After Anterior Cervical Decompression And Fusion Research Articles

Discrepancies in recommendations for return to regular activities after cervical spine surgery: A survey study

BackgroundThe recommended timing for returning to common activities after cervical spine surgery varies widely among physicians based on training background and personal opinion, without clear guidelines or consensus. The purpose of this study was to analyze spine surgeons’ responses about the recommended timing for returning to common activities after different cervical spine procedures. MethodsThis was a survey study including 91 spine surgeons. The participants were asked to complete an anonymous online survey. Questions regarding their recommended time for returning to regular activities (showering, driving, biking, running, swimming, sedentary work, and nonsedentary work) after anterior cervical decompression and fusion (ACDF), cervical disc replacement (CDR), posterior cervical decompression and fusion (PCDF), and laminoplasty were included. Comparisons of recommended times for return to activities after each surgical procedure were made based on surgeons’ years in practice. ResultsFor ACDF and PCDF, there were no statistically significant differences in recommended times for return to any activity when stratified by years in practice. When considering CDR, return to non-sedentary work differed between surgeons in practice for 10 to 15 years, who recommended return at 3 months, and all other groups of surgeons, who recommended 6 weeks. Laminoplasty surgery yielded the most variability in activity recommendations, with earlier recommended return (6 weeks) to biking, non-sedentary work, and sedentary work in the most experienced surgeon group (>15 years in practice) than in all other surgeon experience groups (3 months). ConclusionsWe observed significant variability in surgeon recommendations for return to regular activities after cervical spine surgery.

Serotonin Reuptake Inhibitor Increases Pseudarthrosis Rates in Anterior Cervical Discectomy and Fusions.

Retrospective cohort. To determine (1) the effects of serotonin reuptake inhibitors in pseudarthrosis rates after anterior cervical decompression and fusion (ACDF) and (2) to identify patient-reported outcome measures in patients taking serotonin reuptake inhibitors. Recent literature suggests that selective serotonin reuptake inhibitors (SSRIs) may inhibit fracture healing via downregulation of osteoblast differentiation. Spinal fusion supplementation with osteoblast-rich substances enhances spinal fusion, thus SSRIs may be detrimental. Patients with 1-year postoperative dynamic cervical spine radiographs following ACDF were grouped into serotonin reuptake inhibitor prescriptions (SSRI, serotonin-norepinephrine reuptake inhibitor [SNRI], or tricyclic antidepressant [TCA]) and no prescription (atypical antidepressant or no antidepressant). Pseudarthrosis was defined as ≥1 mm interspinous process motion on dynamic radiographs. Logistic regression models were controlled for confounding to analyze pseudarthrosis rates. Alpha was set at p - values of <0.05. Of the 523 patients who meet the inclusion criteria, 137 (26.2%) were prescribed an SSRI, SNRI, or TCA. Patients with these prescriptions were more likely to have pseudarthrosis (p =0.008) but not a revision surgery due to pseudarthrosis (p =0.219). Additionally, these patients had worse 1-year postoperative mental component summary (MCS)-12 (p =0.015) and Neck Disability Index (NDI) (p =0.006). The multivariate logistic regression analysis identified SSRI/SNRI/TCA use (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.11-2.99; p =0.018) and construct length (OR, 1.91; 95% CI, 1.50-2.44; p <0.001) as pseudarthrosis predictors. A SSRI/SNRI/TCA prescription was a revision surgery predictor due to adjacent segment disease on univariate analysis (OR, 2.51; p =0.035) but not on multivariate logistic regression analysis (OR, 2.24; p =0.10). Patients taking serotonin reuptake-inhibiting antidepressants are at increased risk of worse postoperative outcome scores, including NDI and MCS-12, likely due to their underlying depression. This may contribute to their greater likelihood of having adjacent segment surgery. Additionally, preoperative use of serotonin reuptake inhibitors in patients undergoing an ACDF is a predictor of radiographic pseudarthrosis but not pseudarthrosis revision.

