Abstract
This study was designed to investigate the clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental diseases following anterior cervical corpectomy and fusion (ACCF) surgery. Between January 2008 and December 2015, 48 patients who underwent laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery, were enrolled into this study. The patients were followed up at least 2 years. Pain assessment was determined by visual analogue scale (VAS) score and Neck Disability Index (NDI) score; neurological impairment was evaluated by Japanese Orthopaedic Association (JOA) score; and radiographic parameters were also compared. All comparisons were determined by paired t test with appropriate Bonferronni correction. VAS score preoperatively and at last follow-up was 5.28 ± 2.35 vs 1.90 ± 1.06 (P < 0.001). JOA score preoperatively and at last follow-up was 8.2 ± 3.6 vs 14.5 ± 1.1 (P < 0.001). NDI score preoperatively and at last follow-up was 30.5 ± 12.2 vs 10.6 ± 5.8 (P < 0.001). Moreover, the losses of cervical lordosis and C2-C7 range of motion after laminectomy were significant (both P < 0.005), but not sagittal vertical axis distance. Postoperative complications were few or mild. In conclusion, clinical effectiveness and safety can be guaranteed when the patients undergo laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery.
Highlights
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have been considered as the “gold standard” surgical treatment of cervical degenerative diseases
Both ACDF and ACCF surgery have changed the original mechanical behavior of the cervical spine at the cost of the activity of the fused level, which is likely to cause the changes of adjacent vertebral stress distribution and the movement patterns, resulting in biomechanical changes including stress concentration of adjacent segments, compensatory increase in activity, and even instability; adjacent segmental disease (ASD) developed[4,5,6]
Once the ASD progressed to a severe extent, the patients would usually undergo another surgery performed via a posterior way, including laminoplasty and laminectomy
Summary
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have been considered as the “gold standard” surgical treatment of cervical degenerative diseases. Data from radiographic and clinical studies showed that the segments adjacent to the fused spinal segments would accelerate the progression of degeneration or become unstable after a certain years[1,2,3] Both ACDF and ACCF surgery have changed the original mechanical behavior of the cervical spine at the cost of the activity of the fused level, which is likely to cause the changes of adjacent vertebral stress distribution and the movement patterns, resulting in biomechanical changes including stress concentration of adjacent segments, compensatory increase in activity, and even instability; adjacent segmental disease (ASD) developed[4,5,6]. To minimize the confounding factors, it was designed to investigate the clinical effectiveness of laminectomy with instrumented fixation in treating ASD following only ACCF, based on a regular follow-up with a minimum of two years
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