Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

Abstract

Background The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known. Questions/purposes We asked whether the postoperative sagittal segmental alignment of the fused vertebrae could be used as a predictor of adjacent-level degeneration. Methods We retrospectively studied 107 patients, aged 35 to 55 years, with one-level cervical disc disease between C4 and C7 operated on from 1985 to 1995 by discectomy and one-level anterior cervical fusion according to the Cloward procedure. In standard radiographs of the cervical spine in lateral view, the alignment of the involved intervertebral space (sagittal segmental alignment) and the sagittal alignment of the cervical spine were measured and the adjacent-level degeneration was assessed using the Kellgren and Lawrence criteria. The minimum followup was 10 years (mean, 16 years; range, 10-23 years).

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

“…Faldini et al reported that the Cloward procedure was a reasonable technique for the treatment of cervical disc herniation. To prevent ASD, it was recommended to maintain a lordotic SSA, which would be considered a protective factor against ASD [16,17]. In the current study, a comparison between preoperative and follow-up SSA and SACS angles proved the effectiveness of the procedure in correcting cervical sagittal misalignment when degenerative changes lead to cervical spine straightening or cervical kyphosis.…”

Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis

“…Park et al [15] suggested that malalignment of the cervical spine following anterior cervical surgery affects the development of clinical adjacent segment pathology [6] found that malalignment after cervical arthrodesis promotes degenerative changes at levels adjacent to fused segments; adjacent segment degeneration was found in 27 and 60 % of cases fused in lordosis or kyphosis, respectively. Katsuura et al [9] evaluated 42 patients that underwent anterior cervical interbody fusion surgery using lateral radiographs of the cervical spine, and diagnosed radiographically adjacent segment pathology when radiographic findings were consistent with symptoms and signs.…”

“…Correlations between HRQOL and sagittal spinal alignment parameters, including spinopelvic parameters, have been previously reported, and some authors have reported on the importance of cervical sagittal balance [6,9,15]. However, no relationships have been established between cervical sagittal alignment and HRQOL in AS.…”

Single level cervical fusion by an anterior approach using autologous bone graft influences the adjacent levels degenerative changes: clinical and radiographic results at 10-year minimum follow-up

“…After surgery, standard radiographs of the cervical spine were performed. Postoperative immobilization consisted of a neck collar for 40 days [10,16]. At follow-up, patients were rated from excellent to poor depending on resolution, improvement, or persistence of preoperative symptoms according to Odom et al [2].…”

“…Cervical fusion by anterior approach was first described by Robinson and Smith [5] and by Cloward [6,7]. These techniques have been widely used by many authors, with satisfactory short-term results [8][9][10]. The aim of this study was to report the clinical and radiological results of 107 patients operated by discectomy and onelevel anterior cervical fusion according to the Cloward procedure, with a minimum 10-year follow-up.…”