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Original Articles

Lumbar Spine

Preoperative Clinical and Radiographic Risk Factors for Recurrent Lumbar Disc Herniation: Systematic Review and Meta-analysis
Mohamed A.R. Soliman, Hendrick Francois, Alexander O. Aguirre, Asham Khan, Waeel Hamouda, Stipe Ćorluka, Zorica Buser, Samuel K. Cho, S. Tim Yoon, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):42-58.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551242.621

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Preoperative Clinical and Radiographic Risk Factors for Recurrent Lumbar Disc Herniation: Systematic Review and Meta-analysis
Neurospine. 2026;23(1):42-58.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551242.621
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Preoperative Clinical and Radiographic Risk Factors for Recurrent Lumbar Disc Herniation: Systematic Review and Meta-analysis
Neurospine. 2026;23(1):42-58.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551242.621
Close
Objective
Lumbar discectomy is one of the most frequently undertaken procedures for the management of lumbar disc herniation. However, it may be complicated by recurrent disc herniation, with reported rates as high as 25%. To the authors’ knowledge, this study is the largest systematic review to date, analyzing the clinical and radiographic risk factors for recurrent disc herniation.
Methods
A systematic literature search of Embase and PubMed/Medline, covering the period from inception to October 1, 2025, was conducted to identify case-control or cohort studies reporting risk factors for recurrent disc herniation. Risk factors were classified into baseline, clinical, and radiographic risk factors. Meta-analysis was performed for any reported risk factor with data from 3 or more studies. The assessment included an evaluation of publication bias and heterogeneity.
Results
A total of 51 studies published during the search timeframe, comprising 52,479 patients, met the inclusion criteria. Recurrent disc herniation occurred in 6,794 patients (12.9%). Significant risk factors for disc herniation included high body mass index (BMI) (standard mean difference [SMD], 0.48; 95% confidence interval [CI], 0.26–0.70), diabetes (odds ratio [OR], 1.48; 95% CI, 1.23–1.77), increased sagittal range of motion (SMD, 2.15; 95% CI, 0.35–3.94), and Modic changes (OR, 2.97; 95% CI, 2.20–4.01). No other significant predictors for recurrent disc herniation were identified.
Conclusion
In conclusion, patients with high BMI, diabetics, increased sagittal range of motion, and presence of Modic changes are at increased risk of recurrent disc herniation. Future prospective studies are needed to validate the risk factors identified in this study associated with recurrent disc herniation.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparison of clinical efficacy and minimal invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy in the treatment of calcified lumbar disc herniation: a retrospective analysis
    Zhifeng Cheng, Lei Sun, Tao Tang, Qiang Wu, Likan Liang, Haonan Lu, Hao Xu, Bo Hu
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • Spine

    Bone & Joint 360.2026; 15(3): 30.     CrossRef
  • Risk factors for residual low back pain at twelve months after low-temperature plasma radiofrequency ablation in lumbar disc herniation: a retrospective cohort study
    Yingying Lou, Song Zhou, Yonggan Ying
    International Orthopaedics.2026;[Epub]     CrossRef
  • 3,487 View
  • 172 Download
  • 3 Web of Science
  • 3 Crossref

Biomechanics

Fixation of the Sacroiliac Joint: A Cadaver-Based Concurrent-Controlled Biomechanical Comparison of Posterior Interposition and Posterolateral Transosseous Techniques
Oluwatodimu Richard Raji, Jason E. Pope, Steven M. Falowski, Michael Stoffman, Jeremi M. Leasure
Neurospine 2025;22(1):185-193.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2448940.470