A novel technique using ultrasonography in upper airway management after anterior cervical decompression and fusion

BackgroundAirway complications are the most serious complications after anterior cervical decompression and fusion (ACDF) and can have devastating consequences if their detection and intervention are delayed. Plain radiography is useful for predicting the risk of dyspnea by permitting the comparison of the prevertebral soft tissue (PST) thickness before and after surgery. However, it entails frequent radiation exposure and is inconvenient. Therefore, we aimed to overcome these problems by using ultrasonography to evaluate the PST and upper airway after ACDF and investigate the compatibility between X-ray and ultrasonography for PST evaluation.MethodsWe included 11 radiculopathy/myelopathy patients who underwent ACDF involving C5/6, C6/7, or both segments. The condition of the PST and upper airway was evaluated over 14 days. The Bland–Altman method was used to evaluate the degree of agreement between the PST values obtained using radiography versus ultrasonography. The Pearson correlation coefficient was used to determine the relationship between the PST measurement methods. Single-level and double-level ACDF were performed in 8 and 3 cases, respectively.ResultsPST and upper airway thickness peaked on postoperative day 3, with no airway complications. The Bland–Altman bias was within the prespecified clinically nonsignificant range: 0.13 ± 0.36 mm (95% confidence interval 0.04–0.22 mm). Ultrasonography effectively captured post-ACDF changes in the PST and upper airway thickness and detected airway edema.ConclusionsUltrasonography can help in the continuous assessment of the PST and the upper airway as it is simple and has no risk of radiation exposure risk. Therefore, ultrasonography is more clinically useful to evaluate the PST than radiography from the viewpoint of invasiveness and convenience.

Change in the postoperative intervertebral space height and its impact on clinical and radiological outcomes after ACDF surgery using a zero-profile device: a single-Centre retrospective study of 138 cases

BackgroundThe effects of postoperative intervertebral height (IH) changes on the clinical and radiological outcomes after anterior cervical decompression and fusion (ACDF) surgery using a zero-profile device remain unclear.MethodsWe retrospectively reviewed patients who had undergone ACDF using a zero-profile device from March 2012 to February 2016 at our institution. Based on the postoperative IH variation, the patients were divided into group A with postoperative IH 0 to 2 mm, group B with postoperative IH 2 to 4 mm, and group C with postoperative IH greater than 4 mm. Clinical efficacy was evaluated using JOA, VAS, and NDI scores in the groups. Imaging parameters including the IH, cervical lordosis, fusion rate, intervertebral foramen (IVF) diameter and complications such as subsidence, dysphagia, and ASD were also compared across the three groups.ResultsThe average IH increased significantly from 6.72 mm preoperatively to 10.46 mm 1 week after surgery, and then gradually decreased to 7.48 mm at the final follow-up. The fusion rate was 61.90% in group A, 63.23% in group B, 53.57% in group C at 3 months, 73.81% in group A, 79.41% in group B, 67.86% in group C at 6 months, 90.48% in group A, 95.59% in group B, 92.86% in group C 1 year after surgery, and at the last follow-up, the fusion rate of three groups was all 100%. The IVF diameter was 6.52 ± 1.80 mm in group A, 9.55 ± 2.36 mm in group B, and 9.34 ± 1.62 mm in group C. ASD at the superior and inferior levels affected 11.90 and 16.67% patients in group A, 5.88 and 7.38% in group B, and 14.28 and 10.71% in group C. Regarding the 3 groups, the subsidence rates were 7.14, 4.41, and 14.29%, respectively.ConclusionsNo clear correlation was found between IH changes and clinical efficacy within a year of surgery. However, the IH may affect various complications after ACDF. If postoperative IH changes are maintained at 2 to 4 mm after a year, a satisfactory imaging parameters and relatively low complications may be achieved after ACDF surgery using a zero-profile device.

Radiographic Measures of Spinal Alignment Are Not Predictive of the Development of C5 Palsy Following Anterior Cervical Discectomy and Fusion Surgery.

