School of Medicine, MD Candidate University of Colorado University of Colorado School of Medicine
Introduction: Cervical disc arthroplasty (cTDR) patients are largely successful. However, there is clinical value in potential radiographical markers that can identify patients likely to have inferior outcomes. The purpose of this abstract is to identify motion thresholds that may be correlated with poorer clinical outcomes in cTDR patients.
Methods: Preoperative and postoperative flexion-extension imaging for 32 subjects treated with cTDR was retrospectively collected. A fully automated AI was used to obtain independent measures of spinal motion . Threshold limit graphs were utilized to discover postoperative motion trends which may be associated with poorer clinical outcomes. A two-tailed t-test was used to compare the means of patients grouped by range of motion at the operated level. Patient reported outcomes gathered include NDI, neck pain, and PROMIS General Physical Health.
Results: cTDR subjects exhibiting limited postoperative intervertebral motion ( < 5°) at the operated level demonstrated poorer neck pain scores (4.5 versus 2.3) and NDI (24 vs 12). Additionally, the subjects exhibiting a limited range of motion postoperatively had worse improvement in pain from pre-op to post-op of 1.8 versus 3.8 (p=0.0336).
Conclusion : While many factors have been investigated with respect to cTDR performance, no validated tests have been developed to easily identify patients likely to exhibit poor outcomes. Post-operative range of motion is an easily understood radiographic signal which may shed light on the performance of the device and the long-term outcomes for the patient. Additionally, our results imply that a low motion cTDR may have been better off with ACDF, though this needs to be balanced with the risks of adjacent segment disease. We acknowledge the limited sample size in this pilot study.
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