{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:19:00Z","timestamp":1790288340093,"version":"4.1.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Total disc arthroplasty (TDA) has been established as a safe and effective alternative to anterior cervical discectomy and fusion for the treatment of cervical spine pathology. However, there remains a paucity of studies in the literature regarding the amount of disc height distraction that can be tolerated, as well as its impact on kinematic and clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients who underwent 1- or 2-level cervical TDA with a minimum follow-up of 1 year with lateral flexion\/extension and patient-reported outcome measures (PROMs) were included. Middle disc space height was measured on preoperative and 6-week postoperative lateral radiographs to quantify the magnitude of disc space distraction, and patients were grouped into &lt; 2-mm distraction and &gt; 2-mm distraction groups. Radiographic outcomes included operative segment lordosis, segmental range of motion (ROM) on flexion\/extension, cervical (C2\u20137) ROM on flexion\/extension, and heterotopic ossification (HO). General health and disease-specific PROMs were compared at the preoperative, 6-week, and final postoperative time points. The independent-samples t<jats:italic>-<\/jats:italic>test and chi-square test were used to compare outcomes between groups, while multivariate linear regression was used to adjust for baseline differences.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Fifty patients who underwent cervical TDA at 59 levels were included in the analysis. Distraction &lt; 2 mm was seen at 30 levels (50.85%), while distraction &gt; 2 mm was observed at 29 levels (49.15%). Radiographically, after adjustment for baseline differences, C2\u20137 ROM was significantly greater in the patients who underwent TDA with &lt; 2-mm disc space distraction at final follow-up (51.35\u00b0 \u00b1 13.76\u00b0 vs 39.19\u00b0 \u00b1 10.52\u00b0, p = 0.002), with a trend toward significance in the early postoperative period. There were no significant postoperative differences in segmental lordosis, segmental ROM, or HO grades. After the authors controlled for baseline differences, &lt; 2-mm distraction of the disc space led to significantly greater improvement in visual analog scale (VAS)\u2013neck scores at 6 weeks (\u22123.68 \u00b1 3.12 vs \u22122.24 \u00b1 2.70, p = 0.031) and final follow-up (\u22124.59 \u00b1 2.74 vs \u22121.70 \u00b1 3.03, p = 0.008).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Patients with &lt; 2-mm disc height difference had increased C2\u20137 ROM at final follow-up and significantly greater improvement in neck pain after controlling for baseline differences. Limiting differences in disc space height to &lt; 2 mm affected C2\u20137 ROM but not segmental ROM, suggesting that less distraction may result in more harmonious kinematics between all cervical levels.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine23160","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T16:52:45Z","timestamp":1685811165000},"page":"335-344","source":"Crossref","is-referenced-by-count":5,"title":["Does disc distraction after cervical total disc arthroplasty impact range of motion and patient-reported outcomes?"],"prefix":"10.3171","volume":"39","author":[{"given":"Vincent P.","family":"Federico","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athan G.","family":"Zavras","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A.","family":"Munim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Nolte","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard S.","family":"An","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Colman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank M.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Spine","first-page":"317","article-title":"Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level","volume":"31","author":"Gornet MF","year":"2019","unstructured":"Gornet MF, Burkus JK, Shaffrey ME, Schranck FW, Copay AG. Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level. J Neurosurg Spine. 2019;31(3):317\u2013325."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"601","article-title":"Ten-year outcomes of cervical disc replacement with the BRYAN cervical disc: results from a prospective, randomized, controlled clinical trial","volume":"44","author":"Lavelle WF","year":"2019","unstructured":"Lavelle WF, Riew KD, Levi AD, Florman JE. Ten-year outcomes of cervical disc replacement with the BRYAN cervical disc: results from a prospective, randomized, controlled clinical trial. 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