우리들병원 이정환 원장님이 The Spine Journal 최신호에 출판한 논문 입니다.
경추 디스크 탈출증이 있어 cervical artificial disc replacement혹은 anterior cervical discectomy and fusion을 받은 환자들을 대상으로 경추의 운동학적인 결과를 비교한 연구입니다.
임상적 결과로서 통증지수(VAS), 일상생활 장애지수(K-NDI)를 측정하였고, 운동학적인 결과분석을 위해 3차원 동작분석을 시행했습니다.
측정결과, VAS, NDI등의 임상결과는 두 군간에 유의한 차이가 없었습니다.
3D 동작분석 결과, cervical artificial disc replacement를 받은 환자군이 anterior cervical discectomy and fusion를 받은 환자군에 비해 굽힘, 편 상태에서 움직임의 범위가 통계적으로 유의하게 유지되었습니다.
아래 링크 들어가서 읽어보세요^^
*Title: Comparison of cervical kinematics between
patients with cervical artificial disc replacement and anterior cervical
discectomy and fusion for cervical disc herniation.
*Authors: Lee JH, Kim
JS, Lee JH, Chung ER, Shim CS, Lee SH
*Bibliography: SpineJ. 2014 Jul 1;14(7):1199-204.
BACKGROUND CONTEXT
Although anterior
cervical discectomy and fusion (ACDF) is an effective treatment option for
patients with cervical disc herniation, it limits cervical range of motion,
which sometimes causes discomfort and leads to biomechanical stress at
neighboring segments.
In contrast, cervical
artificial disc replacement (ADR) is supposed to preserve normal cervical range
of motion than ACDF. A biomechanical measurement is necessary to identify the
advantages and clinical implications of ADR.
However, literature
is scarce about this topic and in those available studies, authors used the
static radiological method, which cannot identify three-dimensional(3-D) motion
and coupled movement during motion of one axis.
PURPOSE
-To compare the
clinical parameters and cervical motion between ACDF and ADR (by 3-D motion
analysis)-To investigate the ability of ADR to maintain cervical kinematics.
STUDY DESIGN
Prospective case
control study.PATIENT SAMPLE
Patients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation.
OUTCOME MEASURES
Visual analog scale
(VAS)Korean version of Neck Disability Index (NDI, %)
3-D motion analysis
METHODS
-Clinical outcomes: evaluated
by VAS and the Korean version of the NDI (%) to assess pain degree and
functional status.-Cervical motions: assessed by 3-D motion analysis in terms of sagittal, coronal, and horizontal planes.
(Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10-20 system of electroencephalography, C7 spinous process, and both acromions)
-These evaluations
were performed preoperatively and 1 month and 6 months after surgery.
»Pre op: no significant difference in VAS, NDI (%), and cervical range of motion (between two groups)
»After
surgery:
-no significant
difference in VAS and NDI (%)
-In motion analysis,
significantly more range of motion was retained in flexion and extension in the
ADR group than the ACDF group at 1 month and 6 months.
There was no
significant difference in lateral tilt and rotation angle. In terms of coupled
motion, ADR group exhibited significantly more preserved sagittal plane motion
during right and left rotation and also showed significantly more preserved
right lateral bending angle during right rotation than ACDF group at 1 month
and 6 months. There was no significant difference in other coupled motions.
CONCLUSION
-3-D motion analysis
could provide useful information in an objective and quantitative way about
cervical motion after surgery. In addition, it allowed us to measure not only
main motion but also coupled motion in three planes. -ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF.
-ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.
