Outcomes of non-contiguous two-level anterior cervical discectomy and fusion in patients with degenerative cervical myelopathy: a retrospective study.
Cervical biomechanics
Degenerative Cervical Myelopathy
Non-contiguous ACDF
Skip ACDF
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
received:
06
05
2024
accepted:
09
08
2024
medline:
22
8
2024
pubmed:
22
8
2024
entrez:
22
8
2024
Statut:
epublish
Résumé
Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments. We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images. Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level. Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare.
Sections du résumé
BACKGROUND
BACKGROUND
Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments.
METHOD
METHODS
We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images.
RESULTS
RESULTS
Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level.
CONCLUSIONS
CONCLUSIONS
Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare.
Identifiants
pubmed: 39172250
doi: 10.1007/s00701-024-06242-4
pii: 10.1007/s00701-024-06242-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
347Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Anastasio AT, Baumann AN, Fiorentino A, Sidloski K, Walley KC, Muralidharan A, Conry KT, Hoffmann JC (2023) The Kinematics and Biomechanics for Non-Contiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review. Biomechanics 3:443–456
doi: 10.3390/biomechanics3040036
Baram A, Capo G, Riva M, Brembilla C, Rosellini E, De Robertis M, Servadei F, Pessina F, Fornari M (2024) Monocentric retrospective analysis of clinical outcomes, complications, and adjacent segment disease in 507 patients undergoing ACDF for degenerative cervical myelopathy. World Neurosurg. https://doi.org/10.1016/j.wneu.2024.07.079
Bisson EF, Samuelson MM, Apfelbaum RI (2011) Intermediate segment degeneration after noncontiguous anterior cervical fusion. Acta Neurochirurgica 153:123–128. https://doi.org/10.1007/s00701-010-0832-1
doi: 10.1007/s00701-010-0832-1
pubmed: 20931238
Deng Y, Li G, Liu H, Hong Y, Meng Y (2020) Mid- to long-term rates of symptomatic adjacent-level disease requiring surgery after cervical total disc replacement compared with anterior cervical discectomy and fusion: a meta-analysis of prospective randomized clinical trials. J Orthop Surg Res 15:468. https://doi.org/10.1186/s13018-020-01957-3
doi: 10.1186/s13018-020-01957-3
pubmed: 33046082
pmcid: 7549243
Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC (2005) Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 30:1165–1172. https://doi.org/10.1097/01.brs.0000162441.23824.95
doi: 10.1097/01.brs.0000162441.23824.95
pubmed: 15897831
El-Ghandour NMF, Soliman MAR, Ezzat AAM, Mohsen A, Zein-Elabedin M (2020) The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: a prospective randomized trial. J Neurosurg Spine SPI 33:288–296. https://doi.org/10.3171/2020.2.SPINE191272
doi: 10.3171/2020.2.SPINE191272
Finn MA, Samuelson MM, Bishop F, Bachus KN, Brodke DS (2011) Two-level noncontiguous versus three-level anterior cervical discectomy and fusion: a biomechanical comparison. Spine (Phila Pa 1976) 36:448–453. https://doi.org/10.1097/BRS.0b013e3181fd5d7c
doi: 10.1097/BRS.0b013e3181fd5d7c
pubmed: 21372655
Fuller DA, Kirkpatrick JS, Emery SE, Wilber RG, Davy DT (1998) A kinematic study of the cervical spine before and after segmental arthrodesis. Spine (Phila Pa 1976) 23:1649–1656. https://doi.org/10.1097/00007632-199808010-00006
doi: 10.1097/00007632-199808010-00006
pubmed: 9704371
Hwang SH, Kayanja M, Milks RA, Benzel EC (2007) Biomechanical comparison of adjacent segmental motion after ventral cervical fixation with varying angles of lordosis. Spine J 7:216–221. https://doi.org/10.1016/j.spinee.2006.05.018
doi: 10.1016/j.spinee.2006.05.018
pubmed: 17321972
Monticone M, Ferrante S, Vernon H, Rocca B, Dal Farra F, Foti C (2012) Development of the Italian Version of the Neck Disability Index: cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change. Spine (Phila Pa 1976) 37:E1038–E1044. https://doi.org/10.1097/BRS.0b013e3182579795
doi: 10.1097/BRS.0b013e3182579795
pubmed: 22487712
Park Y, Maeda T, Cho W, Riew KD (2010) Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine J 10:193–199. https://doi.org/10.1016/j.spinee.2009.09.006
doi: 10.1016/j.spinee.2009.09.006
pubmed: 19850532
Qizhi S, Peijia L, Lei S, Junsheng C, Jianmin L (2016) Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy. Indian J Orthop 50:390–396. https://doi.org/10.4103/0019-5413.185603
doi: 10.4103/0019-5413.185603
pubmed: 27512221
pmcid: 4964772
Ren C, Song Y, Xue Y, Yang X (2014) Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J 23:1115–1123. https://doi.org/10.1007/s00586-014-3220-3
doi: 10.1007/s00586-014-3220-3
pubmed: 24515337
Saavedra-Pozo FM, Deusdara RA, Benzel EC (2014) Adjacent segment disease perspective and review of the literature. Ochsner J 14:78–83
pubmed: 24688337
pmcid: 3963057
Shi S, Liu ZD, You WJ, Ouyang YP, Li XF, Qian L, Zhong GB (2016) Application of a stand-alone anchored spacer in noncontiguous anterior cervical arthrodesis with radiologic analysis of the intermediate segment. J Clin Neurosci 25:69–74. https://doi.org/10.1016/j.jocn.2015.05.050
doi: 10.1016/j.jocn.2015.05.050
pubmed: 26597607
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-a:607–624
doi: 10.2106/00004623-195840030-00009
pubmed: 13539086
Tetreault L, Kopjar B, Nouri A, Arnold P, Barbagallo G, Bartels R, Qiang Z, Singh A, Zileli M, Vaccaro A, Fehlings MG (2017) The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J 26:78–84. https://doi.org/10.1007/s00586-016-4660-8
doi: 10.1007/s00586-016-4660-8
pubmed: 27342612
Wang JC, McDonough PW, Endow KK, Delamarter RB (2001) A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion. J Spinal Disord 14:222–225. https://doi.org/10.1097/00002517-200106000-00006
doi: 10.1097/00002517-200106000-00006
pubmed: 11389372