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Adjacent level ossification development after anterior cervical fusion without plate fixation.
Jun-Young Yang1, Ho-Sup Song, Michael Lee
1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 640 Daesa-Dong, Jung-Gu, Daejeon, Korea. jyyang@cnu.ac.kr
Spine
|January 8, 2009
Summary
Adjacent level ossification development (ALOD) is infrequent after anterior cervical arthrodesis without plates. This study found ALOD in 5.5% of patients, highlighting techniques to minimize its occurrence.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Previous studies described the incidence and timing of adjacent level ossification development (ALOD) after anterior cervical arthrodesis with plating.
- The role of plate proximity in ALOD was previously suggested, but data on unplated procedures were lacking.
Purpose of the Study:
- To evaluate the incidence and characteristics of ALOD in patients who underwent anterior cervical arthrodesis without plate fixation.
- To determine if ALOD is a complication specifically related to anterior plating.
Main Methods:
- A retrospective review of 165 patients (330 adjacent levels) who underwent anterior cervical arthrodesis without plate fixation by a single surgeon.
- Radiographs were assessed for ALOD at 3, 6, 12, and 24 months post-surgery, and then annually, with severity graded.
- Average follow-up was 28.8 months, with patient ages ranging from 32 to 79 years.
Main Results:
- ALOD developed in 9 patients (5.5%) at 10 levels (3%) over a 2-9 year follow-up.
- Proximal ALOD occurred in 7 cases, distal in 1, and both in 1 patient.
- ALOD initially appeared between 6 and 12 months post-surgery, with final grades ranging from I to II.
Conclusions:
- Adjacent level ossification development (ALOD) appears infrequent when specific surgical techniques are followed.
- Techniques such as minimal stripping of the anterior longitudinal ligament and avoidance of Caspar pins and anterior plates may reduce ALOD.
- Further research is needed to pinpoint the dominant factors contributing to ALOD.
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