Zachary P Milestone, Akiro H Duey, Wasil Ahmed, Christopher Gonzalez, Jiwoo Park, Lathan Liou, Pierce Ferriter, Jonathan Markowitz, Jun S Kim, Samuel K Cho
{"title":"前路颈椎椎间盘切除和融合术中融合颈椎水平对固定架和同种异体移植物下沉的影响","authors":"Zachary P Milestone, Akiro H Duey, Wasil Ahmed, Christopher Gonzalez, Jiwoo Park, Lathan Liou, Pierce Ferriter, Jonathan Markowitz, Jun S Kim, Samuel K Cho","doi":"10.1097/BSD.0000000000001721","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>This study aims to evaluate the relationship between the cervical levels fused and the degree of subsidence following anterior cervical discectomy and fusion (ACDF) procedures.</p><p><strong>Background: </strong>Subsidence following ACDF may worsen clinical outcomes. Previous studies have linked lower cervical levels with higher rates of subsidence, but none have quantified the relative degree of subsidence between levels.</p><p><strong>Materials and methods: </strong>Patients who underwent ACDF from 2016 to 2021 at a tertiary medical center were included in this study. Lateral cervical radiographs from the immediate postoperative period and the final follow-ups were used to calculate subsidence. Analysis of variance was used to examine the association between cervical levels fused and subsidence. Multivariable linear regression analysis controlled for age, sex, smoking status, osteopenia/osteoporosis, number of fused levels, cage-to-body ratio, and cage type while examining the relationship between the cervical level fused and subsidence.</p><p><strong>Results: </strong>This study includes 122 patients who underwent 227 levels fused. There were 16 (7.0%) C3-C4 fusions, 55 (24.2%) C4-C5 fusions, 97 (42.7%) C5-C6 fusions, and 59 (26.0%) C6-C7 fusions. There was a significant difference in the degree of anterior subsidence between cervical levels fused (P = 0.013) with a mean subsidence of 1.0 mm (SD: 1.6) for C3-C4, 1.1 mm (SD: 1.4) for C4-C5, 1.8 mm (SD: 1.5) for C5-C6, and 1.8 mm (SD: 1.6) for C6-C7 fusions. Relative to C6-C7 fusions, C4-C5 (P = 0.016), and C3-C4 (P = 0.014) fusions were associated with decreased anterior subsidence, whereas C5-C6 (P = 0.756) fusions were found to have similar degrees of anterior subsidence in the multivariable analysis.</p><p><strong>Conclusion: </strong>We found upper cervical levels experienced a smaller degree of anterior subsidence than lower levels, after controlling for demographic and implant characteristics. Surgeons can consider using larger cages at lower cervical levels to minimize these risks.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Influence of Cervical Level Fused on Subsidence of Cage and Allograft in Anterior Cervical Discectomy and Fusion.\",\"authors\":\"Zachary P Milestone, Akiro H Duey, Wasil Ahmed, Christopher Gonzalez, Jiwoo Park, Lathan Liou, Pierce Ferriter, Jonathan Markowitz, Jun S Kim, Samuel K Cho\",\"doi\":\"10.1097/BSD.0000000000001721\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>This study aims to evaluate the relationship between the cervical levels fused and the degree of subsidence following anterior cervical discectomy and fusion (ACDF) procedures.</p><p><strong>Background: </strong>Subsidence following ACDF may worsen clinical outcomes. Previous studies have linked lower cervical levels with higher rates of subsidence, but none have quantified the relative degree of subsidence between levels.</p><p><strong>Materials and methods: </strong>Patients who underwent ACDF from 2016 to 2021 at a tertiary medical center were included in this study. Lateral cervical radiographs from the immediate postoperative period and the final follow-ups were used to calculate subsidence. Analysis of variance was used to examine the association between cervical levels fused and subsidence. Multivariable linear regression analysis controlled for age, sex, smoking status, osteopenia/osteoporosis, number of fused levels, cage-to-body ratio, and cage type while examining the relationship between the cervical level fused and subsidence.</p><p><strong>Results: </strong>This study includes 122 patients who underwent 227 levels fused. There were 16 (7.0%) C3-C4 fusions, 55 (24.2%) C4-C5 fusions, 97 (42.7%) C5-C6 fusions, and 59 (26.0%) C6-C7 fusions. There was a significant difference in the degree of anterior subsidence between cervical levels fused (P = 0.013) with a mean subsidence of 1.0 mm (SD: 1.6) for C3-C4, 1.1 mm (SD: 1.4) for C4-C5, 1.8 mm (SD: 1.5) for C5-C6, and 1.8 mm (SD: 1.6) for C6-C7 fusions. Relative to C6-C7 fusions, C4-C5 (P = 0.016), and C3-C4 (P = 0.014) fusions were associated with decreased anterior subsidence, whereas C5-C6 (P = 0.756) fusions were found to have similar degrees of anterior subsidence in the multivariable analysis.</p><p><strong>Conclusion: </strong>We found upper cervical levels experienced a smaller degree of anterior subsidence than lower levels, after controlling for demographic and implant characteristics. Surgeons can consider using larger cages at lower cervical levels to minimize these risks.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001721\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001721","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Influence of Cervical Level Fused on Subsidence of Cage and Allograft in Anterior Cervical Discectomy and Fusion.
Study design: Retrospective cohort.
Objective: This study aims to evaluate the relationship between the cervical levels fused and the degree of subsidence following anterior cervical discectomy and fusion (ACDF) procedures.
Background: Subsidence following ACDF may worsen clinical outcomes. Previous studies have linked lower cervical levels with higher rates of subsidence, but none have quantified the relative degree of subsidence between levels.
Materials and methods: Patients who underwent ACDF from 2016 to 2021 at a tertiary medical center were included in this study. Lateral cervical radiographs from the immediate postoperative period and the final follow-ups were used to calculate subsidence. Analysis of variance was used to examine the association between cervical levels fused and subsidence. Multivariable linear regression analysis controlled for age, sex, smoking status, osteopenia/osteoporosis, number of fused levels, cage-to-body ratio, and cage type while examining the relationship between the cervical level fused and subsidence.
Results: This study includes 122 patients who underwent 227 levels fused. There were 16 (7.0%) C3-C4 fusions, 55 (24.2%) C4-C5 fusions, 97 (42.7%) C5-C6 fusions, and 59 (26.0%) C6-C7 fusions. There was a significant difference in the degree of anterior subsidence between cervical levels fused (P = 0.013) with a mean subsidence of 1.0 mm (SD: 1.6) for C3-C4, 1.1 mm (SD: 1.4) for C4-C5, 1.8 mm (SD: 1.5) for C5-C6, and 1.8 mm (SD: 1.6) for C6-C7 fusions. Relative to C6-C7 fusions, C4-C5 (P = 0.016), and C3-C4 (P = 0.014) fusions were associated with decreased anterior subsidence, whereas C5-C6 (P = 0.756) fusions were found to have similar degrees of anterior subsidence in the multivariable analysis.
Conclusion: We found upper cervical levels experienced a smaller degree of anterior subsidence than lower levels, after controlling for demographic and implant characteristics. Surgeons can consider using larger cages at lower cervical levels to minimize these risks.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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