Surgery for postarthrodesis adjacent–cervical segment degeneration

Azmi, Hooman; Schlenk, Richard

doi:10.3171/foc.2003.15.3.6

Cited by 28 publications

(20 citation statements)

References 94 publications

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“…One could postulate that the more pronounced segmental kyphosis 18 and the lower disc height seen in the CP group compared to the CIFC group at 2 year follow-up 8 would eventually have progressed to involve adjacent segmental levels, 19 leading to more intense headaches with increasing flexion of the lower cervical spine and subsequent compensatory extension of the upper cervical spine to maintain optimal sight.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery

Hermansen

Hedlund

Vavruch

et al. 2011

Spine

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Study design. 10-13 year follow-up of a prospective randomized study. Objectives.To compare the 10-13 year outcomes of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC), and the Cloward procedure (CP) using a broad clinical and patient-centered assessment.Summary of Background Data. There are few prospective studies and none with a followup of 10 years or more.Methods. Patient questionnaires completed 10 years or more following ACDF. Seventy-three patients (77%) responded. Radiographs were obtained at 2 years. Results.Apart from greater fulfillment of preoperative expectation (p=0.01) and less headache (p=0.005) in the CIFC group compared to the CP group, there were no significant differences in the outcomes of the two surgical methods. Pain intensity improved in comparison to preoperative levels in both the CIFC and CP groups (p<0.0001), but the Neck Disability Index (NDI) only improved in the CIFC group (p=0.04). Only those with a healed fusion benefited from an improved NDI (p=0.02). There was no deterioration in pain intensity or NDI after the 2-year follow-up.Conclusions. The outcomes of the two surgical methods, with a few exceptions, were equal at 10-13 year follow-up, and there was no deterioration in outcome after the 2-year follow-up.Pain intensity improved more than disability, which may indicate that further improvement of physical function requires early more extensive postoperative rehabilitation. Despite persisting disability, repeat surgery was relatively uncommon.Key words: cervical spine, disc, cage, Cloward, outcome.Comparison between CP and CIFC 3 Key points  Apart from greater fulfillment of preoperative expectation and less headache in the CIFC compared to the CP group, there were no significant differences in the outcomes of the two surgical methods ten or more years after surgery. Pain intensity improved in comparison to preoperative levels in both the CIFC and CP groups, but the NDI only improved in the CIFC group. There was no deterioration in outcome after the two-year follow-up. Only patients with a healed fusion benefited from an improved NDI, otherwise the relationship between radiological findings and clinical outcome was weak. Pain intensity improved more than disability, which may indicate that further improvement of physical function requires early postoperative rehabilitation. Despite persisting disability, repeat surgery was relatively uncommon.Comparison between CP and CIFC 4 Mini Abstract/PrécisThe outcomes of the two methods, anterior cervical decompression and fusion with a cervical intervertebral fusion cage and the Cloward procedure were, with a few exceptions, equal at 10-13 year follow-up of a prospective randomized study. There was no deterioration in outcome after the 2-year follow-up.Comparison between CP and CIFC 5

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Section: Discussionmentioning

confidence: 99%

A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery

Hermansen

Hedlund

Vavruch

et al. 2011

Spine

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“…Adjacent segment degeneration, reported to become clinically symptomatic in up to 25% of patients by 10 years of follow-up [6,[17][18][19][20], is believed to be promoted by increased stress and motion at these levels. These factors have been demonstrated to occur biomechanically and clinically [2,3,12,13,33,35] and likely promote the degeneration by disrupting delicate nutrient pathways to the avascular nucleus pulposus [31,32]. The goal of cervical arthroplasty is to restore normal biomechanics of the treated segment, thereby normalizing motion and stress in adjacent levels and reducing the incidence of long-term failure in the form of adjacent segment degeneration.…”

Section: Introductionmentioning

confidence: 99%

Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty

et al. 2009

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An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4-C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI TM ,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2-C7) were tested in flexion/extension, lateral bending, and axial rotation under a ± 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4-C5 and tested. Then, a fusion using lateral mass fixation and an anterior plate was simulated and tested. Stiffness and range of motion (ROM) data were calculated. The ROM of the C4-C5 motion segment with the arthroplasty device was similar to that of the intact spine in flexion/extension and slightly less in lateral bending and rotation, while the fusion construct allowed significantly less motion in all directions. The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting.

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“…[6][7][8][9][10][11] The number of levels fused should be as small as possible to reduce the risk of operative complications, pseudoarthrosis, and degenerative changes involving adjacent levels. [1][2][3][4][5] TVA is useful because mobility is retained due to the relative preservation of the intervertebral disc. Therefore this method may lower the incidence of complications attributable to fixation because disc mobility is retained and nerve root decompression can be confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…However, anterior fusion sacrifices motion at the operated level and result in progression of degeneration at the adjacent level. [1][2][3] An increase in the number of levels fused is reportedly correlated with operative complications. 4,5 In anterior fusion, we use autologous bone grafts from the cervical vertebral bodies and bioabsorptive screws to prevent graft extrusion (Williams-Isu method; WI-method).…”

Section: Introductionmentioning

confidence: 97%

Combination of the Williams–Isu method and the transvertebral approach to treat cervical disease

Kim

Isu

Sugawara

et al. 2011

Journal of Clinical Neuroscience

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Surgery for postarthrodesis adjacent–cervical segment degeneration

Cited by 28 publications

References 94 publications

A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery

A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery

Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty

Combination of the Williams–Isu method and the transvertebral approach to treat cervical disease

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