Article
3T kinematic MRI of the cervical spine for evaluation of adjacent level diseases after cervical disc arthroplasty and after fusion: Results after 2 years follow-up
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Authors
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Steffen Fleck
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Germany
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Soenke Langner
- Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsmedizin Greifswald, Germany
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Christian Rosenstengel
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Germany
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Marc Matthes
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Germany
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Jan-Uwe Müller
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Germany
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Henry W. S. Schroeder
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Cervical disc arthroplasty may reduce the incidence of adjacent level diseases. We prospectively evaluated the signal intensity (SI) of adjacent disc spaces and movement of the cervical spine before and after cervical disc arthroplasty using 3T kinematic MRI studies to further understand structural and functional alterations after cervical disc prosthesis. Furthermore we compared the data with a group of anterior cervical discectomy and fusion (ACDF).
Method: 32 patients (median 49.01 ys.), underwent an anterior cervical disc operation: 20 patients with total disc arthroplasty (TDA) (Bryan®, Medtronic) (median age 45.5), and 12 patients received ACDF (median age 54.33 ys). All patients underwent kinematic MRI of the cervical spine preoperatively and after 6 and 12 months using 3T wide bore MRI with flexible 4-channel coil. The patient was placed supine and the cervical spine was positioned in neutral, extension and flexion using positioning pads. A sagittal T2-weighted (T2w) 2D TSE-sequence and a 3D T2w dataset were acquired. Signal intensity of all non-operated discs and the height of the adjacent discs to the operated segment were measured. The range of motion was evaluated and compared to plain functional radiographs. Clinically, VAS and neck disability index (NDI) were measured.
Results: There was no statistical significant signal change or reduction in disc height of the adjacent discs indicative of progressive degenerative disc disease within the follow-up period. Kinematic MRI of the cervical spine demonstrated good correlation for ROM compared pre- and postoperatively as well as to plain functional radiographs for the prosthesis group. In comparison with the ACDF group, no significant radiological differences were measured with respect to signal changes, disc height, and ROM. Clinically, the patients improved significantly regarding the VAS (neck, radicular) and NDI for both prosthesis and ACDF groups. Significant differences between these groups have not been observed after 2 years. Heterotopic ossifications were not seen after disc prosthesis.
Conclusions: Our study was able to demonstrate the feasibility of a kinematic study of the cervical spine in a wide-bore 3 T MRI. The results show the absence of significant degenerative changes in adjacent levels after cervical disc arthroplasty within a follow-up period of 2 years. No significant radiological or clinical differences were observed for the comparison of disc prosthesis versus disc fusion.
