No correlation between radiological and clinical outcome 1 year following cervical arthrodesis

Shiban, Ehab; Nies, Moritz; Kogler, Johann; Kogler, Lorenz; Cunha, Paulo Rupino da; Meyer, Bernhard; Lehmberg, Jens

doi:10.1007/s00701-018-3495-y

Cited by 12 publications

(19 citation statements)

References 32 publications

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“…However, radiological ASP findings did not correlate with clinical outcomes at the last follow-up. This finding was in concordance with previously published data 19,20) .…”

Section: Discussionsupporting

confidence: 94%

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

Heemskerk

Vega

Domingo

et al. 2022

Spine Surg Relat Res

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Introduction: Plate distance is correlated with an increased incidence of adjacent segment pathologies (ASP). However, a correct plate-to-disk distance >5 mm is often not achieved. Therefore, this study aimed to quantify the effect of short plateto-disk distance on the development of ASP using epidemiological measures in patients with cervical degenerative spine disease undergoing single-level anterior cervical discectomy and fusion (ACDFs).Methods: Medical records of all patients with cervical degeneration undergoing single-level ACDF with plating (between January 2015 and December 2017), and a follow-up of at least 1 year, were reviewed retrospectively. Radiologic and clinical outcomes were assessed preoperatively, postoperatively, and at last follow-up. The plate-to-adjacent disk distance was measured, and epidemiological measures were calculated to quantify the risk on adjacent-level ossification development (ALOD) and adjacent segment degeneration (ASD).Results: Thirty-eight (47.5%) of the 80 patients developed ALOD, and 12 (15.0%) developed ASD after a 2-year followup. The incidence of ALOD was significantly lower if the plate was >5 mm away from the adjacent disk space compared to <5 mm (cranial adjacent segment, 22.5% vs. 51.3% [P=0.010] and caudal, 21.4% vs. 47.8% [P=0.029]). A correct plate-todisk distance resulted in a relative risk reduction of 57.2% for the cranial segment and 56.0% for the caudal segment, with a number needed to treat of 4. The ASD was only observed in the cranial adjacent segments, and a correct plate-to-disk distance resulted in a relative risk reduction of 32.1% and a number needed to treat of 18.Conclusions: Only four patients need to be treated with a correct plate-to-disk distance to avoid one case of ALOD. Therefore, it is advisable to keep the plate at a distance >5 mm away from the adjacent disk.

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“…However, radiological ASP findings did not correlate with clinical outcomes at the last follow-up. This finding was in concordance with previously published data 19,20) .…”

Section: Discussionsupporting

confidence: 94%

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

Heemskerk

Vega

Domingo

et al. 2022

Spine Surg Relat Res

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“…Even when the cage subsided, Opsenak et al ( 28 ) showed that subsidence had no serious influence on the clinical outcome. A number of additional trials have shown comparable results ( 2 , 30 , 31 ). In our study, the incidence of interbody fusion cage subsidence in the ZP and ST groups was 7.7% and 9.5%, respectively.…”

Section: Discussionmentioning

confidence: 80%

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study

Chen²,

Fu³

et al. 2022

Front. Surg.

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ObjectiveTo assess the mid-long-term clinical and radiological outcomes of zero-profile (ZP) compared with stand-alone (ST) cages for two-level anterior cervical discectomy and fusion (ACDF).MethodsWe included 77 patients (39 women and 38 men) who underwent two-level ACDF between May 5, 2016, and May 5, 2020, and who were followed up for at least 1 year. The subjects were divided into the ST (n = 38) and ZP (n = 39) group. For the evaluation of functional status, Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores were used. Additionally, radiological outcomes and procedure complications were observed at final follow-up.ResultsBoth groups had excellent clinical outcomes at the final follow-up. There were no significant intergroup (ZP vs. ST) differences in the fusion rate (91.02% vs. 90.79%, P > 0.05) and postoperative dysphagia (15.4% vs. 2.6%, P = 0.108). However, the disc height at the final follow-up in the ZP group was higher than that in the ST group (6.86 ± 0.84 vs. 6.17 ± 1.03, P = 0.002). The ZP group accomplished a lower loss of cervical lordosis (18.46 ± 4.78 vs. 16.55 ± 4.36, P = 0.071), but without reaching statistical significance.ConclusionACDF with either ZP or ST cages turns out to be a dependable strategy for two-level ACDF in terms of clinical results. However, compared with the ST, the ZP cage may achieve a significantly lower loss of disc height.

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“…Seventeen studies focused on the safety/efficacy between different ACDF PEEK cage constructs with occasional comparisons to "routine" ACDF controls [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] 1]. [4] PEEK ACDF cages resulted in comparable fusion rates, the same increases in foraminal area, and similar outcomes vs. ACDF/IA.…”

Section: Methodsmentioning

confidence: 99%

“…eir various designs include; Stand Alone (SA) or Zero Profile (ZP) cages with/without screws, cages filled with demineralized bone matrix (DBM) and/or autograft, and PEEK cages coated with hydroxyapatite or titanium [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Here, we reviewed 17 papers comparing the relative safety/efficacy of different single to 3 and 4-level PEEK cage ACDF constructs, with select comparisons to "routine" ACDF controls (i.e. typically using iliac autograft or allograft, and plates).…”

Section: Introductionmentioning

confidence: 99%

Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages

Epstein¹,

Agulnick

2022

Surgical Neurology International

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Background: Multiple anterior cervical diskectomy/fusion (ACDF) techniques now use a variety of Polyehteretherketone (PEEK) cages; stand-alone (SA) and zero-profile (ZP) with/without screws, cages filled with demineralized bone matrix/autograft, and cages coated with hydroxyapatite or titanium. We compared the safety/ efficacy between different PEEK ACDF cage constructs in 17 studies, and in some cases, additionally contrasted results with “routine” ACDF (i.e. series/historical data performed with combinations of iliac autograft/allograft and plates). Methods: We focused on the clinical outcomes, fusion rates, postoperative radiographic changes/lordosis/ subsidence, and/or reoperation rates for various PEEK ACDF constructs vs. “routine” ACDF. Results: One to 3 and 4-level PEEK ACDF cages demonstrated high fusion rates, few cage failures, and low reoperation rates. Subsidence for PEEK ACDF cages did not reduce fusion rates or diminish the quality of postoperative outcomes. Further, titanium-coated (T-C) PEEK cages lowered fusion rates in one study (i.e. 44.1% fusions vs. 88.2% for routine PEEK ACDF) while ACDF PEEK cages coated with hydroxyapatite (HA) showed only a “trend” toward enhanced arthrodesis. Conclusion: One to 3-4 multilevel ACDF PEEK cage constructs demonstrated comparable safety/efficacy when compared with each other, or in select cases, with “routine” ACDF (i.e. using autograft/allograft and plates).

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No correlation between radiological and clinical outcome 1 year following cervical arthrodesis

Abstract: The clinical outcome after ACDF with PEEK cages filled with demineralized bone matrix is highly satisfactory. Radiological signs of non-fusion, subsidence, and cervical alignment have no influence on clinical outcome.

Cited by 12 publications

References 32 publications

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study

Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages

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