Adjacent-Level Range of Motion and Intradiscal Pressure After Posterior Cervical Decompression and Fixation

Kretzer, Ryan M.; Hsu, Wesley; Hu, Nianbin; Umekoji, Hidemasa; Jallo, George I.; McAfee, Paul C.; Tortolani, P. Justin; Cunningham, Bryan W.

doi:10.1097/brs.0b013e31824780b8

Cited by 36 publications

(25 citation statements)

References 24 publications

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“…However, biomechanical and clinical studies suggested that adjacent-level kinematic might predispose to adjacent-level degeneration after ACF. [3,4] Degenerative changes in adjacent-level and unsatisfactory clinical outcomes were documented. [5,6] Adjacent segment diseases (ASDs), whether representing an enhanced degeneration due to adjacent fusions or merely the natural progression of degeneration, have been recognized as an important entity after ACF.…”

Section: Introductionmentioning

confidence: 99%

Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion

Wang

Wang²,

Miao³

et al. 2017

Medicine

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Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (P < .05). However, there were no differences between the 2 groups (P > .05). The operation time of ACDF group was more than Zero-P group, with significant differences (P < .05). However, there were no differences in JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and postoperative (P > .05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (P < .05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.

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Section: Introductionmentioning

confidence: 99%

Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion

Wang

Wang²,

Miao³

et al. 2017

Medicine

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“…The development of adjacent segment degeneration (ASD) following anterior cervical decompression and fusion (ACDF) is well reported in the literature [4][5][6][7][8][9][10][11][12][13][14][15]. Within the past few decades, both in vivo and in vitro biomechanical evidence suggest that arthrodesis may augment stress on the unfused adjacent levels [16][17][18][19][20][21]. Hilibrand et al [7] reported an annualized incidence of 2.9 % per year for developing symptomatic ASD after singlelevel ACDF and estimated that about 25.6 % of patients would have symptomatic ASD within 10 years of their index surgery.…”

Section: Introductionmentioning

confidence: 99%

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

et al. 2015

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Purpose Adjacent segment degeneration (ASD) is known to occur after anterior cervical arthrodesis. However, it is not known whether cervical canal stenosis enhances the risk of ASD. The purpose of this study was to explore whether congenital stenosis could be used as a predictor of ASD after anterior cervical decompression and fusion (ACDF). Methods We enrolled 141 patients who had undergone ACDF for cervical myelopathy and/or radiculopathy, and had at least 6 years of follow-up. In standard radiographs of cervical spine in lateral view, bony congenital stenosis was evaluated and all patients were divided into two groups: stenosis (n = 63) and non-stenosis (n = 78). Radiographic ASD was assessed according to the criteria of Kellgren and Lawrence and correlated with symptomatic ASD. Clinical and radiological parameters were compared between the groups. The primary outcome was the rate of radiographic ASD after initial ACDF. The incidence of symptomatic ASD was assessed by Kaplan-Meier method. Results Radiographic ASD and symptomatic ASD developed in 46.8 % and 18.4 % of all patients, respectively. There was a significant association between congenital stenosis and radiographic ASD. The area under the receiver operating characteristic curve of preoperative anteroposterior (AP) diameter of cervical canal for predicting radiographic ASD was 0.756. 13.0 mm was the cutoff value of preoperative AP diameter of cervical canal predicting radiographic ASD. Kaplan-Meier analysis predicted a disease-free survival rate of symptomatic ASD in 97.2 % of patients at 5 years and 78.0 % at 10 years after ACDF. There was no significant difference in survival rates of the adjacent segment between the two groups via log-rank analysis (P = 0.102). Conclusion Congenital stenosis can increase the rate of radiographic ASD after initial ACDF. The cutoff value of 13.0 mm for preoperative AP diameter of cervical canal had the highest validity for predicting radiographic ASD.

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“…The flexion and extension responses of this model were compared with previous cadaveric studies reported by Nightingale et al [5] and Wheeldon et al [6]. In addition, the inter-vertebral disc pressures(IDP) were compared to 2Nm flexion/extension quasi-static experiment in C2-C3, C6-C7 segments reported by Dmitriev [7] and the 5Nm axial rotation and lateral bending quasi-static experiment in C4-C5, C5-C6 segments reported by Kretzer [8].…”

Section: Figure 1 the Head-neck Model In Cartesian Coordinate Systemmentioning

confidence: 99%

Development and validation of a C0-C7 cervical spine finite element model

Wei

Yin

et al. 2017

MATEC Web Conf.

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Abstract.A finite element model (FEM) of human C0-C7 cervical spine has been developed as a baseline to study the biomechanical factors in spinal surgical intervention. To accurately simulate the anisotropic properties, the intervertebral disc was divided into nucleus, annulus matrix and annulus fiber, and it was simulated with viscoelastic and fabric material models. The nonlinear force-displacement curves of ligament experiments were implemented to simulate the elastic zone and neutral zone at low loads. The model was validated with experimental data on range of motion (ROM) for normal, non-degenerated cervical spines tested in flexion and extension, lateral bending, and axial rotation at loads of 0.33, 0.5, 1.0, 1.5, and 2.0 Nm, and intra-discal pressure (IDP) was validated against experiment data at loads of 2Nm and 5Nm. For lateral bending and axial rotation, the model was well within in vitro experimental standard deviation corridors for the whole load range. For extension and flexion, however, the error index of C3-C4, C4-C5, C5-C6 flexion were 0.268, 0.03, 0.124 and the C6-C7 extension was 0.046 respectively. The IDP result was in well agreement with the experiments. These results indicated the C0-C7 cervical spine model was biofidelic for static simulation of these motions.

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Adjacent-Level Range of Motion and Intradiscal Pressure After Posterior Cervical Decompression and Fixation

Cited by 36 publications

References 24 publications

Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion

Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

Development and validation of a C0-C7 cervical spine finite element model

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