Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease

Background Data: After anterior cervical discectomy; the effect of cervical fusion or cervical arthroplasty on the dynamics of adjacent segments and the overall cervical spine has a direct impact on the final clinical outcome Purpose: To compare the effect of the cervical fusion (ACDF) versus arthr...

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Autores principales:	Ahmed Elsawaf, Salem Faisal
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2018
Materias:	cervical dynamics adjacent segment diseases anterior cervical discectomy cervical prosthesis anterior cervical fusion Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ee2070b296724ae49cb7a933166a9e60
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spelling	oai:doaj.org-article:ee2070b296724ae49cb7a933166a9e602021-12-02T00:13:28ZEffect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment DiseaseDOI:10.21608/ESJ.2017.87142314-89502314-8969https://doaj.org/article/ee2070b296724ae49cb7a933166a9e602018-01-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_8714.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: After anterior cervical discectomy; the effect of cervical fusion or cervical arthroplasty on the dynamics of adjacent segments and the overall cervical spine has a direct impact on the final clinical outcome Purpose: To compare the effect of the cervical fusion (ACDF) versus arthroplasty after anterior cervical discectomy on the cervical dynamics, this can predispose to adjacent segment diseases at those levels. Study Design: A comparative retrospective study between two groups; cervical arthroplasty group, and the cervical fusion group. Patients and Methods: A total of 36 consecutive patients underwent anterior cervical discectomy with a mean follow-up of 24 months. Patients were classified into two groups; Group I (20 patients) were operated for (ACDF), Group II (16 patients) were operated for anterior cervical discectomy and prosthesis (arthroplasty). Preoperative and postoperative clinical assessments were done by using the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) score for myelopathy patients. In all patients, at final follow-up, a neuro-radiographic assessment (cervical spine static and dynamic x-ray and MRI) was done. The angle of the operated disc level, the angle of above and below adjacent segments and their range of motion (ROM), and global cervical curve Cobb angle (C2-7) were measured. Results: In group I; the mean angle of the global cervical curve improved from 3.4° preoperative (kyphosis) to 14.5°postoperative (P<0.001), where in group II, angle improved from 4.6° to 16.5° (P=0.6). The mean segmental ROM of adjacent segments didn’t show significant instability. The mean ROM at upper adjacent levels was 11.1°, and at the lower adjacent levels was 10.2° (normally up to 10 degrees). In group II, however, the mean angle of ROM was 7.8° at upper adjacent levels and 9.6° at lower adjacent levels. Postoperative improvement of JOA and NDI scores was statistically significant (P<0.001) in group-I (JOA improved from14.3±1.25 to 16.6±0.9, and NDI improved from 21.1±5.8 to 7.63±4.9), where in group-II JOA improved from 15.7±1.2 to 16.2±1.1 and NDI improved from 19±2.1 to 16±8.7. Symptomatic ASD was observed in 5 patients (20%) in group I and in none of group II patients Conclusion: Compensatory increase in ROM of the contiguous adjacent segments in patients subjected to ACDF may lead to ASD especially in those with asymptomatic adjacent sub-clinical degenerative disease. In contrary, arthroplasty reduce the incidence of adjacent segment diseases. (2017ESJ147)Ahmed Elsawaf Salem Faisal Salem FaisalEgyptian Spine Associationarticlecervical dynamicsadjacent segment diseasesanterior cervical discectomycervical prosthesisanterior cervical fusionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 25, Iss 1, Pp 36-46 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	cervical dynamics adjacent segment diseases anterior cervical discectomy cervical prosthesis anterior cervical fusion Neurology. Diseases of the nervous system RC346-429
spellingShingle	cervical dynamics adjacent segment diseases anterior cervical discectomy cervical prosthesis anterior cervical fusion Neurology. Diseases of the nervous system RC346-429 Ahmed Elsawaf Salem Faisal Salem Faisal Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
description	Background Data: After anterior cervical discectomy; the effect of cervical fusion or cervical arthroplasty on the dynamics of adjacent segments and the overall cervical spine has a direct impact on the final clinical outcome Purpose: To compare the effect of the cervical fusion (ACDF) versus arthroplasty after anterior cervical discectomy on the cervical dynamics, this can predispose to adjacent segment diseases at those levels. Study Design: A comparative retrospective study between two groups; cervical arthroplasty group, and the cervical fusion group. Patients and Methods: A total of 36 consecutive patients underwent anterior cervical discectomy with a mean follow-up of 24 months. Patients were classified into two groups; Group I (20 patients) were operated for (ACDF), Group II (16 patients) were operated for anterior cervical discectomy and prosthesis (arthroplasty). Preoperative and postoperative clinical assessments were done by using the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) score for myelopathy patients. In all patients, at final follow-up, a neuro-radiographic assessment (cervical spine static and dynamic x-ray and MRI) was done. The angle of the operated disc level, the angle of above and below adjacent segments and their range of motion (ROM), and global cervical curve Cobb angle (C2-7) were measured. Results: In group I; the mean angle of the global cervical curve improved from 3.4° preoperative (kyphosis) to 14.5°postoperative (P<0.001), where in group II, angle improved from 4.6° to 16.5° (P=0.6). The mean segmental ROM of adjacent segments didn’t show significant instability. The mean ROM at upper adjacent levels was 11.1°, and at the lower adjacent levels was 10.2° (normally up to 10 degrees). In group II, however, the mean angle of ROM was 7.8° at upper adjacent levels and 9.6° at lower adjacent levels. Postoperative improvement of JOA and NDI scores was statistically significant (P<0.001) in group-I (JOA improved from14.3±1.25 to 16.6±0.9, and NDI improved from 21.1±5.8 to 7.63±4.9), where in group-II JOA improved from 15.7±1.2 to 16.2±1.1 and NDI improved from 19±2.1 to 16±8.7. Symptomatic ASD was observed in 5 patients (20%) in group I and in none of group II patients Conclusion: Compensatory increase in ROM of the contiguous adjacent segments in patients subjected to ACDF may lead to ASD especially in those with asymptomatic adjacent sub-clinical degenerative disease. In contrary, arthroplasty reduce the incidence of adjacent segment diseases. (2017ESJ147)
format	article
author	Ahmed Elsawaf Salem Faisal Salem Faisal
author_facet	Ahmed Elsawaf Salem Faisal Salem Faisal
author_sort	Ahmed Elsawaf
title	Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
title_short	Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
title_full	Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
title_fullStr	Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
title_full_unstemmed	Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease
title_sort	effect of anterior cervical discectomy and fusion compared to cervical arthroplasty on dynamics of adjacent segment disease
publisher	Egyptian Spine Association
publishDate	2018
url	https://doaj.org/article/ee2070b296724ae49cb7a933166a9e60
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_version_	1718403898999308288

Effect of Anterior Cervical Discectomy and Fusion Compared to Cervical Arthroplasty on Dynamics of Adjacent Segment Disease

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