, Daegu, South Korea

    Seok-Won Chung

Authors
  1. Chi Heon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tae Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun Kee Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyoung-Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yun Hee Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seok-Won Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. C.H. Kim, K.T. Kim, C.K. Chung, Y. Choi, and T.H. Park had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. C.H. Kim, K.T. Kim, T.H. Park and C.K. Chung designed the study protocol. Drs. C.H. Kim, and T.H. Park managed the literature searches and summaries of the previous related works and wrote the first draft of the manuscript. Drs. C.K. Chung, K.T. Kim and Y. Choi provided revisions for intellectual content and the final approval of the manuscript.

Corresponding author

Correspondence to Chun Kee Chung.

Ethics declarations

Conflict of interest

C.H. Kim is a consultant at Richard Wolf GmbH. All the other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of Seoul National University Hospital (H-1702-015-829).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, C.H., Park, T.H., Chung, C.K. et al. Changes in cervical motion after cervical spinal motion preservation surgery. Acta Neurochir 160, 397–404 (2018). https://doi.org/10.1007/s00701-017-3375-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3375-x

Keywords

Search

Navigation