Adjacent segment degeneration after intervertebral fusion surgery by means of cervical block vertebrae

  • Xinlong Ma
  • Yuren Du
  • Shuli Wang
  • Jianxiong Ma
  • Tao Wang
  • Mingjie Kuang
  • Baoyi Ma
Original Article

Abstract

Background

The prevalence of cervical block vertebrae is unknown. Furthermore, there is no consensus on the cause of adjacent segment degeneration (ASD) after cervical fusion.

Questions/purposes

(1) What is the incidence of cervical block vertebrae? Is there a gender difference? (2) Among cervical block vertebrae cases, is ASD related to age and segment? And what is the specific relationship? (3) What are the imaging findings and characteristics of this disease?

Patients and methods

We retrospectively diagnosed cervical block vertebrae cases with bony fusions in any segments of the cervical spine without intervertebral fusion surgery of 33,762 patients reported from 2006 to 2011 in north China. Then the X-ray of the obtained cases were observed and counted. The primary outcome was incidence of ASD according to age and segment. The secondary outcome measures were C2–7 angle in fusion (single segment fusion of lower cervical vertebra) and control groups (randomly selected cases of non-fusion), Cobb’s angle of fusion segments, and curvature of each lower cervical segment in the control group.

Results

A total of 218 cervical block vertebrae cases were found, with a incidence of 0.65%, and C2–3 represented the highest number of fusion segment cases. There were no significant differences in the incidence by sex. Varying degrees of degeneration in the adjacent segment was present in 112 cases (51.4%). The incidence of ASD increased with age, with the ASD growth rate reaching its peak at the age of 51–60 years (55.08%). Cervical curvature shows no significant difference between patients with cervical block vertebrae and normal individuals. The segmental curvature was lower in the fusion group than in the control group, with statistical significance achieved in fusion segments located in C4–5, C5–6, and C6–7, but not C3–4.

Conclusions

Fusion segments located in C4–5, C5–6, and C6–7 are more prone to ASD than C3–4. The incidence of ASD in patients with vertebral fusion increases with age.

Level of evidence

III.

