Kyung-Jin Song; Kwang-Bok Lee; Jong-Han Yim

doi:10.4184/jkss.2014.21.1.1

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Song, Lee, and Yim: Does Preoperative Cervical Sagittal Alignment And Range of Motion Affect Adjacent Segment Degeneration After Anterior Arthrodesis In Degenerative Cervical Spinal Disorders? – Midterm Follow up Study -

Original Article

Journal of Korean Spine Surg 2014;21(1):1-7.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.1

Does Preoperative Cervical Sagittal Alignment And Range of Motion Affect Adjacent Segment Degeneration After Anterior Arthrodesis In Degenerative Cervical Spinal Disorders? – Midterm Follow up Study -

Kyung-Jin Song, M.D., Kwang-Bok Lee, M.D., Jong-Han Yim, M.D.

Departments of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea

Corresponding author: Kwang-Bok Lee, M.D Department of Orthopedic Surgery, Chonbuk University Hospital 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea TEL: 82-63-250-1760, FAX: 82-63-271-6538 E-mail: osdr2815@naver.com

Received 16 November 2011 Revised 10 June 2013 Accepted 12 April 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

The purpose of this study was to investigate whether preoperative sagittal alignment and range of motion (ROM) affect adjacent segment degeneration (ASD) and disease after anterior arthrodesis in degenerative cervical spinal disorders. Summary of Literature Review:There is no study about the relationship between preoperative ROM and sagittal alignment and the development of ASD yet.

Materials and Methods

We took a retrospective approach to study 136 patients who underwent an anterior arthodesis for less than 2 segments with PEEK cage and plate construct method for degenerative cervical diseases and who have a minimum of 3 years of followup. We analyzed ASD and cervical ROM, such as less than 40°(group A) and more than 40°(group B) and sagittal alignment, such as lordosis or kyphosis with less than 10°(group a), 10°~30°(group b) and more than 30°(group c). Adjacent segment degeneration was graded according to Park's classification and Hillibrand method.

Results

There was no statistically significant difference between group A(1.35±0.48) and group B (1.44±0.50) in the correlation between the cervical ROM and the variation of disc height(p=0.07). Concerning the relationship between the ROM and osteophyte formation on adjacent segment, no statistically significant difference has been found between group A(1.64±0.88) and group B(1.43±0.67) (p=0.06). The disc height change at the final follow up after cervical sagittal alignment showed no statistically significant difference among the groups: Group A presented with 1.53±0.50, group B with 1.30±0.46 and group C with 1.40±0.50.(p=0.08) Regarding sagittal alignment and osteophyte change, there was no statistically significant difference among the groups as group A showed an average of 1.33±0.48, group Ban average of 1.56±0.88 and group Can average of 1.60±0.82(p=0.07).

Conclusion

Although the preoperative sagittal alignment and ROM did not significantly affect adjacent segment degeneration and diseases in a midterm followup evaluation after anterior arthrodesis with PEEK cage and plate in degenerative cervical spinal disorders, we think a future study is required with a sufficient number of patients and a long term followup because there were borderline

Keywords: Degenerative cervical disorder, Anterior cervical fusion, Sagittal alignment, Range of motion, Adjacent segment degeneration

REFERENCES

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Figures and Tables%

Fig. 1.

(A) neutral, (B) flexion, (C) extension. Histogram demonstrate Gore angle(C2-7) that determined from the tangent of the posterior body line of C2 and C7.

Table 1.

Demographic Data of Each groups

	Group A (ROM <40)	Group B (ROM >40)	Group a Sag. Align.<10	Group b 10< alignment <30	Group c Sag. Align.>30
N	66	70	30	86	20
성별 (M:F)	34 : 32	36 : 34	16 : 14	44 : 42	10 : 10
평균 나이	56.8 (44~67)	57.5 (43~67)	58.5 (43~66)	57.1 (44~67)	56.3 (45~65)
평균 추시기간 (분포)(ms)	46.1 (40~71)	45.9 (40~72)	48.1 (40~71)	44.3 (40~68)	45.9 (42~72)
수술 level
C2-3 (3)	1	2	1	2	0
C3-4 (10)	5	5	2	6	2
C4-5 (15)	7	8	4	8	3
C5-6 (26)	12	14	6	16	4
C6-7 (22)	11	11	5	14	3
C2-3-4 (1)	0	1	0	1	0
C3-4-5 (15)	7	8	3	10	2
C4-5-6 (23)	12	11	5	15	3
C5-6-7 (21)	11	10	4	14	3

Table 2.

Radiographic Grading of Degenerative Changes at Adjacent Level

Grade	Body spur^*	Disc space narrowing^†	Points
I	No ossification	Normal	1
II	Ossification extendion across <50% of the adjacent disc space	<50% of normal disc height	2
III	Extending > 50% of the adjacent disc space	50%< and <75% of narrowing	3
IV	Complete bring of the adjacent disc space	>75%	4

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 previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999.

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