262. Do large increases in disc space height have consequences after ACDF?

Basques, Bryce A.; Khan, Jannat M.; Nolte, Michael T.; Louie, Philip K.; Sayari, Arash J.; Iloanya, Michael; Goldberg, Edward J.; An, Howard S.

doi:10.1016/j.spinee.2019.05.277

Cited by 4 publications

(3 citation statements)

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“…No correlation was found between the cervical sagittal alignment parameters (cSVA, CL, T1s, and ISH) and PROs (VAS, NDI, and JOA) in previous studies [ 49 ], except that patients with preoperative ISH < 4 mm exhibited increased postoperative ROM, while those with preoperative ISH > 4 mm remained the same [ 48 ], which was similar with the study of Basques et al [ 50 ]. However, in this study, no similar results were found in the ACDR group.…”

Section: Discussionsupporting

confidence: 86%

Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion

Chen

Hai

et al. 2022

Pain Research and Management

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Background. The surgical management of cervical degenerative disc degeneration (CDDD) has not reached a consensus. Artificial cervical disc replacement (ACDR) has been shown to be efficient in reducing symptoms after CDDD, although the topic remains highly controversial in this field. This study aimed to evaluate the effectiveness of ACDR on the treatment of CDDD on the aspect of radiographic reconstruction and clinical improvement compared with anterior cervical discectomy and fusion (ACDF). Methods. This was a retrospective comparative study with 47 patients who underwent single-level ACDR and 46 patients who underwent single-level ACDF. The radiographic reconstruction was assessed by the cervical sagittal alignment parameters, consisting of two aspects, distance and angle, such as cervical sagittal vertical axis (cSVA), cervical lordosis (CL), T1 slope (T1s), and intervertebral space height (ISH). The clinical improvement was assessed by patient-related outcomes (PROs), consisting of two aspects, relief of axial neck pain and recovery of cervical dysfunction, measured through the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA). Results. Significant variations were achieved on aspects of radiographic reconstruction and clinical improvement after ACDR ( P < 0.05 ), which were similar to that of the ACDF group ( P < 0.05 ). A significantly larger postoperative range of motion (ROM) was found in patients less than 45 years of age in the ACDR group ( P < 0.05 ). In addition, a significantly better postoperative JOA was found in patients with a preoperative ISH less than 4 mm in the ACDF group than that in the ACDR group ( P < 0.05 ). Other than that mentioned above, no significant variations in radiographic and clinical outcomes were found between the two groups ( P > 0.05 ). Conclusions. Overall, this study showed that a similar capability in terms of radiographic reconstruction and clinical improvement was found between the two methods. Specific concerns should be analyzed while choosing between an ACDR and an ACDF. It should be pointed out that, based on our experience, if the patient is younger, ACDR is recommended; for patients with preoperative ISH less than 4 mm, ACDF is more recommended.

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Section: Discussionsupporting

confidence: 86%

Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion

Chen

Hai

et al. 2022

Pain Research and Management

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“…A study involving 37 1-level procedures, 50 2-level procedures and 13 3-level procedures evaluated the effects of the IH on overall outcomes after ACDF and found that the IH changed from a preoperative mean of 5.49 ± 1.17 mm to 6.62 ± 1.12 mm at 12 months postsurgery (mean change = 1.13 ± 1.33 mm) [ 13 ] (Fig. 3 ).…”

Section: Discussionmentioning

confidence: 99%

Change in the postoperative intervertebral space height and its impact on clinical and radiological outcomes after ACDF surgery using a zero-profile device: a single-Centre retrospective study of 138 cases

Abudouaini

Huang

Líu

et al. 2021

BMC Musculoskelet Disord

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Background The effects of postoperative intervertebral height (IH) changes on the clinical and radiological outcomes after anterior cervical decompression and fusion (ACDF) surgery using a zero-profile device remain unclear. Methods We retrospectively reviewed patients who had undergone ACDF using a zero-profile device from March 2012 to February 2016 at our institution. Based on the postoperative IH variation, the patients were divided into group A with postoperative IH 0 to 2 mm, group B with postoperative IH 2 to 4 mm, and group C with postoperative IH greater than 4 mm. Clinical efficacy was evaluated using JOA, VAS, and NDI scores in the groups. Imaging parameters including the IH, cervical lordosis, fusion rate, intervertebral foramen (IVF) diameter and complications such as subsidence, dysphagia, and ASD were also compared across the three groups. Results The average IH increased significantly from 6.72 mm preoperatively to 10.46 mm 1 week after surgery, and then gradually decreased to 7.48 mm at the final follow-up. The fusion rate was 61.90% in group A, 63.23% in group B, 53.57% in group C at 3 months, 73.81% in group A, 79.41% in group B, 67.86% in group C at 6 months, 90.48% in group A, 95.59% in group B, 92.86% in group C 1 year after surgery, and at the last follow-up, the fusion rate of three groups was all 100%. The IVF diameter was 6.52 ± 1.80 mm in group A, 9.55 ± 2.36 mm in group B, and 9.34 ± 1.62 mm in group C. ASD at the superior and inferior levels affected 11.90 and 16.67% patients in group A, 5.88 and 7.38% in group B, and 14.28 and 10.71% in group C. Regarding the 3 groups, the subsidence rates were 7.14, 4.41, and 14.29%, respectively. Conclusions No clear correlation was found between IH changes and clinical efficacy within a year of surgery. However, the IH may affect various complications after ACDF. If postoperative IH changes are maintained at 2 to 4 mm after a year, a satisfactory imaging parameters and relatively low complications may be achieved after ACDF surgery using a zero-profile device.

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“…However, the main biomechanical changes after cervical fusion surgery include the concentration of stress and the compensatory increases in the ranges of motion in the upper and lower adjacent segments ( Eck et al, 2002 ; Pu et al, 2014 ; Alhashash et al, 2018 ). These biomechanical changes may cause adjacent segment degeneration (ASD), the loss of disc height at the operated segment, the formation of pseudoarthosis, and the subsidence of the intervertebral cage ( Matsunaga et al, 1999 ; Basques et al, 2019 ; Abudouaini et al, 2021 ). When compared with the cervical intervertebral fusion device, the artificial cervical disc prosthesis not only realizes the function of supporting and withstanding the pressure of the normal cervical disc of the human body but also achieves the function of normal cervical disc motion.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study

Abudouaini,

Wu,

Meng

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is a most frequently used surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration (ASD) rate after ACDF surgery. We creatively designed an elastically deformable cervical implant to reduce the postoperative stress concentration. In this study, we aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical devices.Methods: Biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2–C7) and randomly divided into four groups according to implant types: intact group, Zero-P VA fusion (ACDF) group, the novel cervical implant group and Pretic-I artificial cervical disc (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments and micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments.Results: There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decrease some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups.Conclusion: While the newly developed elastically deformable cervical implant does not completely maintain ROM like the artificial cervical disc, it surpasses the fusion device with regards to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe adjacent segment degeneration after fusion surgery but no indication for artificial cervical disc surgery.

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262. Do large increases in disc space height have consequences after ACDF?

Cited by 4 publications

References 0 publications

Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion

Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion

Change in the postoperative intervertebral space height and its impact on clinical and radiological outcomes after ACDF surgery using a zero-profile device: a single-Centre retrospective study of 138 cases

Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study

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