Does index level sagittal alignment determine adjacent level disc height loss?

Restricted access

OBJECTIVE

The authors sought to compare the effect of index level sagittal alignment on cephalad radiographic adjacent segment pathology (RASP) in patients undergoing cervical total disc arthroplasty (TDA) or anterior cervical discectomy and fusion (ACDF).

METHODS

This was a retrospective study of prospectively collected radiographic data from 79 patients who underwent TDA or ACDF and were enrolled and followed prospectively at two centers in a multicenter FDA investigational device exemption trial of the Bryan cervical disc prosthesis used for arthroplasty. Neutral lateral radiographs were obtained pre- and postoperatively and at 1, 2, 4, and up to 7 years following surgery. The index level Cobb angle was measured both pre- and postoperatively. Cephalad disc degeneration was determined by a previously described measurement of the disc height/anteroposterior (AP) distance ratio.

RESULTS

Sixty-eight patients (n = 33 ACDF; n = 35 TDA) had complete radiographs and were included for analysis. Preoperatively, there was no difference in the index level Cobb angle between the ACDF and TDA patients. Postoperatively, the ACDF patients had a larger segment lordosis compared to the TDA patients (p = 0.002). Patients who had a postoperative kyphotic Cobb angle were more likely to have undergone TDA (p = 0.01). A significant decrease in the disc height/AP distance ratio occurred over time (p = 0.035), by an average of 0.01818 at 84 months. However, this decrease was not influenced by preoperative alignment, postoperative alignment, or type of surgery.

CONCLUSIONS

In this cohort of patients undergoing TDA and ACDF, the authors found that preoperative and postoperative sagittal alignment have no effect on RASP at follow-up of at least 7 years. They identified time as the only significant factor affecting RASP.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; AP = anteroposterior; ASD = adjacent segment degeneration; CASP = clinical adjacent segment pathology; ICC = intraclass correlation coefficient; IDE = investigational device exemption; RASP = radiographic adjacent segment pathology; TDA = cervical total disc arthroplasty.

Article Information

Correspondence Ryan Snowden: Indiana Spine Group, Carmel, IN. rdsnow02lville@gmail.com.

INCLUDE WHEN CITING Published online June 21, 2019; DOI: 10.3171/2019.4.SPINE181468.

Disclosures Dr. Smucker reports being a paid presenter or speaker for Medtronic Sofamor Danek. Dr. Sasso reports receiving IP royalties and research support from Medtronic. Dr. Riew reports direct stock ownership in Axiomed, Spinal Kinetics, Spineology, PSD, Osprey, Expanding Orthopedics, Vertiflex, Amedica, Benvenue, and Paradigm Spine; receiving IP royalties from and being a paid consultant and paid presenter or speaker for Medtronic; receiving clinical or research support for the study described from Medtronic, NuVasive, Biomet, and DePuy; being a consultant for Advance Medical; and receiving royalties from Zimmer-Biomet.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Measurement of target level Cobb angle. Figure is available in color online only.

  • View in gallery

    Measurement of proximal adjacent level disc height/AP distance ratio. Figure is available in color online only.

  • View in gallery

    Lateral cervical radiograph with blinded treatment and sample measurement of cephalad adjacent segment disc height/AP distance ratio. Figure is available in color online only.

References

  • 1

    Anderson PASasso RCHipp JNorvell DCRaich AHashimoto R: Kinematics of the cervical adjacent segments after disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis. Spine (Phila Pa 1976) 37 (22 Suppl):S85S952012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Anderson PASasso RCRiew KD: Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine (Phila Pa 1976) 33:130513122008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bohlman HHEmery SEGoodfellow DBJones PK: Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:129813071993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Ferch RDShad ACadoux-Hudson TATeddy PJ: Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100 (1 Suppl Spine):13192004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Fong SYDuPlessis SJCasha SHurlbert RJ: Design limitations of Bryan disc arthroplasty. Spine J 6:2332412006

