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Vol 54, No 6 (2020)
Research Paper
Submitted: 2020-04-04
Accepted: 2020-08-20
Published online: 2020-12-16
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Changes in cervical range of motion following anterior cervical discectomy with fusion — preliminary results

Bartosz Limanówka1, Leszek Sagan1
DOI: 10.5603/PJNNS.a2020.0098
·
Pubmed: 33373037
·
Neurol Neurochir Pol 2020;54(6):568-575.
Affiliations
  1. Department of Neurosurgery, Pomeranian Medical University, Unii Lubelskiej 1, 71252 Szczecin, Poland

open access

Vol 54, No 6 (2020)
Research papers
Submitted: 2020-04-04
Accepted: 2020-08-20
Published online: 2020-12-16

Abstract

Background. The biomechanics of the cervical spine after anterior cervical discectomy with fusion (ACDF), and in particular changes in its global mobility, are phenomena that have not yet been sufficiently studied. Consequently, their effect on the eventual result of treatment is not fully understood. The aim of this study was to assess changes in global and segmental mobility of the cervical spine after ACDF.

Material and methods. 28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into two stages: preoperative and postoperative. Range of motion (ROM) was analysed based on X-ray AP, lateral and functional images: C1-C7, C1-C2, C2-C7, C1-C4, C4-C7, and segments adjacent to the stabilisation. The patients were divided into groups depending on the length of spondylodesis and the occurrence of adjacent segment degeneration (ASDeg).

Results. A statistically significant difference was found in the total ROM of C2-C7, C1-C7 and C4-C7 after ACDF. The ROM of C2-C7 decreased by 23%, of C1-C7 by 20%, and of C4-C7 by 38%. These changes occurred by reducing the extension ROM C2-C7 by 33%, C1-C7 by 31%, and C4-C7 by 12%. There was a statistically significant (31%) reduction in total ROM in the segment above ACDF, a 41% reduction in extension ROM of this level in the non-ASDeg group, and a 73% increase in the segmental extension ROM above ACDF in patients with ASDeg.

Conclusions. ACDF reduces the total ROM of the cervical spine in the sagittal plane. This change occurs by reducing the neck extension, and its severity depends on the length of the spondylodesis. In patients without ASDeg after ACDF, the mobility of the level above the stabilisation decreases. The occurrence of ASDeg is associated with a higher postoperative ROM of the segment located above the spondylodesis.

Abstract

Background. The biomechanics of the cervical spine after anterior cervical discectomy with fusion (ACDF), and in particular changes in its global mobility, are phenomena that have not yet been sufficiently studied. Consequently, their effect on the eventual result of treatment is not fully understood. The aim of this study was to assess changes in global and segmental mobility of the cervical spine after ACDF.

Material and methods. 28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into two stages: preoperative and postoperative. Range of motion (ROM) was analysed based on X-ray AP, lateral and functional images: C1-C7, C1-C2, C2-C7, C1-C4, C4-C7, and segments adjacent to the stabilisation. The patients were divided into groups depending on the length of spondylodesis and the occurrence of adjacent segment degeneration (ASDeg).

Results. A statistically significant difference was found in the total ROM of C2-C7, C1-C7 and C4-C7 after ACDF. The ROM of C2-C7 decreased by 23%, of C1-C7 by 20%, and of C4-C7 by 38%. These changes occurred by reducing the extension ROM C2-C7 by 33%, C1-C7 by 31%, and C4-C7 by 12%. There was a statistically significant (31%) reduction in total ROM in the segment above ACDF, a 41% reduction in extension ROM of this level in the non-ASDeg group, and a 73% increase in the segmental extension ROM above ACDF in patients with ASDeg.

Conclusions. ACDF reduces the total ROM of the cervical spine in the sagittal plane. This change occurs by reducing the neck extension, and its severity depends on the length of the spondylodesis. In patients without ASDeg after ACDF, the mobility of the level above the stabilisation decreases. The occurrence of ASDeg is associated with a higher postoperative ROM of the segment located above the spondylodesis.

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Keywords

cervical spine, anterior cervical discectomy with fusion, range of motion, biomechanics

About this article
Title

Changes in cervical range of motion following anterior cervical discectomy with fusion — preliminary results

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 6 (2020)

Article type

Research Paper

Pages

568-575

Published online

2020-12-16

Page views

2043

Article views/downloads

1148

DOI

10.5603/PJNNS.a2020.0098

Pubmed

33373037

Bibliographic record

Neurol Neurochir Pol 2020;54(6):568-575.

