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Wu Z, Wang W, Zhou F, Xiang P, Li Y, Yang H, Chu G. Comparative analysis of risk factors associated with degeneration of adjacent segments: zero-profile anchored spacer vs. anterior cervical plate and cage construct. Front Med (Lausanne) 2024; 11:1375554. [PMID: 38887670 PMCID: PMC11182449 DOI: 10.3389/fmed.2024.1375554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/18/2024] [Indexed: 06/20/2024] Open
Abstract
Objective Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease, but cervical spine surgery may affect sagittal alignment parameters and induce adjacent segment degeneration (ASD). This study aimed to determine the risk factors for developing ASD following anterior cervical plate and cage (ACPC) compared with the use of zero-profile anchored spacer (ROI-C). Methods A retrospective contrastive study included 105 patients who underwent ACPC or ROI-C between January 2014 and October 2019 at our treatment centre. There were 50 cases in the ROI-C group and 55 patients in the ACPC group. Clinical and radiological results and the incidence of ASD were assessed after surgery. All patients were further divided into the ASD and non-ASD groups for subgroup analysis. Results At each follow-up time, there was no statistically significant in radiographic parameters between the two groups. The overall ASD rate was higher in the ACPC group than in the ROI-C group (65.5% vs. 44.0%, p = 0.027). The low preoperative Cobb angle, low preoperative segment angle (SA), and loss of Cobb (ΔCobb) were significantly correlated with ASD. However, clinical outcomes were not associated with ASD at any postoperative follow-up visit. Conclusion Equally good therapeutic effects were achieved with both the ROI-C and ACPC. The occurrence of ASD was considerably higher in the ACPC group than in the ROI-C group. The preoperative Cobb angle, preoperative SA, and ΔCobb were the most associated with an increase in the risk of ASD.
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Affiliation(s)
- Zhikai Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenhao Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Pan Xiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yangfeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
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Mesregah MK, Baker M, Yoon C, Meisel HJ, Hsieh P, Wang JC, Yoon ST, Buser Z. Radiographic Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion (ACDF): A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241237500. [PMID: 38469858 DOI: 10.1177/21925682241237500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies. METHODS PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis. RESULTS From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had "not serious" bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, P = .002), reduced last-follow-up cervical lordosis (MD = -3.02°, P = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = -3.68°, P = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, P < .001). CONCLUSIONS Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | | | - Camilla Yoon
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Hans-Joerg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Patrick Hsieh
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Tim Yoon
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Zorica Buser
- Gerling Institute, New York, NY, USA
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Zhu Q, Li N, Ding Y, Zhang Z, Jiang W, Jiang T, Qiao Q, Qian Y, Cheng H. Incidence of Adjacent Segment Degeneration and Its Associated Risk Factors Following Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg 2024; 183:e153-e172. [PMID: 38103684 DOI: 10.1016/j.wneu.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the incidence of adjacent segment degeneration (ASD) and its associated risk factors in adults after anterior cervical discectomy and fusion (ACDF) surgery. METHODS An exhaustive search across multiple databases was conducted, including Embase, PubMed, Cochrane Library, and the Web of Science, to identify pertinent studies. We collected such patient data as demographic variables (including age, gender, body mass index), cervical spondylosis type (such as radiculopathy and myelopathy), diabetes status, smoking and drinking history, and radiological risk factors (such as preoperative ASD status, developmental spinal stenosis, T1 slope, and postoperative less cervical lordosis). Incidence estimates were calculated based on relevant data. Risk factors were assessed using odds ratios and weighted mean differences with 95% confidence intervals (CIs). RESULTS Our analysis incorporated a total of 21 studies for incidence analysis. The overall incidence of CASD following ACDF was found to be 11% and radiographical ASD was 30%. Old age (weighted mean difference = 3.21; 95% CI: 0.06, 6.36; P = 0.05), preoperative ASD status (odds ratio = 2.65; 95% CI: 1.53, 4.60; P < 0.01), developmental spinal stenosis (odds ratio = 2.46; 95% CI: 1.61, 3.77; P < 0.01), and postoperative reduction in cervical lordosis were identified as significant risk factors for the occurrence of CASD. CONCLUSIONS The incidence of CASD following ACDF was 11%. Risk factors for CASD included old age, preoperative adjacent segment degeneration, developmental spinal stenosis, and postoperative reduction in cervical lordosis. These findings provide valuable insights for the assessment of adjacent segment disease risk after ACDF, aiding surgeons in diagnosis and treatment decisions.
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Affiliation(s)
- Qianmiao Zhu
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ning Li
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yi Ding
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zifeng Zhang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wenkang Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ting Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qiujiang Qiao
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yuhang Qian
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Huilin Cheng
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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Li S, Yan P, Fan Y, Wang R, Zhang C. Biomechanical analysis of the door-shaped titanium plate in single-level anterior cervical discectomy and fusion. J Orthop Surg Res 2023; 18:982. [PMID: 38129900 PMCID: PMC10734066 DOI: 10.1186/s13018-023-04474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Analyse and discuss the immediate stability of the cervical spine after anterior cervical discectomy and fusion using a door-shaped titanium plate and compare it with the traditional titanium plate, to provide biomechanical evidence for the rationality and effectiveness of the door-shaped titanium plate in clinical applications. METHODS Ten adult goat C4/5 vertebral bodies were obtained, and models were prepared using denture base resin. Biomechanical experiments were performed on the specimens before internal fixation. MTS was used to conduct non-destructive biomechanical loading tests in six directions, including flexion, extension, left-right bending, and left-right torsion, recording the range of motion (ROM) and neutral zone (NZ) of each specimen. The specimens were then randomly divided into two groups: the study group was fixed with a door-shaped titanium plate, and the control group was fixed with a traditional titanium plate. ROM and NZ in each direction were measured again. After measurements, both groups were subjected to 0.5 Hz torsion loading with a torque of 2 N m for a total of 3000 cycles, followed by measuring ROM and NZ in six directions once more. RESULTS Compared to before fixation, ROM and NZ in both groups significantly decreased in all six directions after fixation, with statistical significance (P < 0.05); after fixation, the study group showed slightly lower values for various mechanical reference parameters compared to the control group, with no statistical significance (P > 0.05); after 3000 torsional loads, both internal fixation groups showed increased ROM and NZ compared to after fixation but to a lower extent, and no screw or titanium plate loosening was observed. Compared to before fixation, the differences were still statistically significant (P < 0.05), with the study group having slightly lower ROM and NZ values in all directions compared to the control group, with no statistical significance (P > 0.05). CONCLUSION The door-shaped titanium plate exhibits mechanical properties similar to the traditional titanium plate in all directions, and its smaller size and simpler surgical operation can be used for anterior cervical endoscopic surgery, reducing surgical trauma. It is clinically feasible and deserves further research and promotion.
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Affiliation(s)
- Senli Li
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Peng Yan
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanwei Fan
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Ruibo Wang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Changjiang Zhang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Kwok WCH, Wong CYY, Law JHW, Tsang VWT, Tong LWL, Samartzis D, An HS, Wong AYL. Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion with Plate Fixation: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2022; 104:1915-1945. [PMID: 36321969 DOI: 10.2106/jbjs.21.01494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and clinical ASD (CASD) after ACDF-P. METHODS Six electronic databases were searched from inception to October 30, 2021. Four reviewers independently screened titles, abstracts, and full-text articles to identify relevant studies. Methodological quality of the included studies was evaluated. Meta-analyses for risk factors were conducted, if possible. RESULTS Sixteen cohort and 3 case-control studies (3,563 participants) were included. These studies showed low (n = 2), moderate (n = 9), and high (n = 8) risk of bias. One risk factor for RASD was pooled for 2 meta-analyses based on the follow-up period. Four different risk factors for CASD at ≥4 years were pooled for meta-analyses. Limited evidence showed that multi-level fusion, greater asymmetry in total or functional cross-sectional area of the cervical paraspinal muscle, and preoperative degeneration in a greater number of segments were associated with a higher RASD incidence <4 years after ACDF-P. In contrast, no significant risk factors were identified for CASD <4 years after ACDF-P. At ≥4 years after ACDF-P, limited evidence supported that both cephalad and caudal plate-to-disc distances of <5 mm were associated with a higher RASD incidence, and very limited evidence supported that developmental canal stenosis, preoperative RASD, unfused C5-C6 or C6-C7 adjacent segments, use of autogenous bone graft, and spondylosis-related ACDF-P were associated with a higher CASD incidence. CONCLUSIONS Although several risk factors for RASD and CASD development after ACDF-P were identified, the supporting evidence was very limited to limited. Future prospective studies should extend the existing knowledge by more robustly identifying risk factors for RASD and CASD after ACDF-P to inform clinical practice. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wallace C H Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Christina Y Y Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Jason H W Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Vy W T Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Leo W L Tong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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6