Postoperative C5 palsy is a common complication following cervical decompression, occurring more frequently after posterior-based procedures. It has been theorized that this is the result of C5 nerve stretch resulting from spinal cord drift with these procedures. As such, it is thought to be less common after anterior cervical decompression and fusion (ACDF). However, no consensus has been reached on its true etiology. The purpose of this study is to assess the rate of C5 palsy following ACDF and to determine whether any radiographic or demographic parameters were predictive of its development. Two hundred and twenty-six patients who received ACDF between September 2015 and September 2016 were reviewed, and 122 were included in the final analysis. Patient demographic, surgical, and radiographic data were analyzed, including preoperative and postoperative radiographic and motor examination results. The Mann-Whitney U test was used to compare continuous variables between independent groups, and Fisher's exact test was used to compare categorical variables between groups. Seven patients developed a C5 palsy in the postoperative period, an incidence rate of 5.7%. Among the radiographic parameters evaluated, there were no statistically significant differences between the C5 palsy and nonpalsy groups. Additionally, there were no statistically significant differences in age, patient sex, or numbers of vertebral levels fused between groups. Ultimately, we did not identify any statistically significant demographic or radiographic predictive factors for the development of C5 palsy following ACDF surgery. 3.

Analysis of postoperative dysphagia after anterior cervical decompression and fusion

Purpose: To investigate the incidence and risk factors of postoperative dysphagia after anterior cervical decompression and fusion (ACDF) in terms of demographic, procedural and anaesthetic perspectives.Materials and methods: Medical records and radiologic data of patients who underwent anterior cervical surgery performed by two surgeons in a single centre between January 2012 and December 2015 were retrospectively analysed. Patients with spinal tumours, infective spondylitis and traumatic cervical pathologies were excluded. Patients with preoperative dysphagia and previous history of anterior cervical surgery were also excluded. Finally, 127 patients were enrolled. Bazaz dysphagia score was used for the diagnosis of postoperative dysphagia.Results: The incidence of postoperative dysphagia was 10.2% at six weeks after ACDF. Nine patients showed mild dysphagia that fully recovered at three months after ACDF. Four patients showed moderate dysphagia that also recovered fully at six months after surgery. The incidence of postoperative dysphagia increased significantly in cases of C4 or C5 level involvements. Age, sex, hypertension, body mass index, postoperative soft tissue swelling, intubation difficulty and intubation tools were not significant risk factors of ACDF. Diabetes mellitus, two surgical levels, the use of plate, long anaesthetic and operative time and large intubation tube size were causative factors of postoperative dysphagia in multivariable analysis (p < 0.05).Conclusions: The incidence of postoperative dysphagia after ACDF was relatively low, and the prognosis was good.

Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity

IntroductionPatients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack...

Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery: 162. Urinary N-telopeptide can predict pseudarthrosis after anterior cervical decompression and fusion (ACDF): a prospective study

BACKGROUND CONTEXT Anterior cervical decompression and fusion (ACDF) is one of the most successful and widely performed spine surgeries. Although high rates of fusion have been reported, there is a risk for pseudarthrosis. Urinary cross-linked n-telopeptide of type I collagen (uNTx), is an important marker of bone turnover and may prove useful as a predictor of fusion in pts undergoing ACDF. PURPOSE The purpose of present study was to examine the association of preop uNTx level and successful fusion after ACDF. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Adult patients who underwent ACDF with allograft and plating technique. OUTCOME MEASURES Fusion status was assessed using radiographic criteria published by Song et al. METHODS Patients undergoing primary ACDF with allograft and plating technique from 2015 to 2017 by a single surgeon were consecutively enrolled and preop uNTx was measured. Revision cases, improperly timed uNTx collection, pts with a Cr>1.2 were excluded. Demographics, operative, laboratory and fusion data was assessed at 6 months, 1 year and 2 years. NDI and VAS outcome scores were compared between fusion and nonfusion groups. Regression analysis was performed to assess the association of preop uNTx and successful fusion. RESULTS Of the 97 patients enrolled, 67 met inclusion criteria and were studied. 41%, 33%, 18% and 8% underwent one, two, three and four level ACDFs, respectively. Fusion rates were 37.3% at 6 months (n=67), 70.9% at 1 year (n=55) and 95.3% at 2 years (n=43). The preop uNTx was higher in the fusion group at 6mo (31 vs. 22, p CONCLUSIONS Urinary NTx was higher in patients with successful ACDF fusion compared to patients with radiographic pseudarthrosis at 6 months and 1 year. A linear relationship between uNTx levels and Fusion was observed. Surgeons should consider measuring uNTx prior to cervical fusion procedures to identify patients at risk for pseudarthrosis.

Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: new concepts: cervical spine: 246. C5 palsy after single- and multilevel anterior cervical discectomy and fusion

BACKGROUND CONTEXT Postoperative C5 nerve root palsy is a known complication after decompressive cervical surgery, most commonly reported after posterior cervical decompression and fusion (PCDF). However, while the rate of C5 palsy after anterior cervical decompression and fusion (ACDF) is lower, the effect of increasing number of levels fused on the prevalence of C5 palsy is unclear. PURPOSE To examine the rate of C5 palsy after one-, two-, three- and four-level ACDF including the C4-5 level, without corpectomy, and without posterior decompression. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Retrospective review of all anterior cervical discectomy and fusion patients at one institution over a 1 year period. OUTCOME MEASURES Manual motor testing grade. METHODS We performed a retrospective review of ACDFs performed at one institution by multiple surgeons between September 2015 and June 2016. Patient demographic and surgical information was reviewed, including postoperative motor examination results in the immediate postoperative period. C5 palsy was defined as motor decline of the deltoid muscle function by at least one level on standard manual muscle testing. Patients were excluded if undergoing concurrent posterior surgery or corpectomy, or if no postoperative motor strength was documented. Fisher's exact test was used to compare categorical variables between groups, and analysis of variance used to compare continuous variables. RESULTS We identified 226 patients undergoing single- or multilevel ACDF over the study time period, with a total of 196 meeting our inclusion criteria. Average age of all patients was 59.0 years and 49% were male, with no significant differences noted between groups undergoing single- or multilevel ACDF. Average follow up was 7 months. Ten patients developed postoperative C5 palsy, with an overall rate of 5.1%. There were no statistically significant differences in age, patient sex or numbers of levels fused between the palsy and no-palsy groups. We identified two C5 palsies in the single-level group (8.7%), two in the two-level group (3.1%), five in the three-level group (5.6%) and one in the four-level group (5.6%). These rates were not statistically significant between groups (p>.05). Six of the 10 patients with C5 palsy had complete recovery of final deltoid and/or biceps strength, while two patients had at least some level of strength recovery. Two patients had no measured improvement in C5 motor function by final follow up. CONCLUSIONS To our knowledge, no prior study has specifically compared the risk of C5 palsy between single- and multilevel ACDF when excluding corpectomy and posterior cervical cases. We found an overall C5 palsy rate of 5.1% for all patients undergoing one-, two-, three-, and four-level ACDF that included the C4-5 level at our institution. The rate of postoperative deltoid and/or biceps motor strength decline was lowest in the patients undergoing two-level ACDF and highest in the single-level group, but this finding did not reach statistical significance. Our rate of C5 palsy appears comparable to published literature.

Adjacent Segment Disease After Cervical Spine Fusion: Evaluation of a 70 Patient Long-Term Follow-Up.

A retrospective study of 70 patients undergoing surgical treatment for adjacent segment disease (ASD) after anterior cervical decompression and fusion (ACDF). To analyze the risk factors for the development of ASD in patients who underwent ACDF. ACDF has provided a high rate of clinical success for the cervical degenerative disc disease; nevertheless, adjacent segment degeneration has been reported as a complication at the adjacent level secondary to the rigid fixation. Between January 2005 and December 2012, 70 consecutive patients underwent surgery for ASD after ACDF in our institution. In all patients thorough clinical and radiological examination was performed preoperatively, postoperatively, and at the final follow-up. The clinical data included the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). The radiological evaluation included x-rays and magnetic resonance imaging (MRI) for all patients. The duration of follow up after the adjacent segment operation ranged from 3 to 10 years. Surgery for ASD was performed after a mean period of 32 months from the primary ACDF. ASD occurred after single level ACDF in 54% of cases, most commonly after C5/6 fusion (28%). Risk factors for ASD were found to be preexisting radiological signs of degeneration at the primary surgery (74%) and bad sagittal profile after the primary ACDF (90%). ASD occurred predominantly in the middle cervical region (C4-6); especially in patients with preexisting evidence of radiological degeneration in the adjacent segment at the time of primary cervical fusion, notably when this surgery failed to restore or maintain the cervical lordosis. 4.

