Instability of the cervical spine after anterior interbody fusion

Döhler, Joachim Rüdiger; Kahn, M. R. H.; Hughes, Sean

doi:10.1007/bf00450219

Cited by 81 publications

(10 citation statements)

References 10 publications

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“…However, controversy remains as to whether these conditions are related to altered biomechanics [ 5 7 8 9 10 11 ] or represent the natural history of cervical spondylosis at the adjacent segment [ 12 13 14 ]. Clearly, patients who have undergone cervical fusions are at an increased risk of developing ASP.…”

Section: Introductionmentioning

confidence: 99%

Adjacent Segment Pathology after Anterior Cervical Fusion

et al. 2016

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Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.

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Section: Introductionmentioning

confidence: 99%

Adjacent Segment Pathology after Anterior Cervical Fusion

et al. 2016

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“…When discussing ASP, it is important to differentiate between radiographical ASP, which is radiographical evidence of degeneration at the levels adjacent to a previous fusion, and clinical ASP (CASP), which is the development of clinically relevant symptoms (i.e., radiculopathy and/ or myelopathy) that correlate with radiographical evidence of degeneration that is adjacent to a previous fusion [ 2 ]. The prevalence of CASP during the current follow up periods of 4.5 years and 21 years are 25%-89% [ 3 , 4 , 5 ] and 7%-15%, respectively [ 1 , 6 , 7 , 8 ]. Several factors have been associated with the development of ASP, such as the number and location of fusion segments, age, and pre-existing degenerative changes at adjacent segments [ 4 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of CASP during the current follow up periods of 4.5 years and 21 years are 25%-89% [ 3 , 4 , 5 ] and 7%-15%, respectively [ 1 , 6 , 7 , 8 ]. Several factors have been associated with the development of ASP, such as the number and location of fusion segments, age, and pre-existing degenerative changes at adjacent segments [ 4 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Adjacent Segment Pathology Following Anterior Decompression and Fusion Using Cage and Plate for the Treatment of Degenerative Cervical Spinal Diseases

2014

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Study DesignRetrospective study.PurposeTo analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases.Overview of LiteratureNo long-term data on the use of cage and plate augmentation have been reported.MethodsThe study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated.ResultsCASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (p<0.001).ConclusionsACDF with cage and plate for the treatment of degenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.

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“…As a result, degenerative progression of an adjacent segment can be prevented, and reestablishment of cervical curvature aided 20. Thereby, complications related to anterior cervical decompression and fusion encourage the use of cervical arthroplasty as an alternative to fusion surgery 21,22,23,24,25,26. Nevertheless, many studies that have conducted radiographic follow-up review of patients treated by arthroplasty and fusion have demonstrated disappointing clinical results 27,28…”

Section: Discussionmentioning

confidence: 99%

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

Oh¹,

Kim

et al. 2014

Yonsei Med J

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PurposeClinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease.Materials and MethodsSixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery.ResultsVAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded.ConclusionClinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.

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Instability of the cervical spine after anterior interbody fusion

Cited by 81 publications

References 10 publications

Adjacent Segment Pathology after Anterior Cervical Fusion

Adjacent Segment Pathology after Anterior Cervical Fusion

Adjacent Segment Pathology Following Anterior Decompression and Fusion Using Cage and Plate for the Treatment of Degenerative Cervical Spinal Diseases

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

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