Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation
Objective Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surg...
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Korean Spinal Neurosurgery Society
2024-12-01
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| Series: | Neurospine |
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| Online Access: | http://e-neurospine.org/upload/pdf/ns-2448626-313.pdf |
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| author | Chang Hwa Ham Joo Han Kim Youn-Kwan Park Woo-Keun Kwon Hong Joo Moon |
| author_facet | Chang Hwa Ham Joo Han Kim Youn-Kwan Park Woo-Keun Kwon Hong Joo Moon |
| author_sort | Chang Hwa Ham |
| collection | DOAJ |
| description | Objective Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surgeries. This study aims to present the radiological characteristics of multilevel ACDF constructs, which can be considered during intraoperative management to prevent pseudarthrosis. Methods This retrospective cohort study included patients who underwent multilevel (3 or 4 levels) ACDF with anterior plating between June 2010 and August 2022. Patients were regularly followed at 4 months, 12 months, and then annually postoperation. Fusion rates and characteristic radiological patterns, such as the formation of bony buttresses underneath the anterior plate, were graded and evaluated. Results A total of 163 patients were included in the study. Overall fusion rates were 26.38%, 64.34%, and 81.58% at 4-month, 1-year, and the final follow-up, respectively. Nonunions at 4-month follow-up with tightly engaged anterior plate with bony buttress formation were more likely to fuse in the later period (Buttress grade 0 vs. 1; p=0.01, odds ratio [OR], 5.70, Buttress grade 1 vs. >2; p<0.01, OR, 12.00). Conclusion This study emphasizes the significance of pseudarthrosis following multilevel ACDF. Pseudarthrosis predominantly occurs in the caudal-most segment of the construct, particularly when it terminates at C7. Constructs that are not tightly engaged and lack bony buttress formation in the caudal part of multilevel ACDF are more likely to develop pseudarthrosis. |
| format | Article |
| id | doaj-art-566b97c4cdae44e1aaefa3ffa600a0da |
| institution | DOAJ |
| issn | 2586-6583 2586-6591 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj-art-566b97c4cdae44e1aaefa3ffa600a0da2025-08-20T03:04:38ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912024-12-012141241125010.14245/ns.2448626.3131633Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress FormationChang Hwa Ham0Joo Han Kim1Youn-Kwan Park2Woo-Keun Kwon3Hong Joo Moon4 Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Neurosurgery, Gacheon University Gil Hospital, Incheon, Korea Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Neurosurgery, University of Virginia, Charlottesville, VA, USAObjective Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surgeries. This study aims to present the radiological characteristics of multilevel ACDF constructs, which can be considered during intraoperative management to prevent pseudarthrosis. Methods This retrospective cohort study included patients who underwent multilevel (3 or 4 levels) ACDF with anterior plating between June 2010 and August 2022. Patients were regularly followed at 4 months, 12 months, and then annually postoperation. Fusion rates and characteristic radiological patterns, such as the formation of bony buttresses underneath the anterior plate, were graded and evaluated. Results A total of 163 patients were included in the study. Overall fusion rates were 26.38%, 64.34%, and 81.58% at 4-month, 1-year, and the final follow-up, respectively. Nonunions at 4-month follow-up with tightly engaged anterior plate with bony buttress formation were more likely to fuse in the later period (Buttress grade 0 vs. 1; p=0.01, odds ratio [OR], 5.70, Buttress grade 1 vs. >2; p<0.01, OR, 12.00). Conclusion This study emphasizes the significance of pseudarthrosis following multilevel ACDF. Pseudarthrosis predominantly occurs in the caudal-most segment of the construct, particularly when it terminates at C7. Constructs that are not tightly engaged and lack bony buttress formation in the caudal part of multilevel ACDF are more likely to develop pseudarthrosis.http://e-neurospine.org/upload/pdf/ns-2448626-313.pdfmultilevel anterior cervical discectomy and fusionfusion ratepseudarthrosisbony buttress |
| spellingShingle | Chang Hwa Ham Joo Han Kim Youn-Kwan Park Woo-Keun Kwon Hong Joo Moon Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation Neurospine multilevel anterior cervical discectomy and fusion fusion rate pseudarthrosis bony buttress |
| title | Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation |
| title_full | Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation |
| title_fullStr | Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation |
| title_full_unstemmed | Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation |
| title_short | Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation |
| title_sort | radiographic characteristics of caudal segment in multilevel anterior cervical discectomy and fusion the bony buttress formation |
| topic | multilevel anterior cervical discectomy and fusion fusion rate pseudarthrosis bony buttress |
| url | http://e-neurospine.org/upload/pdf/ns-2448626-313.pdf |
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