Artificial Cervical Disk Replacement for the Treatment of Adjacent Segment Disease After Anterior Cervical Decompression and Fusion.

Retrospective study. To evaluate the outcome of artificial cervical disk replacement (ACDR) for the treatment of adjacent segment disease (ASD) after anterior cervical decompression and fusion (ACDF). ACDF is the useful procedure for degenerative cervical diseases. However, studies have reported accelerated degeneration of functional spinal units adjacent to the fusion site after ACDF. Between January 2004 and January 2011, 32 inpatients (18 male, 14 female; age, 38-61 y; mean, 48 y) underwent ACDR for the treatment of ASD after previous ACDF (single-level: n=12; 2-level: n=15; 3-level: n=5). In 22 patients, ASD occurred above the fusion site, and in 10 it occurred below the site. After ACDR, the patients were followed up for 30-62 months (mean, 49 mo). Before and after ACDR, patients were evaluated using the pain visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). In addition, the range of motion (ROM) of the replaced and adjacent unfused segments was measured by flexion/extension lateral radiography. Periprosthetic heterotopic ossification was detected using McAfee's classification. Degeneration of the adjacent unfused segment was evaluated using Goffin scale. All patients had successful surgery. Before ACDR, neck VAS, upper-limb VAS, JOA score, and NDI were 7.2±1.8, 6.9±1.1, 9.8±2.5, and 40.5±4.8, respectively. At the last follow-up, they were 1.2±0.3, 0.9±0.3, 14.5±1.1, and 9.0±2.5, respectively. Compared with presurgery, the improvements in VAS, JOA score, and NDI at the final follow-up were statistically significant (all P<0.05). During follow-up, prosthesis positioning was satisfactory without migration or downward movement. Preoperatively, the ROMs of the replaced and adjacent segments were 8.7±2.6 and 7.6±3.0, respectively. At the last follow-up, they were 8.5±2.2 and 7.2±2.6, respectively (both P>0.05). At the last follow-up, 2 patients had grade II heterotopic ossification; 3 patients had aggravated degeneration (vs. preoperative status) of the adjacent unfused segment. However, the reduction in Goffin grade was not statistically significant. Our follow-up shows that ACDR is an effective treatment for post-ACDF ASD. It can maintain the ROMs of the replaced segment as well as the adjacent unfused segment.

Smith-Robinson procedure with and without Caspar plating as a treatment for cervical spondylotic myelopathy: A 26-year follow-up of 23 patients

The purpose of this study was to assess long-term follow-up data after anterior cervical decompression and fusion (ACDF) with and without Caspar plating (ACDF+PS) for the treatment of cervical spondylotic myelopathy (CSM) with special focus on functional outcome, pain, and repeat surgery for adjacent segment disease (ASD). Hospital records of 45 patients who were affected by CSM and underwent ACDF or ACDF+PS at least 17years ago were reviewed. Information about diagnosis, surgical report, pre- and postoperative clinical process, and complications was analyzed. Clinical outcome was assessed using a standardized questionnaire including the Neck Disability Index (NDI), modified JOA-score, Odom's criteria, limitations in quality of life, and questions about the current neurological status and pain. Twenty-three patients with a mean follow-up of 26years were evaluated. ACDF was performed in nine and ACDF+PS in 14 patients, respectively. At follow-up 78.3% of patients were free of pain, 91.3% had no motor deficit, 73.9% had no sensory deficit, and 60.7% had no gait disturbance. The current mean NDI is 14% (range 2-44%), the mean modified JOA-score was 17.2 (range 15-18). According to Odom's criteria 78.3% of patients had clinical success. In four patients repeat surgery was indicated due to pseudarthrosis or symptomatic ASD (17.4%). ACDF and ACDF+PS yield significant decrease in neck pain, a significant increase in sensorimotor function and a high rate of clinical success. Patients with preoperative gait disturbance completely recovered in about 60% of cases. Overall prevalence for ASD was 17.4% after 25years.

