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Byung-Wan Choi, M.D., Byung-Ryeul Choi M.D., * Kyung-Jin Song, M.D. * and  Kwang-Bok Lee , M.D. * Departments of Orth PowerPoint Presentation
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Byung-Wan Choi, M.D., Byung-Ryeul Choi M.D., * Kyung-Jin Song, M.D. * and  Kwang-Bok Lee , M.D. * Departments of Orth - PowerPoint PPT Presentation


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Cervical adjacent segment degenerative disease ; Is it a natural history or fusion disease? -comparison between adjacent level of fusion and non-fusion segment-. Byung-Wan Choi, M.D., Byung-Ryeul Choi M.D., * Kyung-Jin Song, M.D. * and  Kwang-Bok Lee , M.D. *

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slide1

Cervical adjacent segment degenerative disease; Is it a natural history or fusion disease? -comparison between adjacent level of fusion and non-fusion segment-

Byung-Wan Choi, M.D., Byung-Ryeul Choi M.D.,*

Kyung-Jin Song, M.D. *and Kwang-Bok Lee, M.D.*

Departmentsof Orthopedic Surgery

Gwangju Veterans Hospital,

Chonbuk National University Hospital *

-We have no financial relationships to disclose-

slide2
The purpose of this study was to evaluate the fusion itself can affect the adjacent segment degeneration or disease formation by comparing the radiological and clinical findings between adjacent to fusion segment and non-fusion segment in single level anterior fusion cases.

PURPOSE

adjacent to fusion level group a
Adjacent to fusion level (Group A)

Adjacent above level

Fusion level

Adjacent below level

adjacent to non fusion level group b
Adjacent to non fusion level (Group B)

Natural Segment

Fusion level

radiological criteria of degeneration criteria i
Radiological criteria of degeneration (Criteria I)

1. Modified Hilibrand`s adjacent segmental disc degeneration.

-JBJS 1999-

Grade Disease Plain Radiography

-----------------------------------------------------------------------

I None Normal

II Mild Narrowing of disc space (<50%),

no posterior osteophytes

III Moderate 50< X<75% of normal disc height,

posterior osteophyte

IV Severe > 75% of disc height

posterior osteophyte

---------------------------------------

radiological criteria of degeneration criteria ii
Radiological criteria of degeneration (Criteria II)

2. Development of adjacent-level ossification

- Park et al, JBJS 2005-

Grade II : extended across

< 50% of the disc space

Grade I : none

Grade IV :

complete bridging

Grade III : across > 50 %

of the disc space

radiological criteria of degeneration criteria iii
Radiological criteria of degeneration (Criteria III)

3. Segmental instability

- More than 3mm displacement in flexion/extension

- Abnormal motion -Dvorak et al, 1988 Spine-

Flex

Ext

Flex

Ext

62 Ms

adjacent segment disease
Adjacent segment disease

- interbody fusion may lead to increases in mechanical stress at adjacent disc levels, thereby accelerating degenerative changes and producing clinical symptoms with time: the so-called ‘adjacent segment disease’.

- Clinical evaluation of new radicular or myelopathic symptom occurrence for evaluation of ‘adjacent segment disease’.

→ Follow up MRI was performed.

incidence of radiological degenerative change
Incidence of radiological degenerative change

1. The percentage of the cases showed degenerative change

(according to fusion or not)

Group A

Group B

38/457(8%)

incidence of radiological degenerative change1
Incidence of radiological degenerative change

2. The number of the cases showed degenerative change

(in the cases of adjacent to fusion)

Group A

analysis according to radiographic criteria
Analysis according to radiographic criteria

(Criteria I)

(Criteria II)

(Criteria III)

incidence of degenerative disease
Incidence of degenerative disease

Total: 4 cases/ 87 patient (4%)

In group A: 2/174 segment(1%) → 1 re-operation (58ms)

58 Ms

incidence of degenerative disease1
Incidence of degenerative disease

Total: 4 cases/ 87 patient (4%)

In group B: 2/283 segment(0.7%) → 1 re-operation(64ms) p=0.59

64 Ms

slide16
Fusion itself can accelerate the severity of adjacent level degeneration as compared with non-fusion.

But there was no correlation in the incidence of symptomatic adjacent segment diseases according to the fusion in single level anterior cervical arthrodesis for the degenerative cervical diseases.

Adjacent segment disease is more a result of the natural history.

CONCLUSION