SYNERGISTIC TREATMENT METHODS OF STRUCTURAL REHABILITATION (CBP®) AND NEUROSURGERY MAXIMIZING PRE- AND POST-OPERATIVE CERVICAL LORDOSIS AND PATIENT OUTCOME IN CERVICAL TOTAL DISC REPLACEMENT

Main Article Content

Jason Jaeger
Robert Moore
William Smith
Chi Wu
Paul Oakley
Deed Harrison

Keywords

Cervical Spine, Cervical Lordosis, Total Disc Replacement

Abstract

Objective: We discuss the management of cooperative cervical total disc replacement and Chiropractic BioPhysics® interventions pre- and post-operatively aimed at restoring physiologic cervical lordosis.


Clinical Features: A 38-year-old woman had neck pain radiating into her right shoulder and scapula coupled with paresthesia to the first and second digits, bilaterally. Radiographs revealed significant loss of segmental and global lordosis with degenerative stenosis at C5-C6.


Intervention and Outcome: Preoperatively, conservative methods of chiropractic therapy were completed with progress toward restoration of cervical lordosis but without resolution of symptoms. The patient underwent anterior cervical discectomy at C5-6 and a total disc replacement. Postoperatively, traditional physical therapy failed and Chiropractic BioPhysics cervical extension traction methods helped improve clinical symptoms and lordosis. Successful results were maintained at a 2.5-year follow-up.


Conclusion: This case demonstrates how a combined approach of cervical total disc replacement and Chiropractic BioPhysics technique may help manage degenerative changes in the neck. This can then help lead to future cooperation between specialties.

Downloads

Download data is not yet available.
Abstract 497 | CERVICAL LORDOSIS AND PATIENT OUTCOME Downloads 209

References

1. Takeshima T, Omokawa S, Takaoka T, et al. Sagittal alignment of cervical flexion and extension: lateral radiographic analysis. Spine 2002;27:E348-E355
2. Takasaki H, Hall T, Kaneko S, et al. Radiographic analysis of the influence of initial neck posture on cervical segmental movement at end-range extension in asymptomatic subjects. Man Ther 2011;16:74-79
3. Miyazaki M, Hymanson HJ, Morishita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine 33:E870-E876
4. Panjabi MM, Oda T, Crisco JJ 3rd, et al. Posture affects motion coupling patterns of the upper cervical spine. J Orthop Res 1993;11:525-536
5. Walmsley RP, Kimber P, Culham E. The effect of initial head position on active cervical axial rotation range of motion in two age populations. Spine 1993;21:2435-2442
6. Gum JL, Glassman SD, Douglas LR, et al. Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion. Am J Orthop 2012;41:E81-E84
7. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187-193
8. Harrison DD, Harrison DE, Janik TJ, et al. Modeling of the sagittal cervical spine as a method to discriminate hypo-lordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 2004;29:2485-2492
9. Grosso MJ, Hwang R, Mroz T, et al. Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine 2013;18:537-544
10. Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 1999;12:50-56
11. Naderi S, Ozgen S, Pamir MN, et al. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 1998;43:43-49
12. Okada E, Matsumoto M, Ichihara D, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J 2009;18:1644-1651
13. Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 2001;10:320-324
14. Faldini C, Pagkrati S, Leonetti D, et al. Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure. Clin Orthop Relat Res 2011;469:674-681
15. Park MS, Kelly MP, Lee DH, et al. Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 2014;14:1228-1234
16. Zhang Y, Liang C, Tao Y, et al. Cervical total disc replacement is superior to anterior cervical decompression and fusion: a meta-analysis of prospective randomized controlled trials. PLoS One 2015;10:e0117826
17. Yu L, Song Y, Yang X, et al. Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with anterior cervical decompression and fusion. Orthopedics, 2011;34:e651-658
18. Zechmeister I, Winkler R, Mad P. Artificial total disc replacement versus fusion for the cervical spine: a systematic review. Eur Spine J 2011;20:177-184
19. Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 2013;19:141-159
20. Scheer JK, Tang JA, Smith JS, et al. Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database: clinical article. J Neurosurg Spine 2013;19:464-470
21. Oakley PA, Navid Ehsani N, Moustafa IM, Harrison DE. Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: A systematic review of controlled trials. J Phys Sci Ther 2021;33:784-794
22. Moustafa IM, Diab AA, Hegazy F, et al. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: a randomized, placebo-controlled trial. Sci Rep 2021;11:15379
23. Moustafa I, Youssef ASA, Ahbouch A, et. al. Demonstration of Autonomic Nervous Function and Cervical Sensorimotor Control After Cervical Lordosis Rehabilitation: A Randomized Controlled Trial. J Athl Train 2021;56:427–436
24. Moustafa IM, Diab A, Shousha T, et al. Does restoration of sagittal cervical alignment improve cervicogenic headache pain and disability: A 2-year pilot randomized controlled trial. Heliyon 2021;7:e06467
25. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. Eur J Phys Rehabil Med 2017;53:57-71
26. Moustafa IM, Diab AA, Taha S, et al. Addition of a Sagittal Cervical Posture Corrective Orthotic Device to a Multimodal Rehabilitation Program Improves Short- and Long-Term Outcomes in Patients With Discogenic Cervical Radiculopathy. Arch Phys Med Rehabil 2016;97:2034-2044
27. Harrison DD, Janik TJ, Harrison GR, et al. Chiropractic biophysics technique: A linear algebra approach to posture in chiropractic. J Manipulative Physiol Ther 1996;19:525-535
28. Oakley PA, Harrison DD, Harrison DE, et al. Evidence-based protocol for structural rehabilitation of the spine and posture: review of Clinical Biomechanics of Posture (CBP®) publications. J Can Chiropr Asso 2005;49:270-296
29. Harrison DE, Harrison DD, Cailliet R. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 2000;25:2072-2078
30. Harrison DD, Janik TJ, Troyanovich SJ, et al. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 1996;21:667-675
31. Delamarter RB, Zigler J. Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine 2013;38:711-717
32. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519-528
33. Wigfield C, Gill S, Nelson R, et al. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 2002;96:17-21
34. Harrison DD, Janik TJ, Troyanovich SJ, et al. Evaluation of the assumptions used to derive an ideal normal cervical spine model. J Manipulative Physiol Ther 1997;20:246-256
35. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech 1995;10:363-368
36. Hrysomallis C, Goodman C. A review of resistance exercise and posture realignment. J Strength Cond Res 2001;15:385-390