The Effect of Anterior Cervical Fusion on Neck Motion

Hilibrand, Alan S.; Balasubramanian, Karthik; Eichenbaum, Matthew D.; Thinnes, John H; Daffner, Scott D.; Berta, Scott C.; Albert, Todd J.; Vaccaro, Alexander R.; Siegler, Sorin

doi:10.1097/01.brs.0000224165.66444.71

Cited by 43 publications

(40 citation statements)

References 15 publications

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“…The authors demonstrated that cervical fusion of up to four levels did not reduce cervical ROM significantly [49]. Rather, the clinically assessed cervical ROM decreases with age [15,23] and was reflected by a strong inverse relationship between the absolute ROM and age in the current sample.…”

Section: Functional Outcomementioning

confidence: 63%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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Section: Functional Outcomementioning

confidence: 63%

“…In a study of Hilbrand et al [49] the postoperative clinical ROM in flexion for 1-to 4-level ACDFP averaged 50°-64°and axial rotation showed a mean of 63°-72°. The authors demonstrated that cervical fusion of up to four levels did not reduce cervical ROM significantly [49].…”

Section: Functional Outcomementioning

confidence: 96%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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“…6 Due to the small sample size and retrospective study design, one must be very cautious in interpreting these results, however, and it is well accepted that ACDF is an effective surgical management of multilevel cervical DDD causing CSM. 7,8,13,16,23 In the present study, the authors have demonstrated that the use of arthroplasty for the management of cervical DDD involving more than one vertebral level and causing myelopathy is equally effective as for radiculopathy. Furthermore, previous studies have demonstrated very similar clinical outcomes for 1-and 2-level arthroplasty.…”

Section: Discussionmentioning

confidence: 80%

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

Fay

Huang

et al. 2014

SPI

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Object Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. Methods A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Results Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24–56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. Conclusions The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

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“…Due to the procedure, removal of intervertebral disc and fusion at the compressive site was supposed to reduce neck motion. However, in Hilibrand's research, patients following single-level or double-level anterior cervical decompression and fusion had gained a significant increase in the passive cervical range of motion [9]. To our knowledge, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion.…”

Section: Introductionmentioning

confidence: 98%

“…Anterior cervical decompression and fusion (ACDF) has been a successful and reliable procedure for treatment of cervical degenerative disorders [8][9][10][11][12]. It restores cervical lordosis better and directly decompresses the spinal cord by removing the offending soft or hard discs [13].…”

Section: Introductionmentioning

confidence: 99%

The effect of multilevel anterior cervical fusion on neck motion

Wang

Yuan

et al. 2012

Eur Spine J

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Background Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion. Methods 29 patients underwent a 3-level or 4-level ACDF. In all the patients, preoperative active cervical ROM measurement was performed, and postoperative measurement was performed at 1-year follow-up by a CROM device. The pre-and postoperative data were compared to each other using paired t tests (a = 0.05).Results The patients had significantly less ROM after the surgery in all planes of motion. Major reduction was observed in flexion (39.5%), left and right lateral flexion (25.7 and 25.9%), with relatively minor impact on extension (18.3%), left and right rotation (14.0 and 14.4%) observed. In the three cardinal planes, major reduction was observed in the sagittal plane (28.2%) and coronal plane (25.8%), while minor impact observed in the horizontal plane (14.1%). Conclusions The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.

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The Effect of Anterior Cervical Fusion on Neck Motion

Cited by 43 publications

References 15 publications

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

The effect of multilevel anterior cervical fusion on neck motion

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