Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

Basques, Bryce A.; Louie, Philip K.; Mormol, Jeremy; Khan, Jannat M.; Movassaghi, Kamran; Paul, Justin C.; Varthi, Arya G.; Goldberg, Edward J.; An, Howard S.

doi:10.1007/s00586-018-5677-y

Cited by 44 publications

(45 citation statements)

References 30 publications

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“…Fusion status was also frequently assessed using dynamic lateral radiographs. Using this imaging technique, authors measured ISM (22 of 39, 56.4%) [ 10 , 13 , 14 , 16 , 19 - 22 , 25 , 28 , 29 , 31 , 33 - 39 , 41 - 43 ] or used the Cobb angle method (12 of 39, 30.8%) [ 11 , 15 , 17 , 27 , 32 , 34 , 37 , 42 - 46 ] to assess cervical fusion. No consensus was reached regarding the amount of motion for evaluation of cervical fusion on dynamic lateral radiographs.…”

Section: Resultsmentioning

confidence: 99%

“…The dynamic flexion-extension films can also assess for the change in Cobb angle between the adjacent fused vertebrae to determine postoperative fusion status. Recent literature frequently employed the change in Cobb angle as a criteria to confirm fusion (30.8%) [ 11 , 15 , 17 , 27 , 32 , 34 , 37 , 42 - 46 ], but the radiographic parameters ranged from 1.5 to 5 degrees. Cannada et al [ 4 ] showed that changes in Cobb angle of 2 degrees lead to a sensitivity of 82% and specificity of 39%.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Lin

Boddapati

et al. 2018

Neurospine

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Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Lin

Boddapati

et al. 2018

Neurospine

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“…We assessed the presence of ASD based on the modified Hilibrand criteria on radiography and computed tomography (CT) [1]. Radiographic ASD was determined by the presence of disc space narrowing >25%, new or enlarged osteophytes, anterior/posterior disc herniation, endplate sclerosis, and/or calcification of the anterior/posterior longitudinal ligaments as reported in previously published studies [9,10].…”

Section: Methodsmentioning

confidence: 99%

Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion

Shin

2019

Neurospine

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This study aimed to assess the influence of a fused segment on cervical range of motion (ROM) and adjacent segmental kinematics and determine whether increasing number of fusion levels causes accelerated adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF). Methods: A total of 165 patients treated with ACDF were recruited for assessment, and they were divided into 3 groups based on the number of fusion levels. Radiological measurements and clinical outcomes included visual analogue scale (VAS) and Neck Disability Index (NDI) assessed preoperatively and at ≥ 2 years of follow-up. Results: ASD occurred in 41 of 165 patients who underwent ACDF (1-level, 12 of 78 [15.38%]; 2-level, 14 of 49 [28.57%]; 3-level, 15 of 38 [39.47%]; p = 0.015) at final follow-up (mean, 31.9 months). Significant differences were found in reduction of global ROM based on the number of fusion levels (p < 0.001). The upper adjacent segment ROM increased over time (p = 0.004); however, lower segment ROM did not. Three-level ACDF did not obtain greater amounts of lordosis than did 1-or 2-level ACDF (p = 0.003). Postoperative neck VAS scores and NDI were significantly higher for 3-level ACDF than for 1-or 2-level ACDF (p = 0.033 and p = 0.001). Conclusion: ASD occurred predominantly in multilevel cervical fusion, more frequently in the upper segment of the prior fusion and as the number of fusion levels increased. Patients who underwent multilevel fusion had greater reduction of global ROM and increased compensatory motion at the upper adjacent segment. Three-level ACDF did not appear to restore cervical lordosis significantly compared with 1-or 2-level arthrodesis.

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“…During a longterm follow-up, our series provided comparable incidence of ASD between SSC and ACP although with a rate of more than 60%. While it was reported multi-level procedures may not be at a greater risk of developing ASD compared to single-level procedure [14]. Besides, the fact that no case with adjacent segment pathology for secondary surgery in either group and no significant change of UAL and LAL at FFU indicated the two approaches put little and comparable impact on the progression of ASD.…”

Section: Discussionmentioning

confidence: 90%

“…ACDF allows direct decompression of neural structures, reconstruction of cervical lordosis and stabilization of the operated segments [13]. Since the SSC system as a new-designed implant has been used for CSM, multiple studies mainly concentrated on the comparison between SSC and ACP in terms of surgery-related complications and clinical outcomes by a short-to middle-term cohort, having illustrated favorable outcomes [14][15]. Yun et al [16] conduct a 2-year follow-up on 2-level contiguous ACDF and showed compatible clinical outcomes and capacity of lordosis-maintenance between SSC and ACP.…”

Section: Discussionmentioning

confidence: 99%

Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

Xu¹,

Yu²,

Zhu³

et al. 2020

Preprint

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Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P<0.05) but UAL and LAL were of no significance. NDI and JOA got improvement in both groups at IPO and FFU while ASD was in no difference between SSC and ACP. A total of 40 patients (18 vs 22) acquired CL improvement with a larger population in ACP group. There were no differences on the rate if ASD, NDI, JOA and their change between IM and NIM subgroup and the change of CL were not correlated with NDI, JOA and their change.Conclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

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Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

Cited by 44 publications

References 30 publications

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion

Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

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