Keywords

Cervical block vertebrae Adjacent segment degeneration Interbody fusion 

References

  1. 1.
    Mcmaster MJ, Ohtsuka K (1982) The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Jt Surg Am 64(8):1128–1147CrossRefGoogle Scholar
  2. 2.
    Mcmaster MJ, Singh H (1999) Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients. J Bone Jt Surg Am 81(10):1367–1383CrossRefGoogle Scholar
  3. 3.
    Shands AR Jr, Eisberg HB (1955) The incidence of scoliosis in the state of Delaware; a study of 50,000 minifilms of the chest made during a survey for tuberculosis. J Bone Jt Surg Am 37-A(6):1243–1249CrossRefGoogle Scholar
  4. 4.
    Wynne-Davies R (1975) Congenital vertebral anomalies: etiology and relationship to spina bifida cystica. J Med Genet 12(3):280–288CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hutchinson J (1894) Deformity of shoulder girdle. Br Med J 1:669–673CrossRefPubMedGoogle Scholar
  6. 6.
    Clarke JJ (1906) A note on a case of congenital deformity of the spine. Am J Orthop Surg 24(2):160–162Google Scholar
  7. 7.
    Bayrakli F, Guclu B, Yakicier C et al (2013) Mutation in MEOX1 gene causes a recessive Klippel–Feil syndrome subtype. BMC Genet 14:95CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Duncan PA (1977) Embryologic pathogenesis of renal agenesis associated with cervical vertebral anomalies (Klippel–Feil phenotype). Birth Defects Orig Artic Ser 13(3D):91–101PubMedGoogle Scholar
  9. 9.
    Basu SN (1961) Klippel–Feil syndrome. Indian J Pediatr 28:57CrossRefPubMedGoogle Scholar
  10. 10.
    Gunderson CH, Greenspan RH, Glaser GH, Lubs HA (1967) The Klippel–Feil syndrome: genetic and clinical reevaluation of cervical fusion. Medicine (Baltimore) 46(6):491–512CrossRefGoogle Scholar
  11. 11.
    Michie I, Clark M (1968) Neurological syndromes associated with cervical and craniocervical anomalies. Arch Neurol 18(3):241–247CrossRefPubMedGoogle Scholar
  12. 12.
    Mosberg WH Jr (1953) The Klippel–Feil syndrome; etiology and treatment of neurologic signs. J Nerv Ment Dis 117:479–491CrossRefPubMedGoogle Scholar
  13. 13.
    Shoul MI, Ritvo M (1952) Clinical and roentgenological manifestations of the Klippel–Feil syndrome (congenital fusion of the cervical vertebrae, brevicollis); report of eight additional cases and review of the literature. Am J Roentgenol Radium Ther Nucl Med 68(3):369–385PubMedGoogle Scholar
  14. 14.
    Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15(6):602–617CrossRefPubMedGoogle Scholar
  15. 15.
    Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 5(96):223–224Google Scholar
  16. 16.
    Lund T, Oxland TR (2011) Adjacent level disk disease—is it really a fusion disease? Orthop Clin N Am 42(4):529–541CrossRefGoogle Scholar
  17. 17.
    Chung JY, Kim SK, Jung ST, Lee KB (2014) Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J 14(10):2290–2298CrossRefPubMedGoogle Scholar
  18. 18.
    Papanastassiou ID, Baaj AA, Dakwar E, Eleraky M, Vrionis FD (2011) Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel–Feil syndrome. Indian J Orthop 45(2):174–177CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Falk RH, Mackinnon J (1976) Klippel–Feil syndrome associated with aortic coarctation. Heart 38(11):1220–1221CrossRefGoogle Scholar
  20. 20.
    Li JX, Sun DY (1982) X-ray diagnostics. People’s Medical Publishing House, Beijing, pp 69–70Google Scholar
  21. 21.
    Brown MW, Templeton AW, Hodges FJ 3rd (1964) The incidence of acquired and congenital fusions in the cervical spine. Am J Roentgenol Radium Ther Nucl Med. 92:1255–1259PubMedGoogle Scholar
  22. 22.
    Gray SW, Romaine CB, Skandalakis JE (1964) Congenital fusion of the cervical vertebrae. Surg Gynecol Obstet 118:373–385PubMedGoogle Scholar
  23. 23.
    Lee CK, Weiss AB (1981) Isolated congenital cervical block vertebrae below the axis with neurological symptoms. Spine 2:118–124CrossRefGoogle Scholar
  24. 24.
    Matsumoto M, Okada E, Ichihara D, Watanabe K, Chiba K, Toyama Y et al (2010) Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine (Phila Pa 1976) 35(1):36–43CrossRefGoogle Scholar
  25. 25.
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Jt Surg Am 81(4):519–528CrossRefGoogle Scholar
  26. 26.
    Karasick D, Schweitzer ME, Vaccaro AR (1998) The traumatized cervical spine in Klippel–Feil syndrome: imaging features. AJR Am J Roentgenol 170(1):85–88CrossRefPubMedGoogle Scholar
  27. 27.
    Schwab JS, Diangelo DJ, Foley KT (2006) Motion compensation associated with single-level cervical fusion: where does the lost motion go? Spine (Phila Pa 1976) 31(21):2439–2448CrossRefGoogle Scholar
  28. 28.
    Yi S, Kim SH, Shin HC, Kim KN, Yoon DH (2007) Cervical arthroplasty in a patient with Klippel–Feil syndrome. Acta Neurochir (Wien) 149(8):805–809CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Xinlong Ma
    • 1
  • Yuren Du
    • 1
  • Shuli Wang
    • 2
  • Jianxiong Ma
    • 3
  • Tao Wang
    • 4
  • Mingjie Kuang
    • 1
  • Baoyi Ma
    • 1
  1. 1.Department of OrthopedicsTianjin HospitalTianjinChina
  2. 2.Department of RadiologyTianjin HospitalTianjinChina
  3. 3.Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
  4. 4.Department of Spine SurgeryTianjin HospitalTianjinChina

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