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Abstract
Objectives
To evaluate the factors influencing the radiographic degenerative changes in the adjacent segments in one-level ACDF (ed note: define ACDF).
Summary of Literature Review
There is a 25% incidence of adjacent segment degeneration after 5 years.
Materials and Method
From 2002 to 2005, 34 patients (male 23, female 11) underwent anterior cervical spine fusion using a cage or bone block for degenerative cervical spine. The mean age of the patients was 51 years and the mean follow-up period was 24 months. The degenerative findings of the upper and lower adjacent segment were measured from the preoperative MRI. The fused segment curvature, disc heights of the adjacent segments, displacement of the vertebral bodies and angular mobility in the adjacent segments were measured from the pre-operative and final follow-up lateral views in the neutral position, in both flexion and extension.
Results
Degenerative changes in the adjacent segments were observed in 19 of the 34 patients. The group with degenerative changes showed significantly more lordotic angular loss of the fusion segments (11.9±3.1°) at the follow-up observation than the group with no degenerative changes (9.0±1.1°) (p=0.04). The group with degenerative change showed a significantly larger increase in disc height of the fusion segments (2.8±0.2 mm) at the follow-up observation than the group with no degenerative changes (2.2±0.3 mm) (p=0.02). The group with a Grade IV or higher level of pre-operative disc degeneration showed more degenerative changes in the adjacent segments than those with Grade III or lower.
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Fig. 1.
Measurement of the alignment of the fused segment (angle A). Angle A was formed by the upper plane and lower plane of the fused segment.
Fig. 2.
Changes in the motion segment between vertebrae. Calculation of the angular displacement of the flexion/ extension views.
Fig. 3.
A 42-year-old woman, disc herniation at C3-4 and treated with anterior cervical disectomy and fusion. (A) Preoperative lateral radiograph, (B) Radiograph at postoperative 2-years follow-up shows solid union and maintained lordosis at fusion segment (10°), (C, D) At last follow-up, adjacent intervertebral segment shows degenerative change, angular motion is within normal limit but sagittal translation is 3 mm.
Table 1.
Baseline characteristics of the study population
| Total | Degenerative change (+) | Degenerative change (-) | |
|---|---|---|---|
| Mean age | 51 | 50 | 52 |
| Gender (M:F) | 23:11 | 13:6 | 10:5 |
| Mean follow up | 24 | 23 | 26 |
Table 2.
Summary of the normal values estabilished by different authors (°)
| Bakke | Buetti-Bauml | De Seze | Penning | Dvorak | |
|---|---|---|---|---|---|
| C1-C2 | 11.7 | 12 | |||
| C2-C3 | 12.6 | 11 | 0.13 | 12.5 | 10 |
| C3-C4 | 15.4 | 17 | 15.5 | 0.18 | 15 |
| C4-C5 | 15.1 | 21 | 0.19 | 0.20 | 19 |
| C5-C6 | 20.4 | 23 | 27.5 | 21.5 | 20 |
| C6-C7 | 17.0 | 19 | 17.5 | 15.5 | 19 |
Table 3.
Inflencing factors in degenerative change of adjacent segment
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