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Fixation of the Sacroiliac Joint: A Cadaver-Based Concurrent-Controlled Biomechanical Comparison of Posterior Interposition and Posterolateral Transosseous Techniques
Neurospine. 2025;22(1):185-193.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2448940.470
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Fixation of the Sacroiliac Joint: A Cadaver-Based Concurrent-Controlled Biomechanical Comparison of Posterior Interposition and Posterolateral Transosseous Techniques
Neurospine. 2025;22(1):185-193.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2448940.470
Close
Objective
Our study aimed to compare the posterior interposition technique against the posterolateral transosseous technique in the same cadaver specimens.
Methods
Computer and cadaver models of 2 fixation techniques were developed. The computer model was constructed to analyze bone volume removed during implant placement and the bony surface area available for fusion. The cadaver model included quasi-static multidirectional bending flexibility and dynamic fatigue loading. Relative motions between the sacrum and ilium were measured intact, after joint destabilization, after fixation with direct-posterior and posterolateral techniques, and after 18,500 cycles of fatigue loading. Relative positions between each implant and the sacrum and ilium were measured after fixation and fatigue loading to ascertain the quality of the bone-implant interface. The 2 techniques were randomized to the left and right sacroiliac joints of the same cadavers.
Results
The posterior interposition technique removed less bone volume and facilitated a larger surface area available for bony fusion. Posterior interposition significantly reduced the nutation/counternutation motion of the sacroiliac joint (42% ± 8%) and reduced it more than the posterolateral transosseous technique (14% ± 4%). Upon fatigue loading, the posterior interposition implant maintained the bone-implant interface across all specimens, while the posterolateral transosseous implant migrated or subsided in 20%–50% of specimens.
Conclusion
Posterior interposition fixation of the sacroiliac joint reduces joint motion. The amount of fixation from the posterior technique is superior and more durable than the amount of fixation achieved by the posterolateral technique.

Citations

Citations to this article as recorded by  Crossref logo
  • Sacroiliac joint fixation with a posterior intra-articular implant versus a posterolateral transiliac implant: A biomechanical comparison
    Connor Huxman, Joshua Tandio, Douglas Beall, Sarah Mayer, Adam Rogers, Thomas P. Hedman, Jonathan A. Hyde, Usman Latif, Richard Oluwatodimu Raji, Jeremi M. Leasure
    North American Spine Society Journal (NASSJ).2026; 26: 100871.     CrossRef
  • Best practices for the LinQ sacroiliac joint stabilization procedure for the treatment of sacroiliac joint disorders
    Timothy Deer, Anuj Shah, David Reece, Chau M. Vu, Siddardth Umapathy, Harman Chopra, Colin Mark Buday, Rosa A. Garcia, Johnson S. Ho, Robin Mata, Christopher M. Lam, Christopher L. Robinson, Lucas Bracero, Mateusz Graca, Casey Grillo, Ashley G. Comer, Kas
    Pain Management.2026; 16(7): 809.     CrossRef
  • A Retrospective, Multicenter Analysis of a Novel Sacroiliac Joint Fusion Device on Safety and Efficacy at 12 Months: Access Study
    Michael J. Dorsi, Pankaj Mehta, Chau Vu, Angel Boev, Ashley Bailey-Classen, Greg Moore, David Reece, Alaa Abd-Elsayed, Steven Falowski, Jason E. Pope
    Healthcare.2025; 13(13): 1544.     CrossRef
  • Optimal screw insertion trajectory for sacroiliac joint fusion surgery: An evolutionary and growth process perspective on the sacroiliac joint
    Daisuke Kurosawa, Kouji Sanaka, Eiichi Murakami
    Medical Hypotheses.2025; 202: 111730.     CrossRef
  • 4,243 View
  • 84 Download
  • 4 Web of Science
  • 4 Crossref
Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Jinyoung Park, Yong Eun Cho, Kyung Hyun Kim, Sanghoon Shin, Sungjun Kim, Chae Hwan Lim, Seok Young Chung, Yoon Ghil Park
Neurospine 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253

