J Korean Orthop Assoc.  2009 Dec;44(6):613-618. 10.4055/jkoa.2009.44.6.613.

The Comparison of Multi-level Fusion versus One-level Fusion to the Development of Adjacent Level Degeneration in Anterior Cervical Arthrodesis with PEEK Cage and Plate Augmentation for the Degenerative Cervical Spinal Disorders

• Song KJ
• Lee SK
• Song JH
• Choi BY

• KMID: 2186287
• DOI: http://doi.org/10.4055/jkoa.2009.44.6.613

Abstract

PURPOSE
The purpose of this study was to analyze the effect of multi-level fusion in the development of adjacent level degeneration (ALD) in anterior cervical arthrodesis, as a treatment for degenerative cervical disease.
MATERIALS AND METHODS
Retrospectively, we analyzed 127 patients who underwent arthrodesis with PEEK cage and plate construction for the treatment of degenerative cervical disease. The mean patient age was 54.4+/-10.6 years and the average follow-up period was 48.5+/-8.5 months. Group A composed of 55 patients who underwent one level fusion and group B composed of 72 patients who underwent two or three level fusion. We evaluated and compared the severity of ALD, such as the stage of osteophyte formation, the grade of ALD, and the incidence of ALD according to 4 grading system.
RESULTS
The stage of osteophyte formation was 1.62+/-0.85 points in group A and 2.43+/-1.14 points in group B (p=0.02). The grade of ADL was 1.71+/-0.94 points in group A and 2.38+/-1.11 points in group B (p=0.01). The incidence of symptomatic ALD (radiculopathy and/or myelopathy) was 3.6% (2/55 cases) in group A and 4.2% (3/77 cases) in group B (p>0.05).
CONCLUSION
Multi-level fusion can accelerate the severity of adjacent level degeneration as compared with one level fusion, but there was no correlation in the incidence of symptomatic adjacent level degeneration to the fusion level number after anterior cervical arthrodesis for degenerative cervical diseases.

Keyword

Degenerative cervical disc disease; Anterior cervical arthrodesis; Adjacent segment degeneration

MeSH Terms

Activities of Daily Living
Arthrodesis
Follow-Up Studies
Humans
Incidence
Ketones
Osteophyte
Polyethylene Glycols
Retrospective Studies
Ketones
Polyethylene Glycols

Figure

• 

  Fig. 1 Histogram demonstrate the bony spur grading of adjacent segment in two group, multi-level arthrodesis leads to aggravation bony spur formation than one-level arthrodesis.

• 

  Fig. 2 Histogram demonstrate adjacent segmental degeneration according to disc space, multi-level arthrodesis accelate degeneration of adjacent segment.

Reference

1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958. 40:607–624.

2. Baba H, Furusawa N, Imura S, Kawahara N, Tsuchiya H, Tomita K. Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine (Phila Pa 1976). 1993. 18:2167–2173.

3. Goffin J, van Loon J, Van Calenbergh F, Plets C. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord. 1995. 8:500–508.

4. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assn. 1958. 53:457–481.

5. McGrory BJ, Klassen RA. Arthrodesis of the cervical spine for fractures and dislocations in children and adolescents. A long-term follow-up study. J Bone and Joint Surg Am. 1994. 76:1606–1616.

6. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999. 81:519–528.

7. Dohler JR, Kahn MR, Hughes SP. Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients. Arch Orth Trauma Surg. 1985. 104:247–250.

8. Katsuura A, Hukuda S, Saruhashi Y, Mori K. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J. 2001. 10:320–324.

9. Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005. 87:558–563.

10. Rhin JA, Lawrence J, Gates C, Harris E, Hilibrand AS. Adjacent segment disease after cervical spine fusion. Instr Course Lect. 2009. 58:747–756.

11. Buckwalter JA. Aging and degeneration of the human intevertebral disc. Spine (Phila Pa 1976). 1995. 20:1307–1314.

12. Schwab JS, Diangelo DJ, Foley KT. Motion compension associated with single-level cervical fusion: where does the lost motion go? Spine (Phila Pa 1976). 2006. 31:2439–2448.

13. Ragab AA, Escarcega AJ, Zdeblick TA. A quantitative analysis of strain at adjacent segment after segmental immobilization of the cervical spine. J Spinal Disord Tech. 2006. 19:407–410.

14. Maiman DJ, Kumaresan S, Yoganandan N, Pintar FA. Biomechanical effect of anterior cervical spine fusion on adjacent segment. Biomed Mater Eng. 1999. 9:27–38.

15. Park DH, Ramakrishnan P, Cho TH, et al. Effect of lower two-level anterior cervical fusion on the superior adjacent level. J Neurosurg Spine. 2007. 7:336–340.

16. Rao RD, Wang M, McGrady LM, Perlewitz TJ, David KS. Dose anterior plating of the cervical spine predispose to adjacent segment changes? Spine (Phila Pa 1976). 2005. 30:2788–2792.

17. Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004. 17:79–85.

18. Yue WM, Brodner W, Highland TR. 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 (Phila Pa 1976). 2005. 30:2138–2144.

19. Ishihara H, Kanamori M, Kawaguchi Y, Nakamura H, Kimura T. Adjacent segment disease after anterior cervical interbody fusion. Spine J. 2004. 4:624–628.