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Cervical spinal fusion is the standard of care for treating intractable spinal diseases. However, frequent adjacent segment disease (ASD) has recently drawn a great deal of attention among clinicians and researchers. At present, the etiology of ASD remains controversial. The investigation of cervical spine biomechanics after fusion may contribute to understanding the causes of ASD. In the present study, a cervical spinal musculoskeletal fusion model, with multi-body dynamics method, was established. Dynamic head flexion–extension movements were simulated for both a fusion subject and a normal subject. The cervical spinal loading pattern, load sharing ratios, and translations of instant centers of the rotation at adjacent segments were then predicted. The average intervertebral compressive forces, shear forces, and facet joint forces against the intervertebral angle were also obtained. By comparison, some obvious differences in cervical spinal loading patterns were found between the fusion subject and the normal subject. Fusion surgery would alter the postoperative biomechanical surrounding of the cervical spine, especially the adjacent segments. These changes might affect the intervertebral disc-bearing capacity, and even weaken the physiological structure. From a purely biomechanical perspective, the cervical spinal fusion model can contribute to comprehending the etiology of ASD after spinal fusion. [ABSTRACT FROM AUTHOR]

Abstract Background Currently, self-locking stand-alone cages (SSC) are commonly applied in anterior cervical