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Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Neurospine. 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253
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Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Neurospine. 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253
Close
Objective
This study aimed to investigate the correlation between ossification of the posterior longitudinal ligament (OPLL) size and multifidus fatty degeneration (MFD), hypothesizing that larger OPLL sizes are associated with worse MFD.
Methods
One hundred four patients with cervical OPLL who underwent surgery were screened. OPLL occupying diameter and area ratios, the severity of MFD using the Goutallier classification, and range of motion (ROM) of cervical flexion-extension (ΔCobb) were measured. Correlation analyses between OPLL size, MFD severity, and ΔCobb were conducted. MFD severity was compared for each OPLL type using one-way analysis of variance.
Results
The final clinical data from 100 patients were analyzed. The average Goutallier grade of C2–7 significantly correlated with the average OPLL diameter and area occupying ratios, and OPLL involved vertebral level (r = 0.58, p < 0.01; r = 0.40, p < 0.01; r = 0.47, p < 0.01, respectively). The OPLL size at each cervical level significantly correlated with MFD of the same or 1–3 adjacent levels. ΔCobb angle was negatively correlated with the average Goutallier grade (r = -0.31, p < 0.01) and average OPLL occupying diameter and area ratios (r = -0.31, p < 0.01; r = -0.35, p < 0.01, respectively). Patients with continuous OPLL exhibited worse MFD than those with segmental OPLL (p < 0.01).
Conclusion
OPLL size is clinically correlated with MFD and cervical ROM. OPLL at one spinal level affects MFD at the same and 1–3 adjacent spinal levels. The worsening severity of MFD is associated with the longitudinal continuity of OPLL.

Citations

Citations to this article as recorded by  Crossref logo
  • The Impact of Cervical Multifidus Sarcopenia on Outcomes After Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament
    Yiwei Zhao, Ye Tian, Dihan Sun, Jianguo Zhang, Siyi Cai
    Journal of Bone and Joint Surgery.2026; 108(5): 370.     CrossRef
  • Degenerative characteristics of the subaxial cervical spine in patients with degenerative lateral atlantoaxial osteoarthritis: A propensity score-matched study based on computed tomography imaging
    Shun Han, Yuliang Wu, Haotian Tian, Bo Sun, Songbo Gao, Weitao Han, Zhengqi Huang, Xiaohe Zhang, Yan Peng, Youxi Lin, Wei Ye
    Journal of Craniovertebral Junction and Spine.2026; 17(2): 125.     CrossRef
  • Cervical facet joint angle and deep extensor degeneration are correlated with laterally deviated type ossification of the posterior longitudinal ligament
    Hao Zhou, Tianyu Yao, Tenghui Zhang, Fazhi Zang, Xiaodong Wu, Lei Liang, Huajiang Chen
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • The role of paraspinal muscle degeneration in cervical spondylosis
    Zhifei Li, Yisheng Zhang, Yuanfang Lin, Chunyu Fan, Yin Yang, Yueli Sun, Zhihua Wu, Ziyang Liang
    European Spine Journal.2025; 34(3): 1187.     CrossRef
  • Association between Congestive Heart Failure and Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study
    Dong Soon Jang, Hakyung Kim, Seung Hun Sheen, Inbo Han, Soo Hyun Lee, Woo Seok Choi, Je Beom Hong, Min Jai Cho, Seil Sohn
    The Nerve.2024; 10(1): 19.     CrossRef
  • 5,331 View
  • 180 Download
  • 3 Web of Science
  • 5 Crossref
Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors
Zhongyuan He, Nguyen Tran Canh Tung, Hiroto Makino, Taketoshi Yasuda, Shoji Seki, Kayo Suzuki, Kenta Watanabe, Hayato Futakawa, Katsuhiko Kamei, Yoshiharu Kawaguchi
Neurospine 2023;20(2):651-661.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346124.062

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Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors
Neurospine. 2023;20(2):651-661.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346124.062
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Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors
Neurospine. 2023;20(2):651-661.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346124.062
Close
Objective
Using segmental dynamic and static factors, we aimed to elucidate the pathogenesis and relationship between ossification of the posterior longitudinal ligament (OPLL) and the severity of cervical myelopathy.
Methods
Retrospective analysis of 163 OPLL patients' 815 segments. Imaging was used to evaluate each segmental space available for the spinal cord (SAC), OPLL diameter, type, bone space, K-line, the C2–7 Cobb angle, each segmental range of motion (ROM), and total ROM. Magnetic resonance imaging was used to evaluate spinal cord signal intensity. Patients were divided into the myelopathy group (M group) and the without myelopathy group (WM group).
Results
Minimal SAC (p = 0.043), (C2–7) Cobb angle (p = 0.004), total ROM (p = 0.013), and local ROM (p = 0.022) were evaluated as an independent predictor of myelopathy in OPLL. Different from the previous report, the M group had a straighter whole cervical spine (p < 0.001) and poorer cervical mobility (p < 0.001) compared to the WM group. Total ROM was not always a risk factor for myelopathy, as its impact depended on SAC, when SAC > 5 mm, the incidence rate of myelopathy decreased with the increase of total ROM. Lower cervical spine (C5–6, C6–7) showing increased “Bridge-Formation,” along with spinal canal stenosis and segmental instability (C2–3, C3–4) in the upper cervical spine, could cause myelopathy in M group (p < 0.05).
Conclusion
Cervical myelopathy is linked to the OPLL’s narrowest segment and its segmental motion. The hypermobility of the C2–3 and C3–4, contributes significantly to the development of myelopathy in OPLL.

