Date: 30 Oct 2010
Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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?
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.
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.
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.
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.
Aebi M, Zuber K, Marchesi D. Treatment of cervical spine injuries with anterior plating indications, techniques, and results. Spine (Phila Pa 1976). 1991;16(3 suppl):S38–S45.
Bohler J. Immediate and early treatment of traumatic paraplegias [in German]. Z Orthop Ihre Grenzgeb. 1967;103:512–529.PubMed
Branch CL Jr. Anterior cervical fusion: the case for fusion without plating. Clin Neurosurg. 1999;45:22–24.PubMed
Brodke DS, Gollogly S, Alexander Mohr R, Nguyen BK, Dailey AT, Bachus KN. Dynamic cervical plates: biomechanical evaluation of load sharing and stiffness. Spine (Phila Pa 1976). 2001;26:1324–1329.
Brodke DS, Gollogly S, Bachus KN, Alexander Mohr R, Nguyen BK. Anterior thoracolumbar instrumentation: stiffness and load sharing characteristics of plate and rod systems. Spine (Phila Pa 1976). 2003;28:1794–1801.
Bryan VE Jr. Cervical motion segment replacement. Eur Spine J. 2002;11(Suppl 2):S92–S97.PubMed
Cloward R. Treatment of acute fractures and fracture dislocations of the cervical spine by vertebral body fusion: a report of 11 cases. J Neurosurg. 1961;18:205–209.
DiAngelo DJ, Foley KT, Morrow BR, Schwab JS, Song J, German JW, Blair E. In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant. Neurosurg Focus. 2004:17:E7.PubMed
DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech. 2003:16;314–323.PubMed
Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976). 2005;30:1165–1172.
Duggal N, Rabin D, Chamberlain RH, Baek S, Crawford NR. Traumatic loading of the Bryan cervical disc prosthesis: an in vitro study. Neurosurgery. 2007;60:388–392; discussion 392–393.
Goffin J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V, Van Calenbergh F, van Loon J. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery. 2002;51:840–845; discussion 845–847.
Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS. 2008 Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976). 33:1701–1707.
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.PubMed
Kotani Y, Abumi K, Shikinami Y, Takada T, Kadoya K, Shimamoto N, Ito M, Kadosawa T, Fujinaga T, Kaneda K. Artificial intervertebral disc replacement using bioactive three-dimensional fabric: design, development, and preliminary animal study. Spine (Phila Pa 1976). 2002:27;929–935; discussion 935–936.
McAfee PC, Cunningham B, Dmitriev A, Hu N, Woo Kim S, Cappuccino A, Pimenta L. Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2003;28:S176–S185.
Miura T, Panjabi MM, Cripton PA. A method to simulate in vivo cervical spine kinematics using in vitro compressive preload. Spine (Phila Pa 1976). 2002;27:43–48.
Nabhan A, Ahlhelm F, Shariat K, Pitzen T, Steimer O, Steudel WI, Pape D. The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine (Phila Pa 1976). 2007;32:1935–1941.
Ordway NR, Fayyazi AH, Abjornson C, Calabrese J, Park S, Fredrickson B, Yonemura K, Yuan HA. Twelve month follow up of lumbar spine range of motion following intervertebral disc replacement using radiostereometric analysis. SAS J. 2008:2;9–15.CrossRef
Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine (Phila Pa 1976). 2005;30:1949–1954.
Puttlitz CM, Rousseau MA, Xu Z, Hu S, Tay BK, Lotz JC. Intervertebral disc replacement maintains cervical spine kinetics. Spine (Phila Pa 1976). 2004;29:2809–2814.
Rabin D, Pickett GE, Bisnaire L, Duggal N. The kinematics of anterior cervical discetomy and fusion versus artificial disc: a pilot study. Neurosurgery. 2007:61,100–104; discussion 104–105.
Robinson R, Smith G. Anterolateral cervical disk removing and interbody fusion for cervical disk syndrome. Bull Johns Hopkins Hosp. 1955;96:223–224.
Yang S, Wu X, Hu Y, Li J, Liu G, Xu W, Yang C, Ye S. 2008 Early and intermediate follow-up results after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single- and multiple-level. Spine (Phila Pa 1976). 2008;33:E371–E377.
- Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study
Clinical Orthopaedics and Related Research®
Volume 469, Issue 3 , pp 682-687
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH, USA
- 2. Department of Orthopedics, University of Tokushima, School of Medicine, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan