Adjacent segment degeneration after single-level anterior cervical decompression and fusion: Disc space distraction and its impact on clinical outcomes

Li, Jia; Li, Yongqian; Kong, Fanlong; Zhang, Di; Zhang, Yingze; Shen, Yong

doi:10.1016/j.jocn.2014.08.019

Cited by 51 publications

(34 citation statements)

References 17 publications

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“…Li et al [36] suggested that a postoperative DH that is too big is one of the factors that could lead to the development of ASD. Ahn et al [23] found that the height of the adjacent intervertebral disc in patients with postoperative ASD decreased significantly during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

Wei

et al. 2016

Med Sci Monit

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BackgroundTo explore the related influencing factors of adjacent segment degeneration (ASD) after cervical discectomy and fusion (ACDF).Material/MethodsA retrospective analysis of 263 patients who underwent ACDF was carried out. Cervical x-ray and magnetic resonance imaging (MRI) were required before operation, after operation, and at the last follow-up. General information and some radiographic parameters of all patients were measured and recorded. According to the imaging data, patients were put into one of two groups: non-ASD group and ASD group. The differences between the two groups were compared by t-test and χ2-test, and the related influencing factors of ASD were analyzed by logistic regression.ResultsIn all, 138 patients had imaging ASD. Comparing the age, the postoperative cervical arc chord distance (po-CACD), and the plate to disc distance (PDD) of the two groups, differences were statistically significant (p<0.05). The gender, the fusion segment number, the pre-CACD, the pre-and-po CACD, the preoperative cervical spinal canal ratio, and the upper and lower disc height (DH) showed no statistical difference between the two groups (p>0.05). The results of logistic regression analysis showed that there were significant correlations in the following characteristics: age, postoperative po-CACD, and the PDD (p<0.05). Of all these characteristics, the correlation of age was the highest (R=1.820).ConclusionsAge, po-CACD, and PDD were risk factors for ASD after ACDF. The older the operation age, the worse the recovery was of postoperative physiological curvature of cervical spine, and a PDD < 5 mm was more likely to lead to ASD.

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Section: Discussionmentioning

confidence: 99%

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

Wei

et al. 2016

Med Sci Monit

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“…Preoperative upright neutral radiographs, postoperative upright neutral radiographs, and 1-year postoperative upright neutral radiographs were assessed by the first author (C.C.G.). The measured radiographic parameters included: focal lordosis, which was defined as the Cobb angle from the rostral endplate of the superior vertebral body to the caudal endplate of the inferior vertebral body of the treated segment(s); disc height, which was measured as the average of the anterior and posterior disc heights as described by Li et al and Lee et al 5,6 (the height from the superior to inferior endplate of the involved vertebral body was additionally used as a measure of height and found to correlate with the averaging method for anterior and posterior disc height); C2-7 lordosis, as measured as the Cobb angle from the inferior endplate of C-2 to the inferior endplate of C-7; C1-7 lordosis, as measured as the Cobb angle from a horizontal line passing from the rostral-caudal midpoint of the anterior to the posterior ring of C-1 to the inferior endplate of C-7; T-1 slope (i.e., T-1 sagittal angle), as measured as the angle of the superior endplate of T-1 compared with a horizontal line; and the C2-7 plumbline sagittal vertical axis (i.e., C2-7 SVA) (see Figs. 1 and 2 for examples of measured radiographs).…”

Section: Patient Selectionmentioning

confidence: 99%

Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion

Gillis

Kaszuba

Traynelis

2016

SPI

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OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spine procedures. It can be used to correct cervical kyphotic deformity, which is the most common cervical deformity, and is often performed using lordotic interbody devices. Worsening of the cervical sagittal parameters is associated with decreased health-related quality of life. The study hypothesis is that through the use of machined lordotic allografts in ACDF, segmental and overall cervical lordosis can be maintained or increased, which will have a positive impact on overall cervical sagittal alignment. METHODS Seventy-four cases of 1-level ACDF (ACDF1) and 2-level ACDF (ACDF2) (40 ACDF1 and 34 ACDF2 procedures) were retrospectively reviewed. Upright neutral lateral radiographs were assessed preoperatively and at 6 weeks and 1 year postoperatively. The measured radiographic parameters included focal lordosis, disc height, C2–7 lordosis, C1–7 lordosis, T-1 slope, and C2–7 sagittal vertical axis. Correlation coefficients were calculated to determine the relationships between these radiographic measurements. RESULTS The mean values were as follows: preoperative focal lordosis was 0.574°, disc height was 4.48 mm, C2–7 lordosis was 9.66°, C1–7 lordosis was 42.5°, cervical sagittal vertebral axis (SVA) was 26.9 mm, and the T-1 slope was 33.2°. Cervical segmental lordosis significantly increased by 6.31° at 6 weeks and 6.45° at 1 year. C2–7 lordosis significantly improved by 1 year with a mean improvement of 3.46°. There was a significant positive correlation between the improvement in segmental lordosis and overall cervical lordosis. Overall cervical lordosis was significantly negatively correlated with cervical SVA. Improved segmental lordosis was not correlated with cervical SVA in ACDF1 patients but was significantly negatively correlated in ACDF2 patients. There was also a significant positive correlation between the T-1 slope and cervical SVA. CONCLUSIONS In the study population, the improvement of focal lordosis was significantly correlated with an improvement in overall lordosis (C1–7 and C2–7), and overall lordosis as measured by the C2–7 Cobb angle was significantly negatively correlated with cervical SVA. Using lordotic cervical allografts, we successfully created and maintained significant improvement in cervical segmental lordosis at the 6-week and 1-year time points with values of 6.31° and 6.45°, respectively. ACDF is able to achieve statistically significant improvement in C2–7 cervical lordosis by the 1-year followup, with a mean improvement of 3.46°. Increasing the number of levels operated on resulted in improved cervical sagittal parameters. This establishes a baseline for further examination into the ability of multilevel ACDF to achieve cervical deformity correction through the intervertebral correction of lordosis.

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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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Adjacent segment degeneration after single-level anterior cervical decompression and fusion: Disc space distraction and its impact on clinical outcomes

Cited by 51 publications

References 17 publications

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion

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

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