Citations

Citations to this article as recorded by  Crossref logo
  • Changes in the Cervical Range of Motion and Clinical Outcomes After Laminectomy With Fusion for Ossification of the Posterior Longitudinal Ligament: Impact of K-Line and OPLL Subtypes
    Zhihao Ma, Yi Huang, Peihong Hou, Hao Li, Mengyuan Zhang, Jiayan Wu, Jinxu Chen, Huawei Liu, Wenhao Hu, Guoquan Zheng
    Neurosurgery.2026; 98(6): 1413.     CrossRef
  • Single-cell transcriptome profiling reveals the heterogeneity of ossification of the posterior longitudinal ligament (OPLL) and its immune microenvironment
    Zhongyuan He, Jiaxiang Zhou, Fuan Wang, Peng Guo, Jianfeng Li, Zhengya Zhu, Tao Tang, Nguyen Tran Canh Tung, Yoshiharu Kawaguchi, Shaoyu Liu, ManMan Gao, Xizhe Liu, Zhiyu Zhou
    Cell Biology and Toxicology.2026;[Epub]     CrossRef
  • Reduction of Spinal Cord Cross-Sectional Area Is Associated With Myelopathy in Severe Cervical Ossification of the Posterior Longitudinal Ligaments
    Hyun-Jun Jang, Dong-Kyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Yong-Eun Cho, Dong-Kyu Chin
    Neurosurgery.2026;[Epub]     CrossRef
  • Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography
    Hazem Alaa, Nguyen Tran Canh Tung, Tomoya Ueno, Hiroto Makino, Hayato Futakawa, Shoji Seki, Yoshiharu Kawaguchi
    The Spine Journal.2025; 25(1): 69.     CrossRef
  • Reduced Vertebral Hounsfield Unit Values in the Bridging Group of Ossification-Related Segments in Patients with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine
    Zheming Yu, Junqiao Lv, Zhiqiang Wang, Xuefeng Tian, Xiaohua Hou, Lin Sun
    World Neurosurgery.2025; 195: 123638.     CrossRef
  • A modified measurement method for functional spinal unit ROM of cervical spine
    Jianxi Wang, Hao Zhou, Bo Hu, Fazhi Zang, Wen Yuan, Huajiang Chen, Lei Liang
    Scientific Reports.2025;[Epub]     CrossRef
  • The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
    Jun Jae Shin, Sun Joon Yoo, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Won Joo Jeong, Tae Woo Kim, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shi
    Neurospine.2025; 22(2): 337.     CrossRef
  • Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments
    Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho
    Clinical Spine Surgery.2024; 37(4): 131.     CrossRef
  • Association between Congestive Heart Failure and Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study
    Dong Soon Jang, Hakyung Kim, Seung Hun Sheen, Inbo Han, Soo Hyun Lee, Woo Seok Choi, Je Beom Hong, Min Jai Cho, Seil Sohn
    The Nerve.2024; 10(1): 19.     CrossRef
  • Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
    Jun Jae Shin, Sun Joon Yoo, Tae Woo Kim, Jae-Young So, Won Joo Jeong, Mu Ha Lee, Joongkyum Shin, Yoon Ha
    Neurospine.2024; 21(2): 443.     CrossRef
  • The Improvement of Intraoperative Motor Evoked Potential after Decompression in Cervical Compressive Myelopathy: Its Significance and Related Factors
    Jong Yun Kwon, Dong Hwan Kim, Kyoung Hyup Nam, Byung Kwan Choi, In Ho Han
    The Nerve.2024; 10(2): 80.     CrossRef
  • Bone Density of Vertebral Bodies and Ossified Masses in Cervical Ossification of the Posterior Longitudinal Ligament: An Imaging Study Based on MRI, CT, and DEXA
    Mingliang Shi, Baocheng Niu, Cheng Ye, Dong Xie, Qing Chen, Qi Zhao, Hao Wu, Lili Yang
    Calcified Tissue International.2024;[Epub]     CrossRef
  • Management of Cerebrospinal Fluid Leakage by Pump-Regulated Volumetric Continuous Lumbar Drainage Following Anterior Cervical Decompression and Fusion for Ossification of the Posterior Longitudinal Ligament
    Sun Woo Jang, Sang Hyub Lee, Hong Kyung Shin, Sang Ryong Jeon, Sung Woo Roh, Jin Hoon Park
    Neurospine.2023; 20(4): 1421.     CrossRef
  • 12,463 View
  • 227 Download
  • 11 Web of Science
  • 13 Crossref
Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study
Bernardo de Andrada Pereira, Joshua E. Heller, Jennifer N. Lehrman, Anna G.U. Sawa, Brian P. Kelly
Neurospine 2021;18(1):188-196.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040552.276