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Li W, Zhan B, Jiang X, Zhou G, Li J, Wang Y. A randomized controlled study of two different fixations in anterior cervical discectomy of multilevel cervical spondylotic myelopathy. J Orthop Surg (Hong Kong) 2022; 30:10225536221118601. [PMID: 36069629 DOI: 10.1177/10225536221118601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: To compare the efficacy of anterior cervical discectomy and hybrid fusion (ACDHF) with short-segment plate plus self-locking, stand-alone intervertebral cages versus traditional anterior cervical discectomy and fusion (ACDF) with long-segment plate for multilevel cervical spondylotic myelopathy (MCSM). Methods: All the patients were randomly divided into two groups. 30 cases underwent ACDHF with short-segment plate and self-locking stand-alone cages (hybrid group), while the other 30 cases received ACDF with long-segment plate (control group). In patients meeting the inclusion and exclusion criteria, operation time, blood loss, postoperative drainage volume, length of stay (LOS), visual analogue scale for neck pain (VASNP) scores, Japanese Orthopaedic Association (JOA) score, and the cervical lordosis before and after the operation (5 days, 3, 6, 12 months after operation and final follow-up) were evaluated. The postoperative complications were analyzed as well. Results: All operations were performed uneventfully with followed-up. Compared with ACDF, ACDHF showed a shorter operation time, less intraoperative blood loss and postoperative drainage (p < 0.05). There were no significant difference in LOS between two groups (p ˃ 0.05). Both approaches significantly improved the JOA scores, VASNP scores and the cervical lordosis (p < 0.05). Based on Bazaz grading system, hybrid group had a lower incidence of dysphagia than control group in follow-up periods of 5 days, 3 and 6 months (p < 0.05). Conclusion: ACDF and ACDHF are both effective methods of restoring cervical lordosis following MCSM, but hybrid surgery minimizes intraoperative injury and postoperative dysphagia, making it a viable treatment option for the disorder.
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Affiliation(s)
- Wei Li
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Bishui Zhan
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Xuesheng Jiang
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Guoshun Zhou
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Junjie Li
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Yongli Wang
- Department of Spinal Surgery, Huzhou Central Hospital, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
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7
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Rudisill SS, Hornung AL, Barajas JN, Bridge JJ, Mallow GM, Lopez W, Sayari AJ, Louie PK, Harada GK, Tao Y, Wilke HJ, Colman MW, Phillips FM, An HS, Samartzis D. Artificial intelligence in predicting early-onset adjacent segment degeneration following anterior cervical discectomy and fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2104-2114. [PMID: 35543762 DOI: 10.1007/s00586-022-07238-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/12/2022] [Accepted: 04/17/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative disease in the cervical spine. However, resultant biomechanical alterations may predispose to early-onset adjacent segment degeneration (EO-ASD), which may become symptomatic and require reoperation. This study aimed to develop and validate a machine learning (ML) model to predict EO-ASD following ACDF. METHODS Retrospective review of prospectively collected data of patients undergoing ACDF at a quaternary referral medical center was performed. Patients > 18 years of age with > 6 months of follow-up and complete pre- and postoperative X-ray and MRI imaging were included. An ML-based algorithm was developed to predict EO-ASD based on preoperative demographic, clinical, and radiographic parameters, and model performance was evaluated according to discrimination and overall performance. RESULTS In total, 366 ACDF patients were included (50.8% male, mean age 51.4 ± 11.1 years). Over 18.7 ± 20.9 months of follow-up, 97 (26.5%) patients developed EO-ASD. The model demonstrated good discrimination and overall performance according to precision (EO-ASD: 0.70, non-ASD: 0.88), recall (EO-ASD: 0.73, non-ASD: 0.87), accuracy (0.82), F1-score (0.79), Brier score (0.203), and AUC (0.794), with C4/C5 posterior disc bulge, C4/C5 anterior disc bulge, C6 posterior superior osteophyte, presence of osteophytes, and C6/C7 anterior disc bulge identified as the most important predictive features. CONCLUSIONS Through an ML approach, the model identified risk factors and predicted development of EO-ASD following ACDF with good discrimination and overall performance. By addressing the shortcomings of traditional statistics, ML techniques can support discovery, clinical decision-making, and precision-based spine care.
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Affiliation(s)
- Samuel S Rudisill
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - J Nicolás Barajas
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Jack J Bridge
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,Department of Data Science and Analytics, University of Missouri, Colombia, MO, USA
| | - G Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Wylie Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Virginia Mason Medical Center, Neuroscience Institute, Seattle, WA, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, USA. .,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA.
