School of Medicine, MD Candidate University of Colorado University of Colorado School of Medicine
Introduction: Although cervical disc arthroplasty (cTDR) has generally good patient outcomes, clinically actionable, objective guidelines for identifying patients who might experience below average results would be valuable. The purpose of this abstract is to identify preoperative metrics which may indicate below average clinical outcomes versus traditional, theoretical contraindications listed in FDA IDE clinical trial exclusion criteria.
Methods: Preoperative and postoperative flexion-extension imaging for 32 subjects treated with cTDR was retrospectively collected. Automated AI was used to obtain independent measures of spinal alignment. Threshold-limit graphs were used to discover preoperative metrics that may help to predict below average outcomes. Outcomes collected include NDI, neck pain, and PROMIS General Physical Health (GPH).
Results: cTDR may be contraindicated if significant spondylolisthesis is present preoperatively. This hypothesis is based on the finding that a below average (0% versus > 80%) proportion of patients had a Patient Acceptable Symptom State (NDI <=21) when there was posterior spondylolisthesis, preoperatively. In addition, the average change in the GPH was below average in patients with posterior spondylolisthesis.
Conclusion : There are many factors that have already been identified as potential contraindications to cTDR; however these “exclusion criteria” have not been validated. We have identified objective evidence supporting that preoperative posterior spondylolisthesis, measured using a standardized metric, may help to identify patients that might do poorly if treated using cTDR. This observation is based on a small sample size and further research is needed to assess potential prospective clinical efficacy.