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Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study
Neurospine. 2021;18(1):188-196.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040552.276
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Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study
Neurospine. 2021;18(1):188-196.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040552.276
Close
Objective
Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.
Methods
Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2–7 cadaveric specimens intact and after discectomy (C3–6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance.
Results
All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3–6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion.
Conclusion
All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical Implementation of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges
    Morgan P. Lorio, Pierce D. Nunley, Joshua E. Heller, Bruce M. McCormack, Kai-Uwe Lewandrowski, Jon E. Block
    Journal of Personalized Medicine.2024; 14(8): 837.     CrossRef
  • Overloaded vertebral body: a unique radiographic phenomenon following multilevel anterior cervical discectomy and fusion
    Shihao Chen, Kangkang Huang, Hao Liu, Tingkui Wu, Junbo He, Minghe Yao, Beiyu Wang
    Journal of Orthopaedic Surgery and Research.2023;[Epub]     CrossRef
  • Unilateral spacer distraction of the subaxial cervical facet joint for the treatment of fixed coronal malalignment of the craniovertebral junction
    Luis E. Carelli, Alderico Girão, Ígor Cechin, Juan P. Cabrera
    Journal of Craniovertebral Junction and Spine.2022; 13(2): 121.     CrossRef
  • Biomechanical Effect of Disc Height on the Components of the Lumbar Column at the Same Axial Load: A Finite-Element Study
    Jae-Gyeong Jeong, Sungwook Kang, Gu-Hee Jung, Mingoo Cho, Hyunsoo Kim, Kyoung-Tae Kim, Dong-Hee Kim, Jong-Moon Hwang, V. E. Sathishkumar
    Journal of Healthcare Engineering.2022; 2022: 1.     CrossRef
  • 9,014 View
  • 161 Download
  • 4 Web of Science
  • 4 Crossref
Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Jun Jae Shin
Neurospine 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083