Keywords

cervical spine
anterior cervical discectomy with fusion
range of motion
biomechanics

Authors

Bartosz Limanówka
Leszek Sagan

References (48)
  1. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004; 4(6 Suppl): 190S–194S.
    CrossRefPubMed
  2. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999; 81(4): 519–528.
    CrossRefPubMed
  3. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976). 1986; 11(6): 521–524.
    CrossRefPubMed
  4. Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J. 2001; 10(4): 320–324.
    CrossRefPubMed
  5. Bolesta MJ, Rechtine GR, Chrin AM. One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002; 2(3): 197–203.
    CrossRefPubMed
  6. Greiner-Perth R, Allam Y, El-Saghir H, et al. Analysis of reoperations after surgical treatment of degenerative cervical spine disorders: a report on 900 cases. Cent Eur Neurosurg. 2009; 70(1): 3–8.
    CrossRefPubMed
  7. Marotta N, Landi A, Tarantino R, et al. Five-year outcome of stand-alone fusion using carbon cages in cervical disc arthrosis. Eur Spine J. 2011; 20 Suppl 1: S8–12.
    CrossRefPubMed
  8. Song KJ, Choi BW, Jeon TS, et al. Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments. Eur Spine J. 2011; 20(11): 1940–1945.
    CrossRefPubMed
  9. Komura S, Miyamoto K, Hosoe H, et al. Lower incidence of adjacent segment degeneration after anterior cervical fusion found with those fusing C5-6 and C6-7 than those leaving C5-6 or C6-7 as an adjacent level. J Spinal Disord Tech. 2012; 25(1): 23–29.
    CrossRefPubMed
  10. Döhler JR, Kahn MR, Hughes SP. Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients. Arch Orthop Trauma Surg. 1985; 104(4): 247–250.
    CrossRefPubMed
  11. Park DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976). 2011; 36(9): 721–730.
    CrossRefPubMed
  12. Chien A, Lai DM, Wang SF, et al. Differential segmental motion contribution of single- and two-level anterior cervical discectomy and fusion. Eur Spine J. 2015; 24(12): 2857–2865.
    CrossRefPubMed
  13. Gornet MF, Burkus JK, Shaffrey ME, et al. Cervical disc arthroplasty with PRESTIGE LP disc versus anterior cervical discectomy and fusion: a prospective, multicenter investigational device exemption study. J Neurosurg Spine. 2015; 23(5): 558–573.
    CrossRefPubMed
  14. Anderst WJ, Lee JY, Donaldson WF, et al. Six-degrees-of-freedom cervical spine range of motion during dynamic flexion-extension after single-level anterior arthrodesis: comparison with asymptomatic control subjects. J Bone Joint Surg Am. 2013; 95(6): 497–506.
    CrossRefPubMed
  15. McDonald CP, Chang V, McDonald M, et al. Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients: clinical article. J Neurosurg Spine. 2014; 20(3): 245–255.
    CrossRefPubMed
  16. Cho BoY, Lim J, Sim HBo, et al. Biomechanical analysis of the range of motion after placement of a two-level cervical ProDisc-C versus hybrid construct. Spine (Phila Pa 1976). 2010; 35(19): 1769–1776.
    CrossRefPubMed
  17. Prasarn ML, Baria D, Milne E, et al. Adjacent-level biomechanics after single versus multilevel cervical spine fusion. J Neurosurg Spine. 2012; 16(2): 172–177.
    CrossRefPubMed
  18. Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002; 27(22): 2431–2434.
    CrossRefPubMed
  19. Dmitriev AE, Cunningham BW, Hu N, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976). 2005; 30(10): 1165–1172.
    CrossRefPubMed
  20. Patwardhan AG, Khayatzadeh S, Nguyen NL, et al. Is Cervical Sagittal Imbalance a Risk Factor for Adjacent Segment Pathomechanics After Multilevel Fusion? Spine (Phila Pa 1976). 2016; 41(10): E580–E588.
    CrossRefPubMed
  21. Ishihara H, Kanamori M, Kawaguchi Y, et al. Adjacent segment disease after anterior cervical interbody fusion. Spine J. 2004; 4(6): 624–628.
    CrossRefPubMed
  22. Bartels RH, Donk R, Verbeek ALM. No justification for cervical disk prostheses in clinical practice: a meta-analysis of randomized controlled trials. Neurosurgery. 2010; 66(6): 1153–60; discussion 1160.
    CrossRefPubMed
  23. Burkus JK, Traynelis VC, Haid RW, et al. Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine. 2010; 13(3): 308–318.
    CrossRefPubMed
