, Volume 469, Issue 3, pp 682-687
Date: 30 Oct 2010

Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study

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Abstract

Background

Anterior cervical discectomy and fusion (ACDF) represent the standard treatment for cervical spondylolytic radiculopathy and myelopathy. To achieve solid fusion, appropriate compressive loading of the graft and stability are essential. Fusion may lead to adjacent segment degeneration. Artificial discs have been introduced as motion-preserving devices to reduce the risk of fusion-related complications.

Questions/purposes

We therefore asked: (1) Does the use of a plate reduce motion at the operated level and bone graft compression compared to fusion with bone graft alone; and (2) is adjacent-segment motion higher after fusion with a plate?

Methods

Motions and compressive loads in the graft were quantified for intact, C4–C5 ACDF without and with a plate, and total disc arthroplasty in human cadaver spines.

Results

At the surgery level all motions decreased for ACDF with a plate. The motions were similar to intact motions after total disc arthroplasty. The motions across the adjacent segment increased after fusion in all loading modes except lateral bending and were closer to the intact for the total disc arthroplasty case. The plate maintained a compressive load on the graft with a maximum increase in extension.

Conclusions

Unlike fusion, the arthroplasty can restore motion to normal at the surgery and adjacent segments, compared to fusion cases. A cervical plate with a precompression of the graft provides enhanced stability and fusion due to improved compression.

Clinical Relevance

Our findings support the clinical observations that fusion may lead to the degeneration of the adjacent segments. Disc arthroplasty may be able to circumvent the adjacent segment degeneration.
One or more of the authors (VKG) has received funding from DePuy Spine, Inc, Raynham, MA.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at The University of Toledo.