Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

European Spine Journal - Tập 27 - Trang 2745-2753 - 2018
Bryce A. Basques1, Philip K. Louie1, Jeremy Mormol1, Jannat M. Khan1, Kamran Movassaghi1, Justin C. Paul2, Arya Varthi3, Edward J. Goldberg1, Howard S. An1
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA
2Danbury Orthopaedics, Danbury, USA
3Yale University School of Medicine, Chicago, USA

Tóm tắt

The purpose of this study was to compare the rates of adjacent segment degeneration (ASD), sagittal alignment parameters, and patient-reported outcomes in patients who underwent multi-level versus single-level anterior cervical discectomy and fusion (ACDF). A retrospective cohort analysis was performed on consecutive patients who underwent an ACDF. Pre- and post-operative radiographic assessment included ASD, change in C2–C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis. Patient-reported outcomes were obtained. Of the 404 that underwent an ACDF with a minimum of 6 months of follow-up (average 28 months), there was no significant difference in the rate of radiographic ASD overall (p = 0.479) or in the proximal or distal adjacent segments on multivariate analysis. Secondarily, the multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures (p < 0.001) and are able to maintain the corrected cervical lordosis and fusion segment lordosis over time. From the immediate post-operative period to final follow-up, the single-level ACDFs show continuing lordosis improvement (p = 0.005) that is significantly greater than that of the multi-level constructs. There were no significant differences between pre-operative, post-operative, or change in patient-reported outcomes. Two years following an ACDF, patients who underwent multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures, while single-level ACDFs show significantly greater amounts of lordosis improvement over time. Multi-level procedures may not be at a significantly greater risk of developing early radiographic evidence of ASD compared to single-level procedure. These slides can be retrieved under Electronic Supplementary Material.

Tài liệu tham khảo

Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg Am 75-A(9):1–10 Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine 30(19):2138–2144 Chang SW, Kakarla UK, Maughan PH et al (2010) Four-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Neurosurgery 66(4):639–646. https://doi.org/10.1227/01.neu.0000367449.60796.94 (discussion 646–7) 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(3):193–199. https://doi.org/10.1016/j.spinee.2009.09.006 Oh MC, Zhang HY, Park JY, Kim KS (2009) Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine 34(7):692–696. https://doi.org/10.1097/BRS.0b013e318199690a Veeravagu A, Cole T, Jiang B, Ratliff JK (2014) Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine J 14(7):1125–1131. https://doi.org/10.1016/j.spinee.2013.07.474 Guo Q, Bi X, Ni B et al (2011) Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J 20(9):1539–1544. https://doi.org/10.1007/s00586-011-1735-4 Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81(4):519–528 Matsumoto M, Okada E, Ichihara D et al (2010) Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine 35(1):36–43. https://doi.org/10.1097/BRS.0b013e3181b8a80d Baba H, Furusawa N, Imura S, Kawahara N, Tsuchiya H, Tomita K (1993) Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine 18(15):2167–2173 Prasarn ML, Baria D, Milne E, Latta L, Sukovich W (2012) Adjacent-level biomechanics after single versus multilevel cervical spine fusion. J Neurosurg Spine 16(2):172–177. https://doi.org/10.3171/2011.10.SPINE11116 Louie PK, Presciutti SM, Iantorno SE et al (2017) There is no increased risk of adjacent segment disease at the cervicothoracic junction following an anterior cervical discectomy and fusion to C7. Spine J. https://doi.org/10.1016/j.spinee.2017.04.027 DuBois CM, Bolt PM, Todd AG, Gupta P, Wetzel FT, Phillips FM (2007) Static versus dynamic plating for multilevel anterior cervical discectomy and fusion. Spine J 7(2):188–193. https://doi.org/10.1016/j.spinee.2006.07.004 Carrier CS, Bono CM, Lebl DR (2013) Evidence-based analysis of adjacent segment degeneration and disease after ACDF: a systematic review. Spine J 13(10):1370–1378. https://doi.org/10.1016/j.spinee.2013.05.050 Bydon M, Xu R, Macki M et al (2014) Adjacent segment disease after anterior cervical discectomy and fusion in a large series. Neurosurgery 74(2):139–146. https://doi.org/10.1227/NEU.0000000000000204 Kim JT, Lee HJ, Choi DY, Shin MH, Hong JT (2016) Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine. Eur Spine J 25(7):2223–2232. https://doi.org/10.1007/s00586-016-4401-z Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6):S190–S194. https://doi.org/10.1016/j.spinee.2004.07.007 Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29(17):1938–1944 van Eck CF, Regan C, Donaldson WF, Kang JD, Lee JY (2014) The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion. Spine 39(26):2143–2147. https://doi.org/10.1097/BRS.0000000000000636 Zigler JE, Rogers RW, Ohnmeiss DD (2016) Comparison of 1-level versus 2-level anterior cervical discectomy and fusion: clinical and radiographic follow-up at 60 months. Spine 41(6):463–469. https://doi.org/10.1097/BRS.0000000000001263 Han Y-C, Liu Z-Q, Wang S-J, Li L-J, Tan J (2014) Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis. PLoS One 9(1):e87191-12. https://doi.org/10.1371/journal.pone.0087191 Song K-J, Yoon S-J, Lee K-B (2012) Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Eur Spine J 21(12):2492–2497. https://doi.org/10.1007/s00586-012-2447-0 Zhou J, Li X, Dong J et al (2011) Three-level anterior cervical discectomy and fusion with self-locking stand-alone polyetheretherketone cages. J Clin Neurosci 18(11):1505–1509. https://doi.org/10.1016/j.jocn.2011.02.045 Samartzis D, Shen FH, Matthews DK, Yoon ST, Goldberg EJ, An HS (2003) Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation. Spine J 3(6):451–459. https://doi.org/10.1016/S1529-9430(03)00173-6 Shamji MF, Massicotte EM, Traynelis VC, Norvell DC, Hermsmeyer JT, Fehlings MG (2013) Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy. Spine 38:S195–S209. https://doi.org/10.1097/BRS.0b013e3182a7eb27 Nagoshi N, Tetreault L, Nakashima H et al (2017) Risk factors for and clinical outcomes of dysphagia after anterior cervical surgery for degenerative cervical myelopathy: results from the AOSpine International and North America Studies. J Bone Joint Surg Am 99(13):1069–1077. https://doi.org/10.2106/JBJS.16.00325 Bolesta MJ, Rechtine GR II, Chrin AM (2000) Three- and four-level anterior cervical discectomy and fusion with plate fixation. Spine 25(16):2040–2046. https://doi.org/10.1097/00007632-200008150-00007 Lowery GL, McDonough RF (1998) The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow-up. Spine 23(2):181–187 Paramore CG, Dickman CA, Sonntag VKH (1996) Radiographic and clinical follow-up review of Caspar plates in 49 patients. J Neurosurg 84(6):957–961. https://doi.org/10.3171/jns.1996.84.6.0957 Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP (2006) Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine 31(8):897–902. https://doi.org/10.1097/01.brs.0000209348.17377.be