  24. Maldonado CV, Paz RDR, Martin CB. Adjacent-level degeneration after cervical disc arthroplasty versus fusion. Eur Spine J. 2011; 20 Suppl 3: 403–407.
    CrossRefPubMed
  25. McAfee PC, Reah C, Gilder K, et al. A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from 4 prospective multicenter randomized clinical trials and up to 1226 patients. Spine (Phila Pa 1976). 2012; 37(11): 943–952.
    CrossRefPubMed
  26. Nunley PD, Jawahar A, Kerr EJ, et al. Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty: 2- to 4-year follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). 2012; 37(6): 445–451.
    CrossRefPubMed
  27. Coric D, Kim PK, Clemente JD, et al. Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine. 2013; 18(1): 36–42.
    CrossRefPubMed
  28. Gao F, Mao T, Sun W, et al. An Updated Meta-Analysis Comparing Artificial Cervical Disc Arthroplasty (CDA) Versus Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Cervical Degenerative Disc Disease (CDDD). Spine (Phila Pa 1976). 2015; 40(23): 1816–1823.
    CrossRefPubMed
  29. Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007; 6(3): 198–209.
    CrossRefPubMed
  30. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009; 34(2): 101–107.
    CrossRefPubMed
  31. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J. 2009; 9(4): 275–286.
    CrossRefPubMed
  32. Hilibrand AS, Balasubramanian K, Eichenbaum M, et al. The effect of anterior cervical fusion on neck motion. Spine (Phila Pa 1976). 2006; 31(15): 1688–1692.
    CrossRefPubMed
  33. Landers MR, Addis KA, Longhurst JK, et al. Anterior cervical decompression and fusion on neck range of motion, pain, and function: a prospective analysis. Spine J. 2013; 13(11): 1650–1658.
    CrossRefPubMed
  34. Lee JH, Kim JS, Lee JHo, et al. Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation. Spine J. 2014; 14(7): 1199–1204.
    CrossRefPubMed
  35. Morvan G, Mathieu P, Vuillemin V, et al. Standardized way for imaging of the sagittal spinal balance. Eur Spine J. 2011; 20 Suppl 5: 602–608.
    CrossRefPubMed
  36. Cobb JR. Outlines for the study of scoliosis. In: Edwards, editor. Instructional course lectures of the American Academy of Orthoedic Surgeons. 51948 p. : 261–75.
  37. Singer KP, Jones TJ, Breidahl PD. A comparison of radiographic and computer-assisted measurements of thoracic and thoracolumbar sagittal curvature. Skeletal Radiol. 1990; 19(1): 21–26.
    CrossRefPubMed
  38. Polly DW, Kilkelly FX, McHale KA, et al. Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976). 1996; 21(13): 1530–5; discussion 1535.
    CrossRefPubMed
  39. Harrison D, Harrison D, Cailliet R, et al. Cobb Method or Harrison Posterior Tangent Method. Spine. 2000; 25(16): 2072–2078.
    CrossRef
  40. Srinivasalu S, Modi HN, Smehta S, et al. Cobb angle measurement of scoliosis using computer measurement of digitally acquired radiographs-intraobserver and interobserver variability. Asian Spine J. 2008; 2(2): 90–93.
    CrossRefPubMed
  41. Akbar M, Terran J, Ames CP, et al. Use of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation. Neurosurg Clin N Am. 2013; 24(2): 163–172.
    CrossRefPubMed
  42. Lafage R, Ferrero E, Henry JK, et al. Validation of a new computer-assisted tool to measure spino-pelvic parameters. Spine J. 2015; 15(12): 2493–2502.
    CrossRefPubMed
  43. Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990; 72(8): 1178–1184.
    PubMed
  44. Gore DR. Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine (Phila Pa 1976). 2001; 26(22): 2463–2466.
    CrossRefPubMed
  45. Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993; 75(9): 1298–1307.
    CrossRefPubMed
  46. Nassr A, Lee JY, Bashir RS, et al. Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration? Spine (Phila Pa 1976). 2009; 34(2): 189–192.
    CrossRefPubMed
  47. Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005; 87(3): 558–563.
    CrossRefPubMed
  48. Kim HJo, Kelly MP, Ely CG, et al. The risk of adjacent-level ossification development after surgery in the cervical spine: are there factors that affect the risk? A systematic review. Spine (Phila Pa 1976). 2012; 37(22 Suppl): S65–S74.
    CrossRefPubMed

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