Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study
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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.
We thank Christopher Bono (Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA), Steven Garfin (University of California, San Diego, San Diego, CA), Ashok Biyani and Hossein Elgafy (University of Toledo, Toledo, OH), and Hassan Serhan (DePuy Spine, Inc, Raynham, MA) for their guidance in this study.
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