Radiographic measurements of cervical alignment, fusion and subsidence after ACDF surgery and their impact on clinical outcome

Obermueller, Thomas; Wagner, Arthur; Kogler, Lorenz; Joerger, Ann-Kathrin; Lange, Nicole; Lehmberg, Jens; Meyer, Bernhard; Shiban, Ehab

doi:10.1007/s00701-019-04139-1

Cited by 15 publications

(22 citation statements)

References 42 publications

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“…Although there were no significant differences in clinical outcomes or the fusion rate between the two groups at the final follow-up, it is crucial to improve the early fusion rate and reduce postoperative subsidence in ACDF. The fusion rate, fusion time, and extent of subsidence are usually used as critical indexes to evaluate the efficacy of a surgical technique [26][27][28][29]. Early fusion can also reduce the frequency of follow-up imaging examinations and increase the confidence of spinal surgeons performing this surgical technique.…”

Section: Discussionmentioning

confidence: 99%

“…Early fusion can also reduce the frequency of follow-up imaging examinations and increase the confidence of spinal surgeons performing this surgical technique. At present, there are still a number of studies revealing that postoperative subsidence is related to poor clinical outcomes [28][29][30][31]. Igarashi et al [31] proposed that cage subsidence must be avoided in ACDF since it is often the cause of cervical foraminal stenosis and cage displacement.…”

Section: Discussionmentioning

confidence: 99%

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Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Liao

et al. 2021

BMC Musculoskelet Disord

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Background Using a cage filled with local bone in anterior cervical discectomy and fusion (ACDF) can eliminate morbidities associated with autograft harvest from the iliac crest while achieving high fusion rates. However, there is still no consensus regarding the methods for using local bone grafts. This retrospective study was performed to compare the clinical and radiological outcomes of using a mixture of bone dust and morselized bone versus morselized bone alone in ACDF. Methods A retrospective study of 228 patients affected by cervical degenerative disease who had undergone single- or double-level ACDF between January 2014 and June 2018 was performed. Nanohydroxyapatite/polyamide-66 (n-HA/PA66) combined with morselized bone was used in 111 patients (group A: single-level ACDF in 51 patients and double-level ACDF in 60 patients), whereas the n-HA/PA66 cage combined with a mixture of bone dust and morselized bone was used in 117 patients (group B: single-level ACDF in 58 patients and double-level ACDF in 59 patients). The fusion rate, extent of cage subsidence, fusion segmental height (FSH), C2-7 lordosis, segmental sagittal alignment (SSA), 10-point visual analog scale (VAS) score, and Neck Disability Index (NDI) were compared between the two groups. Results The VAS score and NDI were significantly reduced after the operation in group A and group B. At the final follow-up, the fusion rate was 90.2 % (46/51) and 94.8 % (55/58) in patients treated with single-level ACDF in group A and group B, respectively (p > 0.05). In patients treated with double-level ACDF, bone fusion was achieved in 52 patients (86.7 %) in group A and 55 patients (93.2 %) in group B (p > 0.05). The fusion rate of single- and double-level ACDF was higher in patients in group B than those in group A at the 3-month, 6-month and 12-month follow-ups (p < 0.05). The extent of cage subsidence after single- and double-level ACDF was lower in patients in group B (1.5 ± 0.5 mm and 2.3 ± 0.8 mm, respectively) than in those in group A (1.8 ± 0.7 mm and 2.9 ± 1.4 mm, respectively) (p < 0.05). There was no significant difference between the two groups in the C2-7 lordosis, FSH, SSA, VAS score, or NDI before or after the operation (p > 0.05). Conclusions Using a mixture of local bone dust and morselized bone as cage-filling materials yielded comparably good clinical outcomes as using morselized bone alone in single- and double-level ACDF. However, the mixture graft of bone dust and morselized bone was more beneficial in promoting early fusion and reducing cage subsidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Liao

et al. 2021

BMC Musculoskelet Disord

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“…Cervical disc replacement with a stand-alone cage can restore physiologic disc height, provide immediate load-bearing support to the cervical spine and may promote osseous fusion. Implant subsidence after ACDF is an undesirable effect that should be prevented [1][2][3][4][5]. We investigated the relation between implant subsidence and the ratio of the surface area of the implant to that of the adjacent bone.…”

Section: Introductionmentioning

confidence: 99%

Subsidence following cervical discectomy and implant-to-bone ratio

Godlewski

Bębenek

Dominiak

et al. 2022

BMC Musculoskelet Disord

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Background Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone. Methods We operated 170 disc spaces in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated (TC) PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on computed tomography images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disc space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated. Results Twelve months after the surgery, computed tomography was performed on 86 patients (144 disc spaces). Furthermore, in 166 disc spaces and 102 patients, conventional radiographs were obtained. Subsidence was observed in 21% of the examined intervertebral spaces, and it was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs TC-PEEK cages) did not significantly influence the rate of implant subsidence. Conclusions Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.

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“…24 Another study of 1-to 2-level ACDFs reported a 14.4% nonunion rate. 25 However, for multilevel anterior procedures, fusion rates are often lower. In 72 patients undergoing 3-to 4-level ACDFs, purely radiographic pseudarthrosis occurred in 42%.…”

Section: Anterior Proceduresmentioning

confidence: 99%

Pseudarthrosis of the Cervical Spine

Zuckerman

Devin

2021

Clinical Spine Surgery: A Spine Publication

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Pseudarthrosis of the cervical spine represents a common and challenging problem for spine surgeons. Rates vary greatly from as low as 0%-20% to > 60% and depend heavily on patient factors, approach, and number of levels. While some patients remain asymptomatic from pseudarthrosis, many require revision surgery due to instability, continued neck pain, or radiculopathy/myelopathy. We aimed to provide a practical, narrative review of cervical pseudarthrosis to address the following areas: (1) definitions, (2) incidence, (3) risk factors, (4) presentation and workup, (5) treatment decision-making, and (6) postoperative care. It is our hope the current review provides a concise summary for how to diagnose and treat challenging cervical nonunions.

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Radiographic measurements of cervical alignment, fusion and subsidence after ACDF surgery and their impact on clinical outcome

Cited by 15 publications

References 42 publications

Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Subsidence following cervical discectomy and implant-to-bone ratio

Pseudarthrosis of the Cervical Spine

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