Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease

Crispin Wigfield F.R.C.S.1, Steven Gill F.R.C.S.1, Richard Nelson F.R.C.S.1, Ilana Langdon F.R.C.S.1, Newton Metcalf B.Sc.1, and James Robertson M.D.1
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  • 1 Departments of Neurosurgery and Orthopaedic Surgery, Spinal Research Unit, Frenchay Hospital, Bristol, United Kingdom
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Object. The authors report the preservation of motion at surgically treated and adjacent spinal segments after placing an artificial cervical joint (ACJ) and they describe the influence of interbody fusion on changes in angulation occurring in the sagittal plane at adjacent levels in the treatment of cervical spondylosis.

Methods. The authors conducted a prospective nonrandomized study of patients in whom an ACJ was placed or autologous bone graft interbody fusion was performed. Angular measurements at levels adjacent to that surgically treated were calculated using plain flexion—extension radiographs obtained at 6-month intervals. Analyses of qualitative data, such as increase or decrease in adjacent-level motion, and the degree of disc degeneration were performed. Quantitative data were also analyzed. In the fusion group a significant increase in adjacent-level movement was demonstrated at the 12-month follow-up visit compared with the group of patients in whom ACJs were placed (p < 0.001). The increase in movement occurred predominantly at intervertebral discs that were preoperatively regarded as normal (p < 0.02). An overall reduction in adjacent-level movement was observed in patients who underwent joint replacement, although this was compensated for by the movement provided by the ACJ itself.

Conclusions. Fusion results in increased motion at adjacent levels. The increase in adjacent-level motion derives from those discs that appear radiologically normal prior to surgery. It remains unknown whether ACJs have a protective influence on adjacent intervertebral discs.

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  • 1.

    Aota Y, , Kumano K, & Hirabayashi S: Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:464473, 1995 Aota Y, Kumano K, Hirabayashi S: Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:464–473, 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Bao QB, , McCullen GM, & Higham PA, et al: The artificial disc: theory, design and materials. Biomaterials 17:11571167, 1996 Bao QB, McCullen GM, Higham PA, et al: The artificial disc: theory, design and materials. Biomaterials 17:1157–1167, 1996

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

    Cherubino P, , Benazzo F, & Borromeo U, et al: Degenerative arthritis of the adjacent spinal joints following anterior cervical fusion: clinico-radiologic and statistical correlations. Ital J Orthop Traumatol 16:533543, 1990 Cherubino P, Benazzo F, Borromeo U, et al: Degenerative arthritis of the adjacent spinal joints following anterior cervical fusion: clinico-radiologic and statistical correlations. Ital J Orthop Traumatol 16:533–543, 1990

    • Search Google Scholar
    • Export Citation
  • 4.

    Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 10:602617, 1958 Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 10:602–617, 1958

    • Search Google Scholar
    • Export Citation
  • 5.

    Cummins BH, , Robertson JT, & Gill SS: Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943948, 1998 Cummins BH, Robertson JT, Gill SS: Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943–948, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Dvorak J, , Panjabi M, & Novotny J, et al: In vivo flexion/extension of the normal cervical spine. J Orthop Res 9:828834, 1991 Dvorak J, Panjabi M, Novotny J, et al: In vivo flexion/extension of the normal cervical spine. J Orthop Res 9:828–834, 1991

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

    Gore DR, & Sepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:667671, 1984 Gore DR, Sepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:667–671, 1984

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

    Gore DR, , Sepic SB, & Gardner GM: Roentgenographic findings of the cervical spine in asymptomatic people. Spine 11:521524, 1986 Gore DR, Sepic SB, Gardner GM: Roentgenographic findings of the cervical spine in asymptomatic people. Spine 11:521–524, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Hilibrand AS, , Carlson GD, & Palumbo M, et al: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am) 81:519528, 1999 Hilibrand AS, Carlson GD, Palumbo M, et al: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am) 81:519–528, 1999

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

    Hilibrand AS, , Yoo JU, & Carlson GD, et al: The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine 22:15741579, 1997 Hilibrand AS, Yoo JU, Carlson GD, et al: The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine 22:1574–1579, 1997

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

    Kostuik J: Intervertebral disc replacement. Experimental study. Clin Orthop 337:2741, 1997 Kostuik J: Intervertebral disc replacement. Experimental study. Clin Orthop 337:27–41, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Lee CK: Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13:375377, 1988 Lee CK: Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13:375–377, 1988

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

    Matsunaga S, , Kabayama S, & Yamamoto T, et al: Strain on intervertebral discs after anterior cervical decompression and fusion. Spine 24:670675, 1999 Matsunaga S, Kabayama S, Yamamoto T, et al: Strain on intervertebral discs after anterior cervical decompression and fusion. Spine 24:670–675, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Murphey F, , Simmons J, & Brunson B: Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939–1972. J Neurosurg 38:679683, 1973 Murphey F, Simmons J, Brunson B: Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939–1972. J Neurosurg 38:679–683, 1973

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

    Odom G, , Finney W, & Woodhall B: Cervical disc lesions. JAMA 166:2328, 1958 Odom G, Finney W, Woodhall B: Cervical disc lesions. JAMA 166:23–28, 1958

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

    Penning L: Normal movements of the cervical spine. Am J Roentgenol 130:317326, 1978 Penning L: Normal movements of the cervical spine. Am J Roentgenol 130:317–326, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Pospiech J, , Stolke D, & Wilke HJ, et al: Intradiscal pressure recordings in the cervical spine. Neurosurgery 44:379384, 1999 Pospiech J, Stolke D, Wilke HJ, et al: Intradiscal pressure recordings in the cervical spine. Neurosurgery 44:379–384, 1999

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

    Robinson R, & Smith G: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223224, 1955 Robinson R, Smith G: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–224, 1955

    • Search Google Scholar
    • Export Citation
  • 19.

    Scoville W: Types of cervical disc lesions and their surgical approaches. JAMA 196:479481, 1966 Scoville W: Types of cervical disc lesions and their surgical approaches. JAMA 196:479–481, 1966

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

    Shea M, , Edwards WT, & White AA, et al: Variations of stiffness and strength along the human cervical spine. J Biomech 24:95107, 1991 Shea M, Edwards WT, White AA, et al: Variations of stiffness and strength along the human cervical spine. J Biomech 24:95–107, 1991

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

    Smith G, & Robinson R: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 49:607622, 1958 Smith G, Robinson R: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 49:607–622, 1958

    • Search Google Scholar
    • Export Citation
  • 22.

    Weinhoffer SL, , Guyer RD, & Herbert M, et al: Intradiscal pressure measurements above an instrumented fusion. Spine 20:526531, 1995 Weinhoffer SL, Guyer RD, Herbert M, et al: Intradiscal pressure measurements above an instrumented fusion. Spine 20:526–531, 1995

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

    White AA III, & Panjabi MM: Clinical Biomechanics of the Spine, Ed 2. Philadelphia: JB Lippincott, 1990 White AA III, Panjabi MM: Clinical Biomechanics of the Spine, Ed 2. Philadelphia: JB Lippincott, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Whittle M, & Evans M: Instrument for measuring the Cobb angle in scoliosis. Lancet 1:414415, 1979 Whittle M, Evans M: Instrument for measuring the Cobb angle in scoliosis. Lancet 1:414–415, 1979

    • Search Google Scholar
    • Export Citation

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