Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Objective 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 (ACD...
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2019-09-01
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| Series: | Neurospine |
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| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1938166-083.pdf |
| _version_ | 1827361465533726720 |
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| author | Jun Jae Shin |
| author_facet | Jun Jae Shin |
| author_sort | Jun Jae Shin |
| collection | DOAJ |
| description | Objective 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. |
| first_indexed | 2024-03-08T07:05:37Z |
| format | Article |
| id | doaj.art-4fb17a719caa424082aca71bcdd9cb0e |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T07:05:37Z |
| publishDate | 2019-09-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-4fb17a719caa424082aca71bcdd9cb0e2024-02-03T04:42:33ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912019-09-0116358960010.14245/ns.1938166.083906Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and FusionJun Jae ShinObjective 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.http://www.e-neurospine.org/upload/pdf/ns-1938166-083.pdfAdjacent-segment degenerationAnterior spinal fusionCervical degenerative disc diseaseMultilevel spondylosisRange of motionAlignment |
| spellingShingle | Jun Jae Shin Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion Neurospine Adjacent-segment degeneration Anterior spinal fusion Cervical degenerative disc disease Multilevel spondylosis Range of motion Alignment |
| title | Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion |
| title_full | Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion |
| title_fullStr | Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion |
| title_full_unstemmed | Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion |
| title_short | Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion |
| title_sort | comparison of adjacent segment degeneration cervical alignment and clinical outcomes after one and multilevel anterior cervical discectomy and fusion |
| topic | Adjacent-segment degeneration Anterior spinal fusion Cervical degenerative disc disease Multilevel spondylosis Range of motion Alignment |
| url | http://www.e-neurospine.org/upload/pdf/ns-1938166-083.pdf |
| work_keys_str_mv | AT junjaeshin comparisonofadjacentsegmentdegenerationcervicalalignmentandclinicaloutcomesafteroneandmultilevelanteriorcervicaldiscectomyandfusion |