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01.03.2011 | Symposium: Current Concepts in Cervical Spine Surgery | Ausgabe 3/2011

Clinical Orthopaedics and Related Research® 3/2011

Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 3/2011
Autoren:
MD Cesare Faldini, MD Stavroula Pagkrati, MD Danilo Leonetti, MD Maria Teresa Miscione, MD Sandro Giannini
Wichtige Hinweise
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Abstract

Background

The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known.

Questions/purposes

We asked whether the postoperative sagittal segmental alignment of the fused vertebrae could be used as a predictor of adjacent-level degeneration.

Methods

We retrospectively studied 107 patients, aged 35 to 55 years, with one-level cervical disc disease between C4 and C7 operated on from 1985 to 1995 by discectomy and one-level anterior cervical fusion according to the Cloward procedure. In standard radiographs of the cervical spine in lateral view, the alignment of the involved intervertebral space (sagittal segmental alignment) and the sagittal alignment of the cervical spine were measured and the adjacent-level degeneration was assessed using the Kellgren and Lawrence criteria. The minimum followup was 10 years (mean, 16 years; range, 10–23 years).

Results

Preoperatively, mean sagittal segmental alignment was 0.6° ± 2.0° and sagittal alignment of the cervical spine was 17.0° ± 4.9°. At last followup, the mean sagittal segmental alignment was 1.8° ± 4.1° and mean sagittal alignment of the cervical spine was 19.7° ± 6.6°. Adjacent-level degeneration was present in 60% of cases with postoperative sagittal segmental alignment of 0° or less and in 27% of cases with postoperative sagittal segmental alignment of more than 0°.

Conclusions

To prevent adjacent-level degeneration, we recommend proper lordotic sagittal segmental alignment when anterior interbody fusion of the cervical spine is indicated.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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