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INFLUENCE OF INTRAOPERATIVE CERVICAL POSTURE IN SINGLE SEGMENTAL CERVICAL DISC REPLACEMENT ON RESTORATION OF CERVICAL CURVE IN NEUTRAL POSITION

HONG Ying1,DENG Yuxiao2,LIU Hao2,GONG Renrong1,AN Jingjing1,GONG Quan2,LI Tao2,SONG Yueming2.1Operation Room,2Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China.  
Objective To study the correlation between the cervical posture in the cervical disc replacement(CDR) and the cervical curve restoration in neutral position after surgery.Methods Between January 2008 and August 2010,51 patients underwent single segmental PRESTIGE LP replacement,and the clinical data were retrospectively analyzed.During the surgery,the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck.Of them,28 were male and 23 were female,aged 30-64 years(mean,45 years);32 were diagnosed as having cervical spondylotic myelopathy,7 having radiculopathy,and 12 having myelopathy and radiculopathy.The disease duration was 3-48 months(mean,15 months).CDR was performed at C4,5 in 5 cases,at C5,6 in 42 cases,and at C6,7 in 4 cases.The Cobb angles of the cervical alignment,targeted functional spinal unit(FSU),and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery,as well as the intraoperative C-arm fluroscopy of the cervical spine.Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation.Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation(P 0.05).The difference of the Cobb angle between intra-and pre-operation was(6.72 ± 9.13)° on cervical alignment,(2.10 ± 5.12)° on targeted FSU,and(3.33 ± 3.75)° on targeted disc.At 3 months after operation,the Cobb angle improvement of the cervical alignment,targeted FSU,and targeted disc was(6.30 ± 7.28),(3.99 ± 5.37),and(4.29 ± 5.36)°,respectively.There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc(t=—0.391,P=0.698),and between the targeted disc and the cervical alignment(t=—1.917,P=0.061),but significant difference was found between the targeted FSU and the cervical alignment(t=—2.623,P=0.012).The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed(P 0.05).Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.
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