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8
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Lee HJ, You ST, Kim JH, Kim IS, Sung JH, Hong JT. Significance of Cervical Spine Computed Tomography Hounsfield Units to Predict Bone Mineral Density and the Subsidence After Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2021; 34:E450-E457. [PMID: 34091491 DOI: 10.1097/bsd.0000000000001218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This study was a retrospective review. OBJECTIVE The purpose of this study was to investigate the correlation analysis between Hounsfield units (HU) and dual x-ray absorptiometry (DXA) based on the clinical results of patients who underwent anterior cervical discectomy and fusion (ACDF) surgery. SUMMARY OF BACKGROUND DATA There is no technique to directly measure bone mineral density (BMD) in the cervical spine. As computed tomography is a very popular preoperative planning modality, using the HU value from that analysis to predict osteoporosis is important for patient outcomes and applications in the clinical field. MATERIALS AND METHODS We reviewed the records for 235 patients who underwent 1-level (n=120) or 2-level (n=115) ACDF surgery. In the 1-level ACDF group, the HU was measured from C3 to C6 vertebra, while that for the 2-level ACDF group was measured from 3 surgical index vertebrae. The correlation patterns were analyzed with the corresponding DXA (T-score) for each patient. Subsidence of fusion segment was defined as change in distance between plate-tip and upper (lower) margin of the vertebra (index level) after 4 months of follow-up. In addition, to determine the relevant factors that influence fusion segment subsidence, other preoperative (C2 slope, C7 slope, C2-C7 angle, and C2-C7 sagittal vertical axis) and postoperative parameters (coronal angle and segmental angle change) were measured. RESULTS The correlation coefficient between HU and DXA ranged from 0.57 to 0.71 in the 1-level ACDF group and from 0.59 to 0.66 in the 2-level ACDF group. The correlation between HU and DXA was statistically significant regardless of the degree of anterior osteophyte (r=-0.65 to 0.78). Total subsidence height was 3.8 mm after ACDF, and both HU and DXA were statistically correlated with total subsidence (r=0.26-0.28). In multivariate analysis, HU (middle vertebra) value was statistically associated with the degree of total subsidence. The high-subsidence group (≥4.5 mm) showed smaller HU values (284.1 vs. 316.0) and T-scores (-0.5 vs. 0.1) compared to the low-subsidence group (<4.5 mm). The discrepancy group, defined as cases with excess plate shift on 1 side, also showed smaller HU values (260.4 vs. 312.4) and higher degrees of total subsidence than the matched group. CONCLUSIONS The correlation between HU in cervical computed tomography and lumbar DXA (T-score) was statistically significant in both 1-level and 2-level ACDF. The level of BMD (HU or DXA) is a very important factor for clinically determining the amount and regularity of subsidence after ACDF. Therefore, HU can be a good alternative assessment to accurately reflect as much of the BMD degree as DXA in the cervical spine.
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Affiliation(s)
- Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Soon Tae You
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Jung Hee Kim
- Department of Neurosurgery, Seoul Medical Center
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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9
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Wong AYL, Harada G, Lee R, Gandhi SD, Dziedzic A, Espinoza-Orias A, Parnianpour M, Louie PK, Basques B, An HS, Samartzis D. Preoperative paraspinal neck muscle characteristics predict early onset adjacent segment degeneration in anterior cervical fusion patients: A machine-learning modeling analysis. J Orthop Res 2021; 39:1732-1744. [PMID: 32816312 DOI: 10.1002/jor.24829] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
Early onset adjacent segment degeneration (ASD) can be found within six months after anterior cervical discectomy and fusion (ACDF). Deficits in deep paraspinal neck muscles may be related to early onset ASD. This study aimed to determine whether the morphometry of preoperative deep neck muscles (multifidus and semispinalis cervicis) predicted early onset ASD in patients with ACDF. Thirty-two cases of early onset ASD after a two-level ACDF and 30 matched non-ASD cases were identified from a large-scale cohort. The preoperative total cross-sectional area (CSA) of bilateral deep neck muscles and the lean muscle CSAs from C3 to C7 levels were measured manually on T2-weighted magnetic resonance imaging. Paraspinal muscle CSA asymmetry at each level was calculated. A support vector machine (SVM) algorithm was used to identify demographic, radiographic, and/or muscle parameters that predicted proximal/distal ASD development. No significant between-group differences in demographic or preoperative radiographic data were noted (mean age: 52.4 ± 10.9 years). ACDFs comprised C3 to C5 (n = 9), C4 to C6 (n = 20), and C5 to C7 (n = 32) cases. Eighteen, eight, and six patients had proximal, distal, or both ASD, respectively. The SVM model achieved high accuracy (96.7%) and an area under the curve (AUC = 0.97) for predicting early onset ASD. Asymmetry of fat at C5 (coefficient: 0.06), and standardized measures of C7 lean (coefficient: 0.05) and total CSA measures (coefficient: 0.05) were the strongest predictors of early onset ASD. This is the first study to show that preoperative deep neck muscle CSA, composition, and asymmetry at C5 to C7 independently predicted postoperative early onset ASD in patients with ACDF. Paraspinal muscle assessments are recommended to identify high-risk patients for personalized intervention.
