Adjacent Level Degeneration After Anterior Cervical Fusion: A Clinical Review

Bartolomei, Juan C.; Theodore, Nicholas; Sonntag, Volker K. H.

doi:10.1016/j.nec.2005.07.004

Cited by 65 publications

(29 citation statements)

References 52 publications

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“…However, the reconstruction of the cervical spine after multisegment ACDF or ACCF is technically demanding for the surgeon and more bone grafts are needed for fusion, resulting in an increased rate of graft-, instrumentation-, and surgery-related complications. In addition, some authors have argued that anterior surgery also appears to be associated with a high rate of adjacent degeneration [6,7].…”

Section: Introductionmentioning

confidence: 99%

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

et al. 2015

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In summary, our meta-analysis suggested that a definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel CSM. Although anterior approach was associated with better postoperative neural function than posterior approach in the treatment of multilevel CSM, there was no apparent difference in the neural function recovery rate between the two approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when anterior approach is used for patients with multilevel CSM.

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Section: Introductionmentioning

confidence: 99%

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

et al. 2015

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“…Findings from a recently published meta-analysis demonstrated that the fusion rate associated with the anterior procedure and plating was 97.1 % at the one-disc level, 94.6 % at the twodisc level, and 82.5 % at the three-disc level [11]. Anterior surgery also appears to be associated with a high rate of adjacent degeneration [12][13][14]. However, some authors have argued that although the adjacent degeneration rate is high with anterior cervical canal decompression approaches, it rarely leads to significant clinical symptoms or the need for reoperation [15,16].…”

Section: Introductionmentioning

confidence: 99%

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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Purpose To compare the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Study design Systematic review and meta-analysis. Methods We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials or non-randomized controlled trials that compared anterior and posterior surgical approaches for the treatment of multilevel cervical spondylotic myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up \1 year, cervical kyphosis [15°, and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; reoperation rate; complication rate; blood loss; and operation time. Subgroup analysis was conducted according to the mean number of surgical segments. Result A total of eight studies were included in the metaanalysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale. In five studies involving 351 patients, the preoperative JOA score was similar between the anterior and posterior groups [P [ 0.05, WMD: -0.00 (-0.56, 0.56)]. In four studies involving 268 patients, the postoperative JOA score was higher in the anterior group compared with the posterior group [P \ 0.05, WMD: 0.79 (0.16, 1.42)]. For recovery rate, there was significant heterogeneity among the four studies involving 304 patients, hence, only descriptive analysis was performed. In seven studies involving 447 patients, the postoperative complication rate was significant higher in the anterior group compared with the posterior group [P \ 0.05, odds ratio: 2.60 (1.63, 4.15)]. Of the 245 patients in the 8 studies who received anterior surgery, 21 (8.57 %) received reoperation. Of the 285 patients who received posterior surgery, only 1 (0.3 %) received reoperation. The reoperation rate was significantly higher in the anterior group compared with the posterior group (P \ 0.001). In the 3 studies involving 236 patients compared subtotal corpectomy and laminoplasty/laminectomy, blood loss and operation time were significantly higher in the anterior subtotal corpectomy group compared with the posterior laminoplasty/laminectomy group [P \ 0.05, WMD: 150.10 (63.53, 236.66) and P \ 0.05, WMD: 59.17 (45.69, 72.66)]. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in the treatment of multilevel cervical spondylotic myelopathy. There was no apparent difference in the neural function recovery rate. The complication and reoperation rates were significantly higher in the anterior group compared with the posterior group. The surgical trauma associated with corpectomy was significantly higher than that associated with laminoplasty/laminectomy.

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“…Some investigators have postulated that these changes may lead to an increased risk of adjacentsegment degeneration (ASD) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Adjacent-level degeneration after cervical disc arthroplasty versus fusion

Maldonado

Paz

Martin³

2011

Eur Spine J

113

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Introduction The principal objective of this study was to evaluate the incidence of adjacent-segment degeneration (ASD) in patients who underwent cervical disc arthroplasty (CDA) as compared with anterior cervical discectomy and fusion (ACDF). Methods It is a prospective cohort study of patients with a single-level cervical degenerative disc disease from C3 to C7 who underwent CDA or ACDF between January 2004 and December 2006, with a minimum follow-up of 3 years. The patients were evaluated pre-and postoperatively with the visual analog scale (VAS), the neck disability index (NDI), and a complete neurological examination. Plain radiographic assessments included sagittal-plane angulation, range of motion (ROM), and radiological signs of ASD. Results One hundred and five patients underwent ACDF and 85 were treated with CDA. The postoperative VAS and NDI were equivalent in both groups. The ROM was preserved in the CDA group but with a small decreased tendency within the time. Radiographic evidence of ASD was found in 11 (10.5%) patients in the ACDF group and in 7 (8.8%) subjects in the CDA group. The Kaplan-Meier survival analysis for the ASD occurrence did not reach statistically significant differences (log rank, P = 0.72).

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Adjacent Level Degeneration After Anterior Cervical Fusion: A Clinical Review

Cited by 65 publications

References 52 publications

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Adjacent-level degeneration after cervical disc arthroplasty versus fusion

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