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Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Neurospine. 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083
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Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Neurospine. 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083
Close
Objective
This study aimed to assess the influence of a fused segment on cervical range of motion (ROM) and adjacent segmental kinematics and determine whether increasing number of fusion levels causes accelerated adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF).
Methods
A total of 165 patients treated with ACDF were recruited for assessment, and they were divided into 3 groups based on the number of fusion levels. Radiological measurements and clinical outcomes included visual analogue scale (VAS) and Neck Disability Index (NDI) assessed preoperatively and at ≥2 years of follow-up.
Results
ASD occurred in 41 of 165 patients who underwent ACDF (1-level, 12 of 78 [15.38%]; 2-level, 14 of 49 [28.57%]; 3-level, 15 of 38 [39.47%]; p=0.015) at final follow-up (mean, 31.9 months). Significant differences were found in reduction of global ROM based on the number of fusion levels (p<0.001). The upper adjacent segment ROM increased over time (p=0.004); however, lower segment ROM did not. Three-level ACDF did not obtain greater amounts of lordosis than did 1- or 2-level ACDF (p=0.003). Postoperative neck VAS scores and NDI were significantly higher for 3-level ACDF than for 1- or 2-level ACDF (p=0.033 and p=0.001).
Conclusion
ASD occurred predominantly in multilevel cervical fusion, more frequently in the upper segment of the prior fusion and as the number of fusion levels increased. Patients who underwent multilevel fusion had greater reduction of global ROM and increased compensatory motion at the upper adjacent segment. Three-level ACDF did not appear to restore cervical lordosis significantly compared with 1- or 2-level arthrodesis.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparison of 10-year follow-up result of hybrid surgery and anterior cervical discectomy and fusion for the treatment of contiguous three-level cervical degenerative disc diseases: risk factors for heterotopic ossification
    Ziye Qiu, Yang Xiong, Xing Yu, Yongdong Yang, Qing Kang, Ningning Feng, Wenhao Li, Luchun Xu, Yukun Ma, Jiawei Song, Guozheng Jiang, Sixue Chen
    European Spine Journal.2026; 35(4): 1828.     CrossRef
  • A review of combined anterior cervical discectomy and fusion with cervical disc replacement for multilevel cervical disc disease
    Jeffrey Weinreb, Claire van Ekdom, Diarra Oden, Joseph O’Brien
    Current Orthopaedic Practice.2026;[Epub]     CrossRef
  • Prospective Comparison of Posterior Decompression and ACDF for 1- to 2-level Degenerative Cervical Myelopathy
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Clinical Articles

Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Jang Ho Ahn, Moon Sun Park, Seong Min Kim, Seung Young Chung, Do Sung Lee, Ki Seok Park
Korean J Spine 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134

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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
Close
Objective

Anterior cervical microforaminotomy (ACMF) is a motion-preserving surgical procedure. The purpose of this study is to assess radiologic changes of operated and adjacent segments after ACMF.

Methods

We retrospectively reviewed 52 patients who underwent ACMF between 1998 and 2008. From X-ray film-based changes, disc height and sagittal range of motion (ROM) of operated and adjacent segments were compared at preoperative and last follow-up periods. Radiological degeneration of both segments was analyzed as well.

Results

The mean follow-up period was 48.2 months. There were 78 operated, 52 upper adjacent, and 38 lower adjacent segments. There were statistically significant differences in the ROM and disc height of operated segment between preoperative and last follow-up periods. However, there were no statistically significant differences in the ROM and disc height of adjacent segment between both periods. Radiological degenerative changes of operated segments were observed in 30%. That of adjacent segments was observed in 11 and 11% at upper and lower segments, respectively.

Conclusion

After mean 4-year follow-up periods, there were degenerative changes of operated segments. However, ACMF preserved motion and prevented degenerative changes of adjacent segments.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical and radiological outcomes of anterior cervical foraminotomy: Insights from a pioneering Australian case series and systematic review
    Jiahua Huang, Daniel Liu, Keshan Murugananthan, Saeed Kohan
    Journal of Clinical Neuroscience.2025; 142: 111698.     CrossRef
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    Yong Ahn
    Neurospine.2023; 20(1): 11.     CrossRef
  • Long-term Radiological Evidence of Affected and Adjacent Segment Disease after Anterior Cervical Foraminotomy
    Yasufumi OHTAKE, Junya HANAKITA, Toshiyuki TAKAHASHI, Manabu MINAMI, Hirohiko NAKAMURA, Taigo KAWAOKA
    Neurologia medico-chirurgica.2020; 60(10): 492.     CrossRef
  • 9,753 View
  • 109 Download
  • 3 Crossref
Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy
Tack Geun Cho, Young Baeg Kim, Seung Won Park
Korean J Spine 2014;11(1):1-6.   Published online March 31, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.1.1

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Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy
Korean J Spine. 2014;11(1):1-6.   Published online March 31, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.1.1
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Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy
Korean J Spine. 2014;11(1):1-6.   Published online March 31, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.1.1
Close
Objective

Posterior cervical foraminotomy (PCF) is a motion-preserving surgical technique. The objective was to determine whether PCF alter cervical motion as a long-term influence.

