Skip to main content

Advertisement

SpringerLink
Log in

Clinical impact of 3-level anterior cervical decompression and fusion (ACDF) on the occipito-atlantoaxial complex: a retrospective study of patients who received a zero-profile anchored spacer versus cage-plate construct

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To evaluate changes in the sagittal parameters of the occipito-atlantoaxial complex after three-level anterior cervical decompression and fusion (ACDF) and identify the influential factors by comparing ACDF with a zero-profile anchored spacer (ACDF-Z) versus a cage-plate construct (ACDF-P).

Methods

The cohort comprised 106 patients who underwent three-level contiguous ACDF-Z or ACDF-P for cervical radiculopathy and/or myelopathy. Standing, flexion, and extension radiographs of cervical spine were obtained preoperatively, and 3 and 12 months postoperatively. The assessed cervical sagittal parameters were the platform angle of the axis, Cobb angle, and range of motion (ROM) of C2⁃7, C0⁃1, and C1⁃2.

Results

In both the ACDF-Z and ACDF-P groups, the Cobb angle of the upper cervical spine decreased and the C0-1 ROM increased from preoperatively to 3 and 12 months postoperatively (P < 0.01). The alignment restoration was lost at 12 months compared with 3 months in the ACDF-Z group, but not in the ACDF-P group (P < 0.01). The ACDF-P group showed more loss of C2-7 ROM and more compensatory changes in C0-2 ROM than the ACDF-Z group (P < 0.05).

Conclusion

The Cobb angle decreased and ROM increased significantly as compensatory changes of the atlantooccipital or atlantoaxial joint after both types of ACDF, which may accelerate degeneration. The zero-profile anchored spacer had less impact on the occipito-atlantoaxial complex but was worse at maintaining the alignment restoration, which were contrary to the cage-plate construct. Surgeons should be aware of the impact of multi-level ACDFs on the occipito-atlantoaxial complex.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ct K, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6:104–112. https://doi.org/10.3171/spi.2007.6.2.104

    Article  Google Scholar 

  2. Kauther MD, Piotrowski M, Hussmann B, Lendemans S, Wedemeyer C (2012) Cervical range of motion and strength in 4,293 young male adults with chronic neck pain. Eur Spine J 21:1522–1527. https://doi.org/10.1007/s00586-012-2369-x

    Article  PubMed  PubMed Central  Google Scholar 

  3. Anderst WJ, Donaldson WF 3rd, Lee JY, Kang JD (2015) Cervical motion segment contributions to head motion during flexion\extension, lateral bending, and axial rotation. The Spine Journal 15:2538–2543. https://doi.org/10.1016/j.spinee.2015.08.042

    Article  PubMed  Google Scholar 

  4. Phillips FM, Phillips CS, Wetzel FT, Gelinas C (1999) Occipitocervical neutral position. Possible surgical implications. Spine 24:775–778. https://doi.org/10.1097/00007632-199904150-00008

    Article  CAS  PubMed  Google Scholar 

  5. Rudolfsson T, Bjorklund M, Djupsjobacka M (2012) Range of motion in the upper and lower cervical spine in people with chronic neck pain. Man Ther 17:53–59. https://doi.org/10.1016/j.math.2011.08.007

    Article  PubMed  Google Scholar 

  6. Schafer AGM, Schottker-Koniger T, Hall TM, Mavroidis I, Roeben C, Schneider M, Wild Y, Ludtke K (2020) Upper cervical range of rotation during the flexion-rotation test is age dependent: an observational study. Therapeutic Adv in Musculoskelet 12:1759720X20964139. https://doi.org/10.1177/1759720X20964139

    Article  Google Scholar 

  7. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T (2012) Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: radiographic data from over 1,200 asymptomatic subjects. Eur Spine J 21:1492–1498. https://doi.org/10.1007/s00586-012-2167-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nojiri K, Matsumoto M, Chiba K, Maruiwa H, Nakamura M, Nishizawa T, Toyama Y (2003) Relationship between alignment of upper and lower cervical spine in asymptomatic individuals. J Neurosurg 99:80–83. https://doi.org/10.3171/spi.2003.99.1.0080

    Article  PubMed  Google Scholar 

  9. Wang S, Passias PG, Cui L, Li G, Yan M, Zhou H, Wang C (2013) Does atlantoaxial dislocation influence the subaxial cervical spine? Eur Spine J 22:1603–1607. https://doi.org/10.1007/s00586-013-2742-4

    Article  PubMed  PubMed Central  Google Scholar 

  10. Matsunaga S, Onishi T, Sakou T (2001) Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine 26:161–165. https://doi.org/10.1097/00007632-200101150-00010

    Article  CAS  PubMed  Google Scholar 

  11. Kim JT, Lee HJ, Choi DY, Shin MH, Hong JT (2016) Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine. Eur Spine J 25:2223–2232. https://doi.org/10.1007/s00586-016-4401-z

    Article  PubMed  Google Scholar 

  12. Cui W, Wu B, Liu B, Li D, Wang L, Ma S (2019) Adjacent segment motion following multi-level ACDF: a kinematic and clinical study in patients with zero-profile anchored spacer or plate. Eur Spine J 28:2408–2416. https://doi.org/10.1007/s00586-019-06109-8

