Changes in cervical range of motion following anterior cervical discectomy with fusion — preliminary results

Abstract

Background. The biomechanics of the cervical spine after anterior cervical discectomy with fusion (ACDF), and in particular changes in its global mobility, are phenomena that have not yet been sufficiently studied. Consequently, their effect on the eventual result of treatment is not fully understood. The aim of this study was to assess changes in global and segmental mobility of the cervical spine after ACDF. Material and methods. 28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into two stages: preoperative and postoperative. Range of motion (ROM) was analysed based on X-ray AP, lateral and functional images: C1-C7, C1-C2, C2-C7, C1-C4, C4-C7, and segments adjacent to the stabilisation. The patients were divided into groups depending on the length of spondylodesis and the occurrence of adjacent segment degeneration (ASDeg). Results.A statistically significant difference was found in the total ROM of C2-C7, C1-C7 and C4-C7 after ACDF. The ROM of C2-C7 decreased by 23%, of C1-C7 by 20%, and of C4-C7 by 38%. These changes occurred by reducing the extension ROM C2-C7 by 33%, C1-C7 by 31%, and C4-C7 by 12%. There was a statistically significant (31%) reduction in total ROM in the segment above ACDF, a 41% reduction in extension ROM of this level in the non-ASDeg group, and a 73% increase in the segmental extension ROM above ACDF in patients with ASDeg.Conclusions. ACDF reduces the total ROM of the cervical spine in the sagittal plane. This change occurs by reducing the neck extension, and its severity depends on the length of the spondylodesis. In patients without ASDeg after ACDF, the mobility of the level above the stabilisation decreases. The occurrence of ASDeg is associated with a higher postoperative ROM of the segment located above the spondylodesis.

Anterior Fusion and Long-Term Cervical Mobility in Patients With Traumatic Spinal Cord Injury: An Observational Study

“…Our findings regarding the correlation between fusion length and reclination are in line with a previous study by Limanówka and Sagan, on a small number of patients who underwent ACIF in degenerative diseases that reported a correlation between fusion length and range of motion in the sagittal plane [21]. A general reduction in reclination and rotational ability compared to healthy adults after single-level anterior fusion in patients with degenerative disc disease was also reported by Ylinen et al and could also be supported by our findings [22].…”

The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: A meta-analysis of randomised controlled trials for clinical and radiological outcomes

“…The mobility retained in adjacent superior and inferior segments can influence abnormal biomechanical loading patterns and ultimately the development of ASD. Limanówka et al ( Limanowka and Sagan, 2020 ) show that in a study of 28 patients who underwent ACDF for cervical spondylosis, patients who developed ASD superior to the fixation site had significantly greater extension range of motion (ROM) compared to those who did not develop ASD (p = 0.032). Such findings are corroborated by Park et al (2007) in a cadaveric model of five cervical spine specimens.…”

Diagnostic value of diffusion tensor imaging in patients with clinical signs of cervical spondylotic myelopathy

“…On the one hand, we have physiotherapists, neurologists and anaesthetists involved in treatment at pain clinics who conduct non-surgical treatments such as physical therapy, immobilisation with orthotics, medications, and spinal injections. On the other hand, there are orthopaedic surgeons and neurosurgeons performing spinal decompression surgery with anterior or posterior stabilisation anteriorly or posteriorly [28,29]. Some studies have suggested that surgical treatment may be more advantageous than non-operative treatment [30,31].…”