Methods

Thirty one patients who followed up more than 36 months after PCF for cervical radiculopathy from January 2004 to September 2008 were enrolled in this study. The range of motion (ROM) of whole cervical spine, the operated segment, the cranial and the caudal adjacent segment were obtained. The clinical result and the change of ROMs were compared with those in the patients performed anterior cervical discectomy and fusion (ACDF) during the same period.

Results

In PCF group, the ROM of whole cervical spine had no significant difference in statistically at preoperative and last follow up. The operated segment ROM was significantly decreased from 11.02±5.72 to 8.82±6.65 (p<0.05). The ROM of cranial adjacent segment was slightly increased from 10.42±5.13 to 11.02±5.41 and the ROM of caudal adjacent segment was decreased from 9.44±6.26 to 8.73±5.92, however these data were not meaningful statistically. In ACDF group, the operated ROM was decreased and unlike in PCF group, especially the ROM of caudal adjacent segment was increased from 9.39±4.21 to 11.33±5.07 (p<0.01).

Conclusion

As part of the long-term effects of PCF on cervical motion, the operated segment motions decreased but were preserved after PCF. However, unlikely after ACDF, the ROMs of the adjacent segment did not increase after PCF. PCF, by maintaining the motion of the operated segment, imposes less stress on the adjacent segments. This may be one of its advantages.

Citations

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    Clinical Spine Surgery.2026; 39(4): 180.     CrossRef
  • Evaluating Three-Dimensional Navigation versus Conventional Fluoroscopy for Posterior Cervical Foraminotomy: An Exploratory Cohort Comparison
    Christian Blume, Andrej Bitter, Guido Wapenhans, Patrick Weidle, Kerstin Jütten, Miguel Pishnamaz, Alexander Romagna, Ulf Bertram, Christian Andreas Mueller, Hans Clusmann, Tobias Philip Schmidt
    Journal of Neurological Surgery Part A: Central European Neurosurgery.2026;[Epub]     CrossRef
  • Current role and future perspectives of endoscopic spine surgery: a narrative review
    Hyung-Rae Lee
    Journal of the Korean Medical Association.2025; 68(8): 528.     CrossRef
  • Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy
    Dong-Ho Lee, Hyung Rae Lee, Sang Yun Seok, Ji Uk Choi, Jae Min Park, Jae-Hyuk Yang
    Medicina.2024; 60(9): 1496.     CrossRef
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    Hyung Rae Lee, Jae Min Park, In-Hee Kim, Jun-Hyun Kim, Jae-Hyuk Yang
    Journal of Clinical Medicine.2024; 14(1): 164.     CrossRef
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    Dong-Ho Lee, Hyeong-Joo Lee, Jae Hwan Cho, Chang Ju Hwang, Jae Jun Yang, Choon Sung Lee, Sehan Park
    Global Spine Journal.2023; 13(8): 2357.     CrossRef
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    Simon Thomson, Gemma Ainsworth, Senthil Selvanathan, Rachel Kelly, Howard Collier, Ruben Mujica-Mota, Rebecca Talbot, Sarah Tess Brown, Julie Croft, Nikki Rousseau, Ruchi Higham, Yahia Al-Tamimi, Neil Buxton, Nicholas Carleton-Bland, Martin Gledhill, Vict
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    Andrew Platt, Richard G. Fessler, Vincent C. Traynelis, John E. O’Toole
    Global Spine Journal.2022; 12(7): 1573.     CrossRef
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    R. Misra, N.K. Rath
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Original Articles

Preliminary Radiological Outcomes of Cervical Arthroplasty with Bryan and Prestige LP Cervical Disc Prosthesis.
Hyun Min Oh, Hwa Seung Park, Dong Youl Rhee, Joon Suk Song, Weon Heo, Chang Joo Lee, Se Hyun Joung
Korean J Spine 2008;5(3):124-129.

