International journal of spine surgery · 2026
Likelihood of Achieving Physiological Mobility After Cervical Disc Arthroplasty-Assessing Physiological Motion Restoration vs Physiological Motion Preservation.
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Camerini Andrea, Rondini Marianna, Garrone Ornella, Valsuani Chiara, Donati Sara, Siclari Olimpia, Sgambato Alessandro, Tartarelli Gianna, Vincenti Maura, Mattiot Valentina Polla, Porta Romana Prosperi, Puccetti Cheti, Puccinelli Paolo, Amoroso Domenico
Аннотация
BACKGROUND: A previous study investigated the likelihood of cervical artificial discs achieving post-cervical disc arthroplasty (CDA) range of motion (ROM) in the physiological range, defined as 5° to 16°. Here, we delve deeper into the capability of a disc prosthesis to restore physiological motion when the patient is preoperatively hypomobile (ROM < 5°) or hypermobile (ROM > 16°), and capability to preserve physiological mobility when the preoperative ROM falls in the 5° to 16° range.
METHODS: This is a secondary analysis of prospectively collected radiographic data from 131 patients who participated in a 1-level clinical trial of the M6-C (Orthofix) artificial disc. We chose this prosthesis for demonstration purposes due to the availability of pre- and postoperative flexion-extension ROM data on each individual patient. This allowed calculation of the number of implanted levels with preoperative and postoperative flexion-extension ROM in the following motion ranges: hypomobile (ROM < 5°), physiological mobility (ROM: 5°-16°), and hypermobile (ROM > 16°), resulting in a preoperative vs postoperative 3 × 3 mobility matrix.
RESULTS: Preoperatively, 35 of the 131 implanted levels were hypomobile (ROM: 2.2° ± 1.5°). Of these, physiological ROM was restored to 26 implanted segments by 2 years after CDA (ROM: 7.6° ± 2.0°). A total of 89 of 131 levels had physiological mobility preoperatively (ROM: 9.1° ± 3.3°). Of these, 73 segments preserved their physiological range 2 years after CDA (ROM: 10.2° ± 3.1°). Seven of 131 segments were hypermobile preoperatively (ROM: 18.5° ± 0.9°). Of these, physiological motion was restored to 4 segments by 2 years after CDA (10.9° ± 1.4°). Since the group of patients with preoperative hypermobility was small (n = 7), we combined preoperatively hypo- and hypermobile groups in calculating the restoration rate, resulting in a 2 × 2 mobility matrix. The calculated physiological motion restoration rate was 71% (30/[35 + 7] = 0.71), and preservation rate was 82% (73/89 = 0.82). The combined result was that the prosthesis had a 79% likelihood of yielding physiological mobility at 2 years post-CDA follow-up ([73 + 30]/131).
CONCLUSIONS: The ability to restore and preserve physiological motion are 2 distinct mechanisms that combine to yield physiological motion after CDA. The cervical disc prosthesis analyzed in this study restored physiological motion to 71% of segments with preoperatively nonphysiological (hypomobile plus hypermobile) ROM, while preserving physiological mobility in 82% of segments with preoperative ROM in the physiological range.
CLINICAL RELEVANCE: Knowing the likelihood of achieving an ideal postoperative motion outcome for a range of preoperative mobilities can help in guiding patient expectations about CDA and give clinicians additional information to use during implant selection.
METHODS: This is a secondary analysis of prospectively collected radiographic data from 131 patients who participated in a 1-level clinical trial of the M6-C (Orthofix) artificial disc. We chose this prosthesis for demonstration purposes due to the availability of pre- and postoperative flexion-extension ROM data on each individual patient. This allowed calculation of the number of implanted levels with preoperative and postoperative flexion-extension ROM in the following motion ranges: hypomobile (ROM < 5°), physiological mobility (ROM: 5°-16°), and hypermobile (ROM > 16°), resulting in a preoperative vs postoperative 3 × 3 mobility matrix.
RESULTS: Preoperatively, 35 of the 131 implanted levels were hypomobile (ROM: 2.2° ± 1.5°). Of these, physiological ROM was restored to 26 implanted segments by 2 years after CDA (ROM: 7.6° ± 2.0°). A total of 89 of 131 levels had physiological mobility preoperatively (ROM: 9.1° ± 3.3°). Of these, 73 segments preserved their physiological range 2 years after CDA (ROM: 10.2° ± 3.1°). Seven of 131 segments were hypermobile preoperatively (ROM: 18.5° ± 0.9°). Of these, physiological motion was restored to 4 segments by 2 years after CDA (10.9° ± 1.4°). Since the group of patients with preoperative hypermobility was small (n = 7), we combined preoperatively hypo- and hypermobile groups in calculating the restoration rate, resulting in a 2 × 2 mobility matrix. The calculated physiological motion restoration rate was 71% (30/[35 + 7] = 0.71), and preservation rate was 82% (73/89 = 0.82). The combined result was that the prosthesis had a 79% likelihood of yielding physiological mobility at 2 years post-CDA follow-up ([73 + 30]/131).
CONCLUSIONS: The ability to restore and preserve physiological motion are 2 distinct mechanisms that combine to yield physiological motion after CDA. The cervical disc prosthesis analyzed in this study restored physiological motion to 71% of segments with preoperatively nonphysiological (hypomobile plus hypermobile) ROM, while preserving physiological mobility in 82% of segments with preoperative ROM in the physiological range.
CLINICAL RELEVANCE: Knowing the likelihood of achieving an ideal postoperative motion outcome for a range of preoperative mobilities can help in guiding patient expectations about CDA and give clinicians additional information to use during implant selection.