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Differential segmental motion contribution of single- and two-level anterior cervical discectomy and fusion

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Abstract

Purpose

To determine and compare the biomechanical effects of single- and two-level anterior cervical decompression and fusion (ACDF) on the re-distribution of the segmental contribution to total cervical range of motion (ROM) in a prospective longitudinal design.

Methods

Fifty-one patients undergoing either a single- or two-level ACDF due to cervical disc disease were recruited. Functional radiographs were taken preoperatively and then at 3, 6 and 12-month follow-ups. Global ROM of C2–C7, ROM of the treated functional spinal unit (FSU) and the superior and inferior segmental ROMs were then measured. The relative contribution from the FSU and each of the adjacent segments to total cervical ROM were compared pre- and post-operatively within and between the two groups at each of the time points.

Results

Single-level ACDF patients demonstrated a significantly greater total cervical ROM at 6 and 12 months compared with the two-level ACDF group (p = 0.021 and 0.045, respectively). A significantly greater contribution from the FSU to the total ROM was found at 3 months in the two-level ACDF group (p = 0.016), but the greater contribution shifted to the superior adjacent segment at 6 and 12 months (p = 0.025 and 0.046). The two-level ACDF group did not demonstrate a significant difference at 3 months (p = 0.087), but a significant increase in contribution was found at 6 and 12 months (p < 0.01).

Conclusions

Single-level ACDF maintains and restores a more physiological re-distribution of segmental contribution of ROM compared with two-level ACDF, which required longer time to achieve stable FSU immobilization and coupled with significantly increased superior segment contribution.

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Acknowledgments

This study was supported by a research grant from The National Science Council, Taiwan (NSC 102-2221-E-002-060-MY3).

Conflict of interest

None.

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Author notes

    Authors and Affiliations

    1. Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan

      Andy Chien

    2. Institute of Biomedical Engineering, Department of Mechanical Engineering, College of Medicine and College of Engineering, National Taiwan University, 602 Jen-Su Hall, 1 Section 4, Roosevelt Road, Taipei, 10617, ROC, Taiwan

      Andy Chien & Jaw-Lin Wang

    3. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

      Dar-Ming Lai

    4. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

      Shwu-Fen Wang & Wei-Li Hsu

    5. Department of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan

      Chih-Hsiu Cheng

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    1. Andy Chien
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    Correspondence to Dar-Ming Lai or Jaw-Lin Wang.

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    Chien, A., Lai, DM., Wang, SF. et al. Differential segmental motion contribution of single- and two-level anterior cervical discectomy and fusion. Eur Spine J 24, 2857–2865 (2015). https://doi.org/10.1007/s00586-015-3900-7

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    • DOI: https://doi.org/10.1007/s00586-015-3900-7

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