Benedikt W Burkhardt1, Andreas Simgen2, Matthias Dehnen3, Gudrun Wagenpfeil4, Wolfgang Reith5, Joachim M Oertel6. 1. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: benedikt.burkhardt@gmail.com. 2. Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: andreas.simgen@uks.eu. 3. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: matthias.dehnen@hotmail.de. 4. Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: gw@med-imbei.uni-saarland.de. 5. Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: wolfgang.reith@uks.eu. 6. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. Electronic address: oertelj@freenet.de.
Abstract
BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear. PURPOSE: To assess whether CP accelerates the degeneration of the adjacent and adjoining segments. STUDY DESIGN/ SETTING: This is an imaging cohort study. PATIENT SAMPLE: Retrospectively, a total of 84 patients who underwent ACDF or ACDF+CP were identified. At final follow-up, an MRI was performed and evaluated in this study. MATERIALS AND METHODS: An MRI of 84 patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed. The mean follow-up was 24 years (17-45 years). None of the patients had a repeat procedure in the cervical spine. The grade of degeneration of the segments adjacent and adjoining to the fusion was assessed via a five-step grading system (segmental degeneration index, or SDI) that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis. Furthermore, the disc height (DH) and sagittal segmental angle (SSA) of fused segments were measured. RESULTS: A significantly (p<.001) greater SDI was identified at the caudal adjacent segment following ACDF compared to ACDF+CP. No other significant differences were identified in patients following ACDF and ACDF+CP. Between 50% and 96% of all segments showed severe degenerative changes according to SDI. There was no significant difference in DH between the patients following ACDF and ACDF+CP. The SSA in patients who underwent ACDF+CP was significantly greater than in the ACDF patients (p=.002). CONCLUSIONS: In this cohort of patients, cervical plating had no significant impact on segmental degeneration and decrease of DH in the adjacent and adjoining segments. ACDF+CP seem to preserve the lordotic alignment more with respect to the SSA than ACDF.
BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear. PURPOSE: To assess whether CP accelerates the degeneration of the adjacent and adjoining segments. STUDY DESIGN/ SETTING: This is an imaging cohort study. PATIENT SAMPLE: Retrospectively, a total of 84 patients who underwent ACDF or ACDF+CP were identified. At final follow-up, an MRI was performed and evaluated in this study. MATERIALS AND METHODS: An MRI of 84 patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed. The mean follow-up was 24 years (17-45 years). None of the patients had a repeat procedure in the cervical spine. The grade of degeneration of the segments adjacent and adjoining to the fusion was assessed via a five-step grading system (segmental degeneration index, or SDI) that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis. Furthermore, the disc height (DH) and sagittal segmental angle (SSA) of fused segments were measured. RESULTS: A significantly (p<.001) greater SDI was identified at the caudal adjacent segment following ACDF compared to ACDF+CP. No other significant differences were identified in patients following ACDF and ACDF+CP. Between 50% and 96% of all segments showed severe degenerative changes according to SDI. There was no significant difference in DH between the patients following ACDF and ACDF+CP. The SSA in patients who underwent ACDF+CP was significantly greater than in the ACDF patients (p=.002). CONCLUSIONS: In this cohort of patients, cervical plating had no significant impact on segmental degeneration and decrease of DH in the adjacent and adjoining segments. ACDF+CP seem to preserve the lordotic alignment more with respect to the SSA than ACDF.
Authors: Brandon J Toll; Amer F Samdani; Joshua M Pahys; Amir A Amanullah; Steven W Hwang Journal: Childs Nerv Syst Date: 2021-03-17 Impact factor: 1.475
Authors: Helena Milavec; Christoph Kellner; Nivetha Ravikumar; Christoph E Albers; Till Lerch; Sven Hoppe; Moritz C Deml; Sebastian F Bigdon; Naresh Kumar; Lorin M Benneker Journal: J Funct Biomater Date: 2019-07-02
Authors: Benedikt W Burkhardt; Lukas Baumann; Andreas Simgen; Gudrun Wagenpfeil; Philipp Hendrix; Wolfgang Reith; Joachim M Oertel Journal: Sci Rep Date: 2022-08-03 Impact factor: 4.996