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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 3/2011

01-03-2011 | Symposium: Current Concepts in Cervical Spine Surgery

Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study

Authors: Tomoya Terai, MD, PhD, Ahmad Faizan, PhD, Koichi Sairyo, MD, PhD, Vijay K. Goel, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2011

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Abstract

Background

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.

Questions/purposes

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?

Methods

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.

Results

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.

Conclusions

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.

Clinical Relevance

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.
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Metadata
Title
Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study
Authors
Tomoya Terai, MD, PhD
Ahmad Faizan, PhD
Koichi Sairyo, MD, PhD
Vijay K. Goel, PhD
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 3/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1646-4

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