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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Adjacent level disease-background and update based on disc replacement data.

I David Kaye, I David Kaye1, Alan S Hilibrand2

  • 1Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA. iandavid.kaye@gmail.com.

Current Reviews in Musculoskeletal Medicine
|March 25, 2017
PubMed
Summary
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Adjacent segment disease after cervical spine surgery is debated. While cervical disc arthroplasty (CDA) shows promise, its effectiveness in preventing adjacent segment disease needs further investigation.

Area of Science:

  • Spine surgery
  • Biomechanics
  • Degenerative cascade

Background:

  • The exact cause of adjacent segment disease after cervical spine surgery is debated.
  • Theories include natural degenerative progression and altered biomechanics from fusion.
  • Motion-preserving techniques like cervical disc arthroplasty (CDA) aim to reduce adjacent segment pathology.

Purpose of the Study:

  • To review cervical adjacent segment disease, incorporating recent 7-year investigational device exemption (IDE) data.
  • To analyze the impact of cervical disc arthroplasty (CDA) on adjacent segment pathology rates.

Main Methods:

  • Review of recently published 7-year investigational device exemption (IDE) study data.
  • Analysis of comparative studies on anterior cervical discectomy and fusion (ACDF) versus CDA.
Keywords:
Adjacent segment diseaseAnterior cervical discectomy and fusionCervical disc arthroplastyCervical spineIDE studies

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Main Results:

  • Seven-year data for CDA shows continued success in improving neck pain and reducing re-operation rates.
  • The impact of CDA on reducing adjacent segment pathology rates remains uncertain.
  • While some studies show more radiographic adjacent segment disease after ACDF than CDA, clinical symptoms are not consistently associated.

Conclusions:

  • Cervical disc arthroplasty (CDA) offers benefits over cervical disc fusion for certain patient parameters.
  • It remains unknown if CDA effectively reduces radiographic and clinical adjacent segment pathology.
  • Further studies specifically designed to address this question are needed.