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Preliminary Radiological Outcomes of Cervical Arthroplasty with Bryan and Prestige LP Cervical Disc Prosthesis.
Korean J Spine. 2008;5(3):124-129.
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Preliminary Radiological Outcomes of Cervical Arthroplasty with Bryan and Prestige LP Cervical Disc Prosthesis.
Korean J Spine. 2008;5(3):124-129.
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OBJECTIVE
Postoperative motion preservation and prevention of adjacent segment degeneration is well recognized after placing artificial cervical disc prosthesis in patients with degenerative cervical disc disease. The authors investigated postoperative changes in motion dynamics in two different types of artificial cervical disc prosthesis, Bryan and Prestige LP cervical disc prosthesis, and compared them.
METHODS
Twenty five patients underwent anterior cervical discectomy and implantation of artificial cervical disc prosthesis: 10 with Bryan and 15 with Prestige LP. Radiological assessments, including overall sagittal alignment angle, range of motion (ROM) of overall sagittal, functional spine unit (FSU) angle, segmental ROM of FSU and ROM of adjacent segment (Upper and Lower level) using static and dynamic lateral radiographs, were performed preoperatively and postoperatively. The mean postoperative follow up period was 18.6 months (range 10.4~28.5) in Bryan and 9.2 months (range 6.5~12.6) in Prestige LP.
RESULTS
The overall sagittal alignment angle was decreased 2.9degrees in Bryan group (p=0.033) and increased 5.7degrees in Prestige LP group (p=0.017). The FSU angle at treated level was decreased 0.4degrees in Bryan group (p=0.929) and increased 2.9degrees in Prestige LP group (p=0.008). The ROM of overall sagittal was decreased in both groups (Bryan: 8.6degrees p=0.075, Prestige LP: 2.9degrees p=0.182). The segmental ROM of FSU was increased 1.0degrees in Prestige LP group (p=0.191) but, decreased 0.6degrees in Bryan group (p=0.929). The ROM of adjacent segment was decreased in both groups (Bryan: upper p=0.023 lower p=0.050, Prestige LP: upper p=0.570 lower p=0.132). The postoperative radiological results of comparison between two different artificial disc showed that overall sagittal alignment angle and FSU angle were more increased in Prestige LP (p=0.005, p=0.026, respectively).
CONCLUSION
The segmental ROM of FSU was preserved and ROM of adjacent segment was decreased in both groups. This means that postoperative adjacent segment disease may be prevented regardless of types of implants. On comparison study, postoperative cervical curvature was more lordotic in Prestige LP. Therefore, Prestige LP is more suitable to maintain postoperative cervical lordosis. The limitation of our study is small number of case and short and unequal follow up period between two types of implants. Further long term study will be needed.
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Radiologic Comparison of Cervical Athroplasty with Cervical Arthrodesis.
Jeong Hoon Lee, Eun Sang Kim, Hwan Eoh, Sang Hyuk Kim
Korean J Spine 2008;5(1):7-12.

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Radiologic Comparison of Cervical Athroplasty with Cervical Arthrodesis.
Korean J Spine. 2008;5(1):7-12.
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Radiologic Comparison of Cervical Athroplasty with Cervical Arthrodesis.
Korean J Spine. 2008;5(1):7-12.
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OBJECTIVE
The incidence of symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year, following anterior cervical discectomy and fusion. Recently, cervical arthroplasty is a preferred procedure to arthrodesis.
METHODS
We performed 16 arthropalsties form January 2005 to December 2006 in the Samsung medical center, using the BRYAN artificial disc and 16 anterior cervical interbody fusions. Radiographic evaluation included flexion and extension roentgenogram images of cervical spine. In the former group, the pre- and postoperative segmental sagittal range of motion(ROM) in the arthroplasty level and the adjacent level were measured. In the later group, the pre- and postoperative segmental sagittal ROM in the adjacent level to the fusion level was measured and the Cobb angles at C2-7(or 6) to ascertain overall cervical alignment was measured in both groups.
RESULTS
There was minimal change in sagittal ROM of whole cervical spine in all patients in the two groups. Sagittal ROM of arthroplaty level were increased 7.581+/-4.222 to 11.512+/-5.398(p<0.05) ROM of adjacent level to arthroplasty level were no significant change pre- and postoperatively. But ROM of adjacent level to arthrodesis level were increased 7.160+/-3.609 to 11.260+/-4.832(p<0.05).
CONCLUSIONS
Artificial disc could maintain ROM of pathologic level and adjacent level to fusion level should replace ROM of pathologic level but adjacent level to arthroplasty level should not replace additional ROM postoperatively. Long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.
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