The effect of multilevel anterior cervical fusion on neck motion

Wu, Xiaodong; Wang, Xinwei; Yuan, Wen; Yang, Lei; Tsai, Nicholas; Peng, Yucheng; Chen, Yu; Wang, Cong; Gu, Shiyi; Chen, Huajiang; Zhou, Xuhui; He, Hailong; Chen, Yuanyuan

doi:10.1007/s00586-012-2157-7

Cited by 44 publications

(27 citation statements)

References 20 publications

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“…In the biomechanics research, Prasarn et al [28] found that the range of motion of adjacent segments increased significantly on the double segments fusion. Wu XD et al [29] found that more than three segments had a significant effect on the cervical range of motion. The reason could be that with the increasing of the number of fusion segments, the activity of the upper adjacent segment and the small joint pressure gradually increase, resulting in the acceleration of ASD.…”

Section: Discussionmentioning

confidence: 99%

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

Wei

et al. 2016

Med Sci Monit

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BackgroundTo explore the related influencing factors of adjacent segment degeneration (ASD) after cervical discectomy and fusion (ACDF).Material/MethodsA retrospective analysis of 263 patients who underwent ACDF was carried out. Cervical x-ray and magnetic resonance imaging (MRI) were required before operation, after operation, and at the last follow-up. General information and some radiographic parameters of all patients were measured and recorded. According to the imaging data, patients were put into one of two groups: non-ASD group and ASD group. The differences between the two groups were compared by t-test and χ2-test, and the related influencing factors of ASD were analyzed by logistic regression.ResultsIn all, 138 patients had imaging ASD. Comparing the age, the postoperative cervical arc chord distance (po-CACD), and the plate to disc distance (PDD) of the two groups, differences were statistically significant (p<0.05). The gender, the fusion segment number, the pre-CACD, the pre-and-po CACD, the preoperative cervical spinal canal ratio, and the upper and lower disc height (DH) showed no statistical difference between the two groups (p>0.05). The results of logistic regression analysis showed that there were significant correlations in the following characteristics: age, postoperative po-CACD, and the PDD (p<0.05). Of all these characteristics, the correlation of age was the highest (R=1.820).ConclusionsAge, po-CACD, and PDD were risk factors for ASD after ACDF. The older the operation age, the worse the recovery was of postoperative physiological curvature of cervical spine, and a PDD < 5 mm was more likely to lead to ASD.

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Section: Discussionmentioning

confidence: 99%

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

Wei

et al. 2016

Med Sci Monit

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“… 1 2 3 4 5 Despite the proven long-term clinical and radiographic success, ACDF is associated with certain disadvantages, including the loss of motion segments, the potential for accelerated adjacent segment disease, and the reliance on the need for solid bony fusion. 6 7 8 9 10 11 …”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of the Clinical and Fusion Results following Treatment of Symptomatic Cervical Pseudarthrosis

McAnany

Baird

Overley

et al. 2015

Global Spine Journal

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Study Design Systematic literature review and meta-analysis. Objective This study is a meta-analysis assessing the fusion rate and the clinical outcomes of cervical pseudarthrosis treated with either a posterior or a revision anterior approach. Methods A literature search of PubMed, Cochrane, and Embase was performed. Variables of interest included fusion rate and clinical success. The effect size based on logit event rate was calculated from the pooled results. The studies were weighted by the inverse of the variance, which included both within- and between-study error. The confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I 2, where I 2 is the estimate of the percentage of error due to between-study variation. Results Sixteen studies reported fusion outcomes; 10 studies reported anterior and/or posterior results. The pooled fusion success was 86.4% in the anterior group and 97.1% in the posterior group (p = 0.028). The anterior group demonstrated significant heterogeneity with Q value of 34.2 and I 2 value of 73.7%; no heterogeneity was seen in the posterior group. The clinical outcomes were reported in 10 studies, with eight reporting results of anterior and posterior approaches. The pooled clinical success rate was 77.0% for anterior and 71.7% for posterior (p = 0.55) approaches. There was significant heterogeneity in both groups (I 2 16.1; 19.2). Conclusions Symptomatic cervical pseudarthrosis can be effectively managed with either an anterior or a posterior approach. The posterior approach demonstrates a significantly greater fusion rate compared with the anterior approach, though the clinical outcome does not differ between the two groups.

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“…Internal instrumentation has undergone significant developments since this report; as such, one may expect a decrease in the use of bracing due to the known restriction of neck motion after multilevel fusion. 35 The paucity of Abbreviations: LOS, length of stay; QALY, quality-adjusted life year; SD, standard deviation. decisive literature has made it challenging to make an informed decision about bracing in the setting of multilevel ACDF.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery

et al. 2020

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Background: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Here, we study the impact of bracing on shortterm outcomes related to safety, quality of care, and direct costs in multilevel ACDF. Methods: Retrospective cohort analyses of all consecutive patients undergoing multilevel ACDF with or without bracing from 2013 to 2017 was undertaken (n ¼ 616). Patient demographics and comorbidities were analyzed. Tests of independence and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility [ARF], or skilled nursing facility [SNF]), quality-adjusted life year (QALY), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Amongst the study population, 553 were braced and 63 were not braced. There was no difference in comorbidities (P. .05) such as obesity, smoking, chronic obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure, and problem list number. A significant difference in American Society of Anesthesiologists (ASA) score was found, with more ASA 2 patients in the braced cohort and more ASA 3 patients in the unbraced cohort (P ¼ .007). LOS was extended for the unbraced group (median 156.9 6 211.4 versus 86.67 6 130.6 h, P ¼ .003), and ER visits within 30 days were 0.21 times less likely in the braced group (P ¼ .006). There was no difference in readmission (P ¼ .181), QALY gain (P ¼ .968), and direct costs (P ¼ .689). Conclusion: Bracing following multilevel cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner.

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The effect of multilevel anterior cervical fusion on neck motion

Cited by 44 publications

References 20 publications

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

In-Depth Analysis on Influencing Factors of Adjacent Segment Degeneration After Cervical Fusion

A Meta-Analysis of the Clinical and Fusion Results following Treatment of Symptomatic Cervical Pseudarthrosis

The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery

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