Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages

Sugawara, Taku; Itoh, Yasunobu; Hirano, Yoshitaka; Higashiyama, Naoki; Mizoi, Kazuo

doi:10.1007/s00701-009-0217-5

Cited by 56 publications

(37 citation statements)

References 33 publications

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“…Recently, there have been several trials to assess ASD with MRI, and usability of MRI to assess ASD has been reported. Matumoto et al [27][28][29][30] reported 40-60 % degenerative change in adjacent disc after ACDF using MRI, and other study by CT also reported that asymptomatic ASD was detected as 50 %, and this result is very similar with our results. There has been no comparative study between ACDF and arthroplasty with MRI.…”

Section: Discussionsupporting

confidence: 92%

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

et al. 2012

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Purpose It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery. Materials and methods This is a retrospective crosssectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured. Results The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2 % in the fusion group and 4.5 % in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50 %, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups. Conclusion The ASD rate of 46.5 % after ACDF or arthroplasty, and arthroplasty did not significantly lower the rate of ASD. ASD occurred in patients who had preexisting ASD and in patients who also had other segment degeneration. ASD may be associated with a natural history of cervical spondylosis rather than arthrodesis.

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Section: Discussionsupporting

confidence: 92%

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

et al. 2012

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“…This could be due to asymptomatic 3 or even absent degeneration at adjacent levels, with a low correlation between radiological/MR findings and clinical symptoms as shown in this and other studies. 3,21 It also illustrates the stability of outcomes over time. 22 It may also imply that the evaluation instruments used, although wellvalidated 13, 23, 24 may be relatively insensitive.…”

Section: Discussionmentioning

confidence: 95%

“…[1][2][3][4][5][6]25 Thorell et al 4 reported that patients with longer follow-up (2 years or more, average 8 years) have less pain and improved function, but Wang et al 5 and Gore and Sepic 1 reported a recurrence of neck pain on long-term follow-up, probably due to cage subsidence. To our knowledge, there are, with the exception of the 6-year follow-up 7 of the present study, no other prospective randomized studies of ACDF with more than two years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Most of these studies are, however, retrospective [1][2][3][4][5][6] and lack patient-centric data such as persisting problems with the activities of daily life resulting from radiculopathy and/or neck pain and dysfunction. Apart from the previously published 6-year follow-up of the present study, 7 we are not aware of any other prospective studies with 5 or more years of follow-up and no other prospective randomized studies with more than 2 years of follow-up.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Persistent mechanical neck pain and disability is often reported by individuals who have previously undergone anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease [1][2][3][4][5][6], despite an overall surgical success rate of approximately 80% [7,8]. Altered muscle function is a recognised feature of painful neck disorders [9,10], and may be a factor in the persistent or recurrent nature of mechanical neck pain as cervical muscles play a significant role in the physical support of the cervical vertebral column [11].…”

Section: Introductionmentioning

confidence: 99%

Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery

Peolsson

Jull

et al. 2015

Physiotherapy

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Please cite this article as: Peolsson A, Jull G, Löfstedt T, Trygg J, O'Leary S, Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery, Physiotherapy (2014), http://dx.doi.org/10. 1016/j.physio.2014.04.010 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Design Preliminary cross-sectional study. 12Results A significant group x muscle interaction was found for muscle deformation (P<0.03) 13but not for deformation rate (P>0.79). The ACDF group showed significantly less 14 deformation of the semispinaliscapitismuscle during the extension task compared withthe 15 control group[mean 3.12(SD 2.06) and 6.64(SD 4.17), respectively; mean difference 3.34 16(95% confidence interval -0.54 to 7.21)]. 17Conclusions As the semispinaliscapitis muscle is a powerful neck extensor, the finding of

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Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages

Abstract: These results are comparable or better than those after ACDF with autograft or allograft. ACDF with TC can achieve rigid fixation and provide good long term results.

Cited by 56 publications

References 33 publications

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

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

Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery

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