S-Space College of Medicine/School of Medicine (의과대학/대학원) Orthopedic Surgery (정형외과학전공) Journal Papers (저널논문_정형외과학전공)
Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?
- Lee, Chang-Hyun; Kim, Ki-Jeong; Hyun, Seung-Jae; Yeom, Jin S.; Jahng, Tae-Ahn; Kim, Hyun-Jib
- Issue Date
- Acta Neurochir, vol.157, pp. 1063-1068
- Background Subsidence is a frequent phenomenon in the interbody fusion process in patients with anterior cervical discectomy and fusion (ACDF). There is little evidence of
whether subsidence in the cervical spine has any impact on clinical outcomes.
Objectives The purpose of this study is to investigate the correlation of subsidence and clinical outcomes after ACDF and to consider reasons subsidence might not cause unfavorable
clinical outcomes. Methods A total of 158 consecutive patients who underwent single-level ACDF were included. The patients were divided
into a subsidence group (S-group) and a no subsidence group (N-group), with subsidence defined as a decrease by ≥3 mm in
total intervertebral height (TIH). We analyzed outcomes resulting from subsidence, particularly focusing on clinical
outcomes and subsequent global and segmental kyphosis using a repeated measure analysis of variance (RM-ANOVA).
Results Subsidence occurred in 74 patients (46.8 %) as
of a 12-month follow-up. The S-group included 58.6 %
with a stand-alone cage for interbody fusion (p=0.002).
Clinical outcomes improved significantly over time
(neck pain, RM-ANOVA: F(1.3, 205)=125.1, p<0.001;
arm pain, RM-ANOVA: F(1.3, 203)=290.8, p<0.001).
There was no significant difference in interaction with
subsidence and clinical outcomes between the S- and Ngroup
(neck pain, RM-ANOVA: F(2,153)=1.04,
p=0.356, partial η2
= 0.229; arm pain, RM-ANOVA:
F(2,153)=0.56, p=0.571, partial η2
angle increased in both groups over time and showed
a statistically significant difference between the S- and
N-groups (RM-ANOVA: F(3,143)=6.148, p=0.001, partial
=0.959). Although, global cervical angle decreased generally
and displayed no statically significant difference between
the S- and N-group (RM-ANOVA: F(3,119) = 2.361,
p=0.075, partial η2
Conclusions Radiographic subsidence after ACDF occurred
in 46.8 % patients as of 12 months after the single-level
ACDF. The lack of correlation between bad clinical outcome
and radiographic subsidence may be due to segmental kyphosis,
preserved posterior height, and maintaining the global
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