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Affiliation(s)
- Arnold Y L Wong
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Garrett Harada
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Remy Lee
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Sapan D Gandhi
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Adam Dziedzic
- Department of Computer Science, University of Chicago, Chicago, Illinois
| | - Alejandro Espinoza-Orias
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Bryce Basques
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
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10
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Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis. BMC Musculoskelet Disord 2021; 22:340. [PMID: 33836709 PMCID: PMC8035773 DOI: 10.1186/s12891-021-04218-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF. Methods We constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed. Results The von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.
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11
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Li XF, Jin LY, Liang CG, Yin HL, Song XX. Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study. BMC Surg 2020; 20:66. [PMID: 32252742 PMCID: PMC7137311 DOI: 10.1186/s12893-020-00729-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The development of adjacent segment degeneration (ASD) following ACDF is well established. There is no analytical study related to effects of plate profile on the biomechanics of the adjacent-level after ACDF. This study aimed to test the effects of plate profile on the adjacent-level biomechanics after single-level anterior cervical discectomy and fusion (ACDF). METHODS A three-dimensional finite element model (FEM) of an intact C2-T1 segment was built and validated. From this intact model, two instrumentation models were constructed with the anchored zero-profile spacer or the standard plate-interbody spacer after a C5-C6 corpectomy and fusion. Motion patterns, the stresses in the disc, the endplate, and the facet joint at the levels cephalad and caudal to the fusion were assessed. RESULTS Compared with the normal condition, the biomechanical responses in the adjacent levels were increased after fusion. Relative to the intact model, the average increase of range of motion (ROM) and stresses in the endplate, the disc, and the facet of the zero-profile spacer fusion model were slightly lower than that of the standard plate-interbody spacer fusion model. The kinematics ROM and stress variations above fusion segment were larger than that below. The biomechanical features of the adjacent segment after fusion were most affected during extension. CONCLUSIONS The FE analysis indicated that plate profile may have an impact on the biomechanics of the adjacent-level after a single-level ACDF. The impact may be long-term and cumulative. The current findings may help explain the decreasing incidence of ASD complications in the patients using zero-profile spacer compared with the patients using cage and plate construct.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, No. 1058, Huan Zheng Bei Rd, Shanghai, 200444, P.R. China.
| | - Lin-Yu Jin
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Chao-Ge Liang
- Department of Orthopaedic Surgery, Shanghai Xijiao Orthopaedic Hospital, Shanghai, 200336, China
| | - Hong-Ling Yin
- School of Materials Science and Engineering, Shanghai Jiaotong University, No. 1954, Huashan Rd, Shanghai, 20030, P.R. China.
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Lu, Shanghai, 200025, China.
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12
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Mu X, Li Z, Ou Y, Wei J. Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China. J Orthop Surg Res 2019; 14:414. [PMID: 31805960 PMCID: PMC6896359 DOI: 10.1186/s13018-019-1487-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023] Open
Abstract
Objective The purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China. Methods CSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis. Results The ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05). Conclusion ACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.
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Affiliation(s)
- Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Zhuhai Li
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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13
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Zhang Y, Shao Y, Liu H, Zhang J, He F, Chen A, Yang H, Pi B. Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:430. [PMID: 31521137 PMCID: PMC6745077 DOI: 10.1186/s12891-019-2800-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease. Methods Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance. Results A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, − 0.69, P = 0.01). Conclusions Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD. Electronic supplementary material The online version of this article (10.1186/s12891-019-2800-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Junxin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Fan He
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Angela Chen
- Department of School of Public Health and Health Systems, Faculty of Applied Health Sciences Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China. .,Orthopedic Institute, Soochow University, Suzhou, 215006, China.
| | - Bin Pi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China. .,Orthopedic Institute, Soochow University, Suzhou, 215006, China.
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14
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Yan SZ, Di J, Shen Y. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty. Med Sci Monit 2017; 23:2692-2700. [PMID: 28574978 PMCID: PMC5466040 DOI: 10.12659/msm.905178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). Material/Methods A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. Results There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005–1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786–0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086–1.193) were significantly correlated with adjacent segment degeneration. Conclusions Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups.
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Affiliation(s)
- Suo-Zhou Yan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jun Di
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, Hebei, China (mainland)
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