The Comparison of Multi-level Fusion versus One-level Fusion to the Development of Adjacent Level Degeneration in Anterior Cervical Arthrodesis with PEEK Cage and Plate Augmentation for the Degenerative Cervical Spinal Disorders

Kyung-Jin Song; Su-Kyung Lee; Ji-Hun Song; Byeong-Yeol Choi

doi:10.4055/jkoa.2009.44.6.613

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Song, Lee, Song, and Choi: The Comparison of Multi-level Fusion versus One-level Fusion to the Development of Adjacent Level Degeneration in Anterior Cervical Arthrodesis with PEEK Cage and Plate Augmentation for the Degenerative Cervical Spinal Disorders

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(6): 613-618.

Published online: 21 December 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.6.613

The Comparison of Multi-level Fusion versus One-level Fusion to the Development of Adjacent Level Degeneration in Anterior Cervical Arthrodesis with PEEK Cage and Plate Augmentation for the Degenerative Cervical Spinal Disorders

Kyung-Jin Song, M.D., Su-Kyung Lee, M.D., Ji-Hun Song, M.D.^*, Byeong-Yeol Choi, M.D.

Department of Orthopedic Surgery, College of Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

^*Department of Orthopedic Surgery, Saint Carollo Hospital, Suncheon, Korea.

Correspondence to Byeong-Yeol Choi, M.D. Department of Orthopedic Surgery, Chonbuk University Hospital, 634-18, Keumam-dong, Dukjin-gu, Jeonju 561-712, Korea. Tel: +82.63-250-1760, Fax: +82.63-271-6538, docby@hanmail.net

Received 27 August 2009 Accepted 12 October 2009

Abstract

Purpose

The purpose of this study was to analyze the effect of multi-level fusion in the development of adjacent level degeneration (ALD) in anterior cervical arthrodesis, as a treatment for degenerative cervical disease.

Materials and Methods

Retrospectively, we analyzed 127 patients who underwent arthrodesis with PEEK cage and plate construction for the treatment of degenerative cervical disease. The mean patient age was 54.4±10.6 years and the average follow-up period was 48.5±8.5 months. Group A composed of 55 patients who underwent one level fusion and group B composed of 72 patients who underwent two or three level fusion. We evaluated and compared the severity of ALD, such as the stage of osteophyte formation, the grade of ALD, and the incidence of ALD according to 4 grading system.

Results

The stage of osteophyte formation was 1.62±0.85 points in group A and 2.43±1.14 points in group B (p=0.02). The grade of ADL was 1.71±0.94 points in group A and 2.38±1.11 points in group B (p=0.01). The incidence of symptomatic ALD (radiculopathy and/or myelopathy) was 3.6% (2/55 cases) in group A and 4.2% (3/77 cases) in group B (p>0.05).

Conclusion

Multi-level fusion can accelerate the severity of adjacent level degeneration as compared with one level fusion, but there was no correlation in the incidence of symptomatic adjacent level degeneration to the fusion level number after anterior cervical arthrodesis for degenerative cervical diseases.

Keywords: Degenerative cervical disc disease, Anterior cervical arthrodesis, Adjacent segment degeneration

Figures and Tables

Fig. 1

Histogram demonstrate the bony spur grading of adjacent segment in two group, multi-level arthrodesis leads to aggravation bony spur formation than one-level arthrodesis.

Fig. 2

Histogram demonstrate adjacent segmental degeneration according to disc space, multi-level arthrodesis accelate degeneration of adjacent segment.

Table 1

The Data of Patients

Table 2

Radiographic Grading of Degenerative Changes at Adjacent Level

^*Park's bony spur grading: Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am 2005; ^†Modified Hilibrand's adjacent segmetal degeneration: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999.

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