The causes and prevention of C₅ nerve root palsy after anterior cervical decompression and fusion

To analyze the causes of muscular paralysis due to C₅ nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way. From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C₅ nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case. The follow up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C₅ nerve root palsy to 14.48±2.10 at final follow up, with significant difference(P<0.05). More complicated factors result in C₅ nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication.

A Meta-Analysis of the Incidence of Patient-Reported Dysphagia After Anterior Cervical Decompression and Fusion with the Zero-Profile Implant System.

Dysphagia is a well-known complication following anterior cervical surgery. It has been reported that the Zero-profile Implant System can decrease the incidence of dysphagia following surgery, however, dysphagia after anterior cervical decompression and fusion (ACDF) with the Zero-profile Implant System remains controversial. Previous studies only focus on small sample sizes. The objective of this study was to determine the incidence of dysphagia after ACDF with the Zero-profile Implant System. Studies were collected from PubMed, EMBASE, the Cochrane library and the China Knowledge Resource Integrated Database using the keywords "Zero-profile OR Zero-p) AND (dysphagia OR [swallowing dysfunction]". The software STATA (Version 13.0) was used for statistical analysis. Statistical heterogeneity across the various trials, a test of publication bias and sensitivity analysis was performed. 30 studies with a total of 1062 patients were included in this meta-analysis. The occurrence of post-operative transient dysphagia ranged from 0 to 76% whilst the pooled incidence was 15.6% (95% CI, 12.6, 18.5%). 23 studies reported no persistent dysphagia whilst seven studies reported persistent dysphagia ranging from 1 to 7%). In summary, the present study observed a low incidence of both transient and persistent dysphagia after ACDF using the Zero-profile Implant System. Most of the dysphagia was mild and gradually decreased during the following months. Moderate or severe dysphagia was uncommon. Future randomized controlled multi-center studies and those focusing on the mechanisms of dysphagia and methods to reduce its incidence are required.

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis.

Adjacent segment degeneration (ASD) is known to occur after anterior cervical arthrodesis. However, it is not known whether cervical canal stenosis enhances the risk of ASD. The purpose of this study was to explore whether congenital stenosis could be used as a predictor of ASD after anterior cervical decompression and fusion (ACDF). We enrolled 141 patients who had undergone ACDF for cervical myelopathy and/or radiculopathy, and had at least 6 years of follow-up. In standard radiographs of cervical spine in lateral view, bony congenital stenosis was evaluated and all patients were divided into two groups: stenosis (n = 63) and non-stenosis (n = 78). Radiographic ASD was assessed according to the criteria of Kellgren and Lawrence and correlated with symptomatic ASD. Clinical and radiological parameters were compared between the groups. The primary outcome was the rate of radiographic ASD after initial ACDF. The incidence of symptomatic ASD was assessed by Kaplan-Meier method. Radiographic ASD and symptomatic ASD developed in 46.8 % and 18.4 % of all patients, respectively. There was a significant association between congenital stenosis and radiographic ASD. The area under the receiver operating characteristic curve of preoperative anteroposterior (AP) diameter of cervical canal for predicting radiographic ASD was 0.756. 13.0 mm was the cutoff value of preoperative AP diameter of cervical canal predicting radiographic ASD. Kaplan-Meier analysis predicted a disease-free survival rate of symptomatic ASD in 97.2 % of patients at 5 years and 78.0 % at 10 years after ACDF. There was no significant difference in survival rates of the adjacent segment between the two groups via log-rank analysis (P = 0.102). Congenital stenosis can increase the rate of radiographic ASD after initial ACDF. The cutoff value of 13.0 mm for preoperative AP diameter of cervical canal had the highest validity for predicting radiographic ASD.