  • 6

    Garrido BJTaha TASasso RC: Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up. J Spinal Disord Tech 23:3673712010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Harrison DDHarrison DEJanik TJCailliet RFerrantelli JRHaas JW: Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine (Phila Pa 1976) 29:248524922004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Harrod CCHilibrand ASFischer DJSkelly AC: Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine (Phila Pa 1976) 37 (22 Suppl):S96S1122012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Heller JGSasso RCPapadopoulos SMAnderson PAFessler RGHacker RJ: Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34:1011072009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Hilibrand ASCarlson GDPalumbo MAJones PKBohlman HH: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:5195281999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hilibrand ASRobbins M: Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4 (6 Suppl):190S194S2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Janssen MEZigler JESpivak JMDelamarter RBDarden BV IIKopjar B: ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single level symptomatic cervical disc disease. J Bone Joint Surg Am 97:173817472015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Johnson JPLauryssen CCambron HOPashman RRegan JJAnand N: Sagittal alignment and the Bryan cervical artificial disc. Neurosurg Focus 17(6):E142004

  • 14

    Katsuura AHukuda SImanaka TMiyamoto KKanemoto M: Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 9:4704761996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Katsuura AHukuda SSaruhashi YMori K: Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:3203242001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Kawakami MTamaki TIwasaki HYoshida MAndo MYamada H: A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res (381):1291362000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Kawakami MTamaki TYoshida MHayashi NAndo MYamada H: Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 12:50561999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Kellgren JHLawrence JS: Osteo-arthrosis and disk degeneration in an urban population. Ann Rheum Dis 17:3883971958

  • 19

    Kim SWShin JHArbatin JJPark MSChung YKMcAfee PC: Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine. Eur Spine J 17:20292008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Luo JGong MHuang SYu TZou X: Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies. Arch Orthop Trauma Surg 135:1551602015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Miller JSasso RAnderson PRiew KDMcPhilamy AGianaris T: Adjacent level degeneration: Bryan total disc arthroplasty versus anterior cervical discectomy and fusion. Clin Spine Surg 31:E98E1012018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Mummaneni PVBurkus JKHaid RWTraynelis VCZdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:1982092007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Murrey DJanssen MDelamarter RGoldstein JZigler JTay B: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:2752862009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Nunley PDJawahar ACavanaugh DAGordon CRKerr EJ IIIUtter PA: Symptomatic adjacent segment disease after cervical total disc replacement: re-examining the clinical and radiological evidence with established criteria. Spine J 13:5122013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Özer EYücesoy KYurtsever CSeçil M: Kyphosis one level above the cervical disc disease: is the kyphosis cause or effect? J Spinal Disord Tech 20:14192007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Phillips FMGeisler FHGilder KMReah CHowell KMMcAfee PC: Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 40:6746832015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Rabin DBertagnoli RWharton NPickett GEDuggal N: Sagittal balance influences range of motion: an in vivo study with the ProDisc-C. Spine J 9:1281332009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Radcliff KDavis RJHisey MSNunley PDHoffman GAJackson RJ: Long-term evaluation of cervical disc arthroplasty with the Mobi-C© Cervical Disc: a randomized, prospective, multicenter clinical trial with seven-year follow-up. Int J Spine Surg 11:312017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Sasso RCMetcalf NHHipp JAWharton NDAnderson PA: Sagittal alignment after Bryan cervical arthroplasty. Spine (Phila Pa 1976) 36:9919962011

  • 30

    Sasso RCSmucker JDHacker RJHeller JG: Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech 20:4814912007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Shim CSLee SHPark HJKang HSHwang JH: Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech 19:4654702006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Verma KGandhi SDMaltenfort MAlbert TJHilibrand ASVaccaro AR: Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine (Phila Pa 1976) 38:225322572013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Yang BLi HZhang THe XXu S: The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA): a meta analysis of randomized controlled trials. PLoS One 7:e350322012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Yoon DHYi SShin HCKim KNKim SH: Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148:9439502006

  • 35

    Zhu YTian ZZhu BZhang WLi YZhu Q: Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of cervical disc diseases: a meta-analysis of prospective randomized controlled trials. Spine (Phila Pa 1976) 41:E733E7412016

    • Crossref
    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 164 164 63
Full Text Views 40 40 13
PDF Downloads 27 27 12
EPUB Downloads 0 0 0

PubMed

Google Scholar