    Article  PubMed  Google Scholar 

  13. Gong L, Ma H, Yi P, Tan M (2021) Flexion dysfunction of atlanto-occipital joint associated with cervical spondylosis. Orthop Surg 13:267–275. https://doi.org/10.1111/os.12928

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wu B, Yi X, Cui W, Rong T, Sang D, Xiao B, Zhao S, Wang D, Zhang J, Liu B (2021). An unrecognized ligament and its ossification in the craniocervical junction: prevalence, patient characteristics, and anatomic evidence. Clinical orthopaedics and related research Publish Ahead of Print. https://doi.org/10.1097/CORR.0000000000001719

  15. Dohzono S, Toyoda H, Takahashi S, Suzuki A, Terai H, Nakamura H (2017) Restrictions of cervical flexion after laminoplasty increase in the mechanical stress at the occipitocervical junction in non-rheumatoid arthritis patients. J Clin Neurosci 45:187–192. https://doi.org/10.1016/j.jocn.2017.06.001

    Article  PubMed  Google Scholar 

  16. Smith GW, Robinson RA (1958). The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 40-A: 607–624.

  17. Penning L (1978) Normal movements of the cervical spine. AJR Am J Roentgenol 130:317–326. https://doi.org/10.2214/ajr.130.2.317

    Article  CAS  PubMed  Google Scholar 

  18. Walraevens J, Liu B, Meersschaert J, Demaerel P, Delye H, Depreitere B, Vander Sloten J, Goffin J (2009) Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints. Eur Spine J 18:358–369. https://doi.org/10.1007/s00586-008-0820-9

    Article  PubMed  Google Scholar 

  19. Noordhoek I, Koning MT, Vleggeert-Lankamp CLA (2019) Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review. Eur Spine J 28:386–399. https://doi.org/10.1007/s00586-018-5820-9

    Article  CAS  PubMed  Google Scholar 

  20. Liu B, Wu B, Van Hoof T, Okito JP, Liu Z, Zeng Z (2015) Are the standard parameters of cervical spine alignment and range of motion related to age, sex, and cervical disc degeneration? J Neurosurg Spine 23:274–279. https://doi.org/10.3171/2015.1.SPINE14489

    Article  PubMed  Google Scholar 

  21. Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2654. https://doi.org/10.1097/00007632-200010150-00017

    Article  CAS  PubMed  Google Scholar 

  22. Kwon WK, Kim PS, Ahn SY, Song J, Kim JH, Park YK, Kwon TH, Moon HJ (2017) Analysis of associating factors with C2–7 sagittal vertical axis after two-level anterior cervical fusion: comparison between plate augmentation and stand-alone cages. Spine 42:318–325. https://doi.org/10.1097/BRS.0000000000001776

    Article  PubMed  Google Scholar 

  23. Wei W, Liao S, Shi S, Fei J, Wang Y, Chen C (2013) Straightened cervical lordosis causes stress concentration: a finite element model study. Australas Phys Eng Sci Med 36:27–33. https://doi.org/10.1007/s13246-013-0182-4

    Article  PubMed  Google Scholar 

  24. Perrini P, Cagnazzo F, Benedetto N, Morganti R, Gambacciani C (2017) Cage with anterior plating is advantageous over the stand-alone cage for segmental lordosis in the treatment of two-level cervical degenerative spondylopathy: a retrospective study. Clin Neurol Neurosurg 163:27–32. https://doi.org/10.1016/j.clineuro.2017.10.014

    Article  PubMed  Google Scholar 

  25. Anderst WJ, Lee JY, Donaldson WF 3rd, Kang JD (2013) Six-degrees-of-freedom cervical spine range of motion during dynamic flexion-extension after single-level anterior arthrodesis: comparison with asymptomatic control subjects. J Bone Joint Surg Am 95:497–506. https://doi.org/10.2106/JBJS.K.01733

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (Grant NO. 81772370; NO. 81972084); the National Key Research and Development Program of China (Grant NO. 2018YFF0301103); the Beijing Health Technologies Promotion Program (Grant NO. BHTPP202033) and the Key Subject Construction Project of Fengtai District of Beijing (Grant NO. 2–2-2–006-12–06).

Author information

Author notes

  1. Bowei Xiao and Bingxuan Wu have equal contribution to this study.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West RD, Fengtai District, Beijing, 100070, China

    Bowei Xiao, Bingxuan Wu, Tianhua Rong, Wei Cui, Dacheng Sang & Baoge Liu

Authors
  1. Bowei Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bingxuan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tianhua Rong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dacheng Sang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baoge Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Baoge Liu.

Ethics declarations

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Institutional Review (Ethic number, IRB: #KY2020-073–02).

Consent to participate

Informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiao, B., Wu, B., Rong, T. et al. Clinical impact of 3-level anterior cervical decompression and fusion (ACDF) on the occipito-atlantoaxial complex: a retrospective study of patients who received a zero-profile anchored spacer versus cage-plate construct. Eur Spine J 30, 3656–3665 (2021). https://doi.org/10.1007/s00586-021-06974-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06974-2

Keywords

Search

Navigation