Adjacent segment degeneration after single-level anterior cervical decompression and fusion: Disc space distraction and its impact on clinical outcomes

The purpose of this study was to find whether excessive distraction of the disc space for cage insertion was a risk factor for adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). One hundred and sixteen consecutive patients who underwent ACDF for single-level cervical disc herniation between June 2006 and November 2008 were retrospectively reviewed. Preoperative, postoperative and final follow-up disc height (DH), sagittal segmental alignment (SSA), and sagittal alignment of the cervical spine (SACS) were measured and compared between the ASD group and non-ASD group. In 116 patients, ASD was radiographically proven in 28 (24.1%) patients. The clinical outcomes were significantly improved compared to the preoperative scores in both groups. However, the postoperative and final follow-up DH of the ASD group were significantly higher than in the non-ASD group (p<0.05). In addition, the postoperative DH was significantly correlated with the postoperative or final follow-up SSA (p<0.05). However, postoperative DH was not found to significantly correlate with postoperative or final follow-up SACS (p=0.072 and p=0.096, respectively). Multivariate analysis showed that postoperative DH was the most significant risk factor for ASD. The clinical outcomes of ACDF for single-level degenerative cervical disc disease were satisfactory. Postoperative DH (the distracted distance) had the greatest impact on the incidence of ASD. Excessive disc space distraction is a considerable risk factor for the development of radiographic ASD.

Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery

ObjectivesTo compare mechanical activity (deformation and deformation rate) of the dorsal neck muscles between individuals with longstanding symptoms after anterior cervical decompression and fusion (ACDF) surgery and healthy controls. DesignPreliminary cross-sectional study. SettingNeurosurgery clinic. ParticipantsTen individuals {mean age 60 [standard deviation (SD) 7.1]} who had undergone ACDF surgery 10 to 13 years previously and 10 healthy age- and sex-matched controls. Main outcomesMechanical activity of the different layers of dorsal neck muscles, measured at the C4 segment using ultrasonography (speckle tracking analysis) during a standardised, resisted cervical extension task. ResultsA significant group×muscle interaction was found for muscle deformation (P<0.03) but not for deformation rate (P>0.79). The ACDF group showed significantly less deformation of the semispinalis capitis muscle during the extension task compared with the control group [mean 3.12 (SD 2.06) and 6.64 (SD 4.17), respectively; mean difference 3.34 (95% confidence interval −0.54 to 7.21)]. ConclusionsAs the semispinalis capitis muscle is a powerful neck extensor, the finding of altered activation following ACDF surgery lends support to the inclusion of exercise to train neck muscle performance in the management of these patients.

Evaluation of Physical Function in Individuals 11 to 14 Years After Anterior Cervical Decompression and Fusion Surgery—A Comparison Between Patients and Healthy Reference Samples and Between 2 Surgical Techniques

ObjectiveThe purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage. MethodsIn this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants' values were compared with values of age- and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques. ResultsSixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (>30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92). ConclusionsIn those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age- and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.

Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study

The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women. To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (≥ 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (≥ 20% improvement in the neck disability index [NDI]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01). Preoperative predictive factors of good outcome 10-13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.

Cervical Muscle Activity During Loaded Arm Lifts in Patients 10 Years Postsurgery for Cervical Disc Disease

ObjectiveThe purpose of this study was to compare the mechanical activity of the neck muscles during loaded arm lifting tasks in individuals with long-standing disability after anterior cervical decompression and fusion (ACDF) with that of healthy controls. MethodsTen individuals (mean age, 60 years; SD, 7.1) who underwent ACDF (10-13 years previously) for cervical disc disease and 10 healthy age- and sex-matched controls participated in the study. Ultrasonography was used to investigate the degree of deformation and deformation rate of ventral and dorsal neck muscles at the C4 segmental level during a single (1× arm flexion to 120°) and repeated (10× arm flexion to 90°) loaded arm elevation condition. ResultsThe ACDF group showed greater deformation and deformation rate of the longus capitis (P = .02) and deformation rate of the sternocleidomastoid (P = .04) during the 120° arm lift. For repeated 90° arm lift, there was a significant group effect with higher deformation rate values observed in the longus capitis (P = .005-.01) and multifidus (P = .03) muscles in the ACDF group. Muscle behavior did not change the repeated arm lifts (no group × time interactions) for either the ventral or the dorsal muscles. ConclusionsFor study participants, greater muscle mechanical activity levels were observed in the ventral and multifidus muscles of patients with persistent symptoms after ACDF. These differences may indicate altered motor strategy in this patient group when performing the upper limb task and may need to be considered when prescribing exercise for postsurgical rehabilitation.