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Acta Neurochirurgica

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01-06-2015 | Clinical Article - Spine

Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?

Authors: Chang-Hyun Lee, Ki-Jeong Kim, Seung-Jae Hyun, Jin S. Yeom, Tae-Ahn Jahng, Hyun-Jib Kim

Published in: Acta Neurochirurgica | Issue 6/2015

Abstract

Background

Subsidence is a frequent phenomenon in the interbody fusion process in patients with anterior cervical discectomy and fusion (ACDF). There is little evidence of whether subsidence in the cervical spine has any impact on clinical outcomes.

Objectives

The purpose of this study is to investigate the correlation of subsidence and clinical outcomes after ACDF and to consider reasons subsidence might not cause unfavorable clinical outcomes.

Methods

A total of 158 consecutive patients who underwent single-level ACDF were included. The patients were divided into a subsidence group (S-group) and a no subsidence group (N-group), with subsidence defined as a decrease by ≥3 mm in total intervertebral height (TIH). We analyzed outcomes resulting from subsidence, particularly focusing on clinical outcomes and subsequent global and segmental kyphosis using a repeated measure analysis of variance (RM-ANOVA).

Results

Subsidence occurred in 74 patients (46.8 %) as of a 12-month follow-up. The S-group included 58.6 % with a stand-alone cage for interbody fusion (p = 0.002). Clinical outcomes improved significantly over time (neck pain, RM-ANOVA: F(1.3, 205) = 125.1, p < 0.001; arm pain, RM-ANOVA: F(1.3, 203) = 290.8, p < 0.001). There was no significant difference in interaction with subsidence and clinical outcomes between the S- and N-group (neck pain, RM-ANOVA: F(2,153) = 1.04, p = 0.356, partial η² = 0.229; arm pain, RM-ANOVA: F(2,153) = 0.56, p = 0.571, partial η² = 0.142). Segmental angle increased in both groups over time and showed a statistically significant difference between the S- and N-groups (RM-ANOVA: F(3,143) = 6.148, p = 0.001, partial η² = 0.959). Although, global cervical angle decreased generally and displayed no statically significant difference between the S- and N-group (RM-ANOVA: F(3,119) = 2.361, p = 0.075, partial η² = 0.056).

Conclusions

Radiographic subsidence after ACDF occurred in 46.8 % patients as of 12 months after the single-level ACDF. The lack of correlation between bad clinical outcome and radiographic subsidence may be due to segmental kyphosis, preserved posterior height, and maintaining the global cervical angle.

Zhang Z, Zhu W, Zhu L, Du Y (2014) Midterm outcomes of total cervical total disc replacement with Bryan prosthesis. Eur J Orthop Surg Traumatol 24(Suppl 1):S275–S281CrossRefPubMed

Yang X, Liu L, Song Y, Kong Q, Zeng J, Tu C (2014) Outcome of single-level anterior cervical discectomy and fusion using nano-hydroxyapatite/polyamide-66 cage. Indian J Orthop 48:152–157CrossRefPubMedCentralPubMed

Zajonz D, Franke AC, von der Hoh N, Voelker A, Moche M, Gulow J, Heyde CE (2014) Is the radiographic subsidence of stand-alone cages associated with adverse clinical outcomes after cervical spine fusion? An observational cohort study with 2-year follow-up outcome scoring. Patient Saf Surg 8:43PubMedCentralPubMed

Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976) 30:2138–2144CrossRef

Zilkens G, Rollinghoff M, Sobottke R, Eysel P, Delank KS (2009) Cage-assisted fusion operation of the spine. Z Orthop Unfall 147:751–760PubMed

Hakalo J, Pezowicz C, Wronski J, Bedzinski R, Kasprowicz M (2007) The process of subsidence after cervical stabilizations by cage alone, cage with plate and plate-cage. A biomechanical comparative study. Neurol Neurochir Pol 41:411–416PubMed

Yamagata T, Takami T, Uda T, Ikeda H, Nagata T, Sakamoto S, Tsuyuguchi N, Ohata K (2012) Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment. J Clin Neurosci 19:1673–1678CrossRefPubMed

Assietti R, Beretta F, Arienta C (2002) Two-level anterior cervical discectomy and cage-assisted fusion without plates. Neurosurg Focus 12:E3CrossRefPubMed

Balabhadra RS, Kim DH, Zhang HY (2004) Anterior cervical fusion using dense cancellous allografts and dynamic plating. Neurosurgery 54:1405–1412CrossRefPubMed

10.

Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S (2012) Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 13:172CrossRefPubMedCentralPubMed

11.

Kim CH, Chung CK, Jahng TA, Park SB, Sohn S, Lee S (2015) Segmental Kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages. J Spinal Disord Tech 28:E17–E24CrossRefPubMed

12.

Kim CH, Kim CH, Chung CK, Jahng TA (2012) Comparison of operating time between stand-alone cage and a standard method for a single level cervical disc disease. Korean J Spine 9:12–17CrossRefPubMedCentral

13.

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:607–624PubMed

14.

van Jonbergen HP, Spruit M, Anderson PG, Pavlov PW (2005) Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. Spine J 5:645–649, discussion 649CrossRefPubMed

15.

Gercek E, Arlet V, Delisle J, Marchesi D (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12:513–516CrossRefPubMedCentralPubMed

16.

Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE (2003) Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976) 28:46–51CrossRef

17.

Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L (2013) Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 19:110–118CrossRefPubMed

18.

Fujibayashi S, Neo M, Nakamura T (2008) Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc herniation: sequential changes in cage subsidence. J Clin Neurosci 15:1017–1022CrossRefPubMed

19.

Haden N, Latimer M, Seeley HM, Laing RJ (2005) Loss of inter-vertebral disc height after anterior cervical discectomy. Br J Neurosurg 19:469–474CrossRefPubMed

20.

Karikari IO, Jain D, Owens TR, Gottfried O, Hodges TR, Nimjee SM, Bagley CA (2014) Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review. J Spinal Disord Tech 27:1–10CrossRefPubMed

21.

Kast E, Derakhshani S, Bothmann M, Oberle J (2009) Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 32:207–214, discussion 214CrossRefPubMed

22.

Lee CH, Hyun SJ, Kim MJ, Yeom JS, Kim WH, Kim KJ, Jahng TA, Kim HJ, Yoon SH (2013) Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech 26:112–118CrossRefPubMed

23.

Wu WJ, Jiang LS, Liang Y, Dai LY (2012) Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J 21:1374–1382CrossRefPubMedCentralPubMed

24.

Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage-assisted anterior cervical fusion. Eur Spine J 16:1395–1400CrossRefPubMedCentralPubMed

25.

Bartels RH, Donk RD, Feuth T (2006) Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 58:502–508, discussion 502-508CrossRefPubMed

26.

Dai LY, Jiang LS (2008) Anterior cervical fusion with interbody cage containing beta-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up. Eur Spine J 17:698–705CrossRefPubMedCentralPubMed

27.

Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP (2009) The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34:2886–2892CrossRef

28.

Truumees E, Demetropoulos CK, Yang KH, Herkowitz HN (2002) Effects of disc height and distractive forces on graft compression in an anterior cervical discectomy model. Spine (Phila Pa 1976) 27:2441–2445CrossRef

Title: Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?
Authors: Chang-Hyun Lee
Ki-Jeong Kim
Seung-Jae Hyun
Jin S. Yeom
Tae-Ahn Jahng
Hyun-Jib Kim
Publication date: 01-06-2015
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 6/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2388-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?

Abstract

Background

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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