Soo-An Park MD, PhD , Nathaniel Ordway MS, PE , Amir Fayyazi MD , Bruce Fredrickson MD , Hansen A. Yuan MD
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The amount of intended and coupled motion was compared in each group and at each postoperative time. The frequency of paradoxical motion was compared between the 2 groups, and the effects of intended motion, operative-level, number of levels, and postoperative time-point were examined.</p></div><div><h3>Results</h3><p>The intended and coupled motions following LTDR and LD did not change over time and did not differ from each other for the flexion and total sagittal movements. The sagittal range of motion (ROM) of LTDR was significantly smaller than that of LD in extension (-0.6°<!--> <!-->±<!--> <!-->1.1° vs -2.2°<!--> <!-->±<!--> <!-->1.6°). LTDR exhibited a significantly higher rate of paradoxical motion when compared to LD (26.4% vs 6.7%). In LTDR, the rate of paradoxical motion at 1 month (40%) was significantly higher than at 1-year (21.1%) or at 2-year (25.0%). The presence of paradoxical motion was significantly less frequent at L4-5 (19.2%) when compared to L5-S1 (31.3%) or L2-3 (36.4%).</p></div><div><h3>Conclusion</h3><p>The overall sagittal ROM of LTDR was 3.5°<!--> <!-->±<!--> <!-->2.4° and not significantly different than LD. The current study did not demonstrate a difference in coupled motions between LTDR and LD. The rate of paradoxical motion was significantly higher in LTDR than in LD. In LTDR, there was a significantly lower rate of paradoxical motion seen at L4-5 and significantly higher rate seen in the earlier postoperative period.</p></div><div><h3>Level of Evidence</h3><p>Prospective cohort study with good follow-up (level 1b).</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"2 3","pages":"Pages 137-139"},"PeriodicalIF":0.0000,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1935-9810(08)70030-6","citationCount":"0","resultStr":"{\"title\":\"Measurement of Paradoxical and Coupled Motions Following Lumbar Total Disc Replacement\",\"authors\":\"Soo-An Park MD, PhD , Nathaniel Ordway MS, PE , Amir Fayyazi MD , Bruce Fredrickson MD , Hansen A. 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The frequency of paradoxical motion was compared between the 2 groups, and the effects of intended motion, operative-level, number of levels, and postoperative time-point were examined.</p></div><div><h3>Results</h3><p>The intended and coupled motions following LTDR and LD did not change over time and did not differ from each other for the flexion and total sagittal movements. The sagittal range of motion (ROM) of LTDR was significantly smaller than that of LD in extension (-0.6°<!--> <!-->±<!--> <!-->1.1° vs -2.2°<!--> <!-->±<!--> <!-->1.6°). LTDR exhibited a significantly higher rate of paradoxical motion when compared to LD (26.4% vs 6.7%). In LTDR, the rate of paradoxical motion at 1 month (40%) was significantly higher than at 1-year (21.1%) or at 2-year (25.0%). 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引用次数: 0
摘要
背景:腰椎全椎间盘置换术(LTDR)后节段性运动的维持是腰椎关节置换术的理论优势之一。这项体内研究检查了椎间盘置换术后矢状面运动中的矛盾和耦合运动，并将这些运动与腰椎间盘切除术后测量的运动进行了比较。方法纳入10例使用ProDisc-L (Synthes, Inc.， West Chester, Pennsylvania)进行LTDR的患者和8例进行腰椎间盘切除术(LD)的患者。在术后1个月、1年和2年的时间点，患者从中立位开始进行屈伸，并通过放射立体分析确定椎间旋转。比较各组和术后各时间的预期运动量和耦合运动量。比较两组间矛盾运动的频率，并检查预期运动、手术水平、水平数和术后时间点的影响。结果LTDR和LD后的预期运动和耦合运动不随时间变化，屈曲和总矢状位运动也没有差异。LTDR的矢状位活动范围(ROM)明显小于LD(-0.6°±1.1°vs -2.2°±1.6°)。与LD相比，LTDR表现出明显更高的矛盾运动率(26.4% vs 6.7%)。在LTDR中，1个月时的矛盾运动率(40%)明显高于1年(21.1%)或2年(25.0%)。与L5-S1(31.3%)或L2-3(36.4%)相比，L4-5(19.2%)出现矛盾运动的频率明显较低。结论LTDR的总体矢状面ROM为3.5°±2.4°，与LD没有显著差异。目前的研究没有证明LTDR和LD之间的耦合运动有差异。LTDR的矛盾运动率明显高于LD。LTDR中，L4-5的矛盾运动率明显较低，术后早期的矛盾运动率明显较高。证据水平:随访良好的前瞻性队列研究(1b级)。
Measurement of Paradoxical and Coupled Motions Following Lumbar Total Disc Replacement
Background
Maintenance of segmental motion following lumbar total disc replacement (LTDR) is one of the theoretical advantages of spinal arthroplasty. This in vivo study examined paradoxical and coupled motions during sagittal plane movements following disc arthroplasty and compared these motions with those measured following lumbar discectomy.
Methods
Ten patients following LTDR using ProDisc-L (Synthes, Inc., West Chester, Pennsylvania) and 8 patients following lumbar discectomy (LD) were enrolled. At 1-month, 1-year and 2-year postoperative time-points, patients performed flexion/extension starting from a neutral position, and the intervertebral rotations were determined with radiostereometric analysis. The amount of intended and coupled motion was compared in each group and at each postoperative time. The frequency of paradoxical motion was compared between the 2 groups, and the effects of intended motion, operative-level, number of levels, and postoperative time-point were examined.
Results
The intended and coupled motions following LTDR and LD did not change over time and did not differ from each other for the flexion and total sagittal movements. The sagittal range of motion (ROM) of LTDR was significantly smaller than that of LD in extension (-0.6° ± 1.1° vs -2.2° ± 1.6°). LTDR exhibited a significantly higher rate of paradoxical motion when compared to LD (26.4% vs 6.7%). In LTDR, the rate of paradoxical motion at 1 month (40%) was significantly higher than at 1-year (21.1%) or at 2-year (25.0%). The presence of paradoxical motion was significantly less frequent at L4-5 (19.2%) when compared to L5-S1 (31.3%) or L2-3 (36.4%).
Conclusion
The overall sagittal ROM of LTDR was 3.5° ± 2.4° and not significantly different than LD. The current study did not demonstrate a difference in coupled motions between LTDR and LD. The rate of paradoxical motion was significantly higher in LTDR than in LD. In LTDR, there was a significantly lower rate of paradoxical motion seen at L4-5 and significantly higher rate seen in the earlier postoperative period.
Level of Evidence
Prospective cohort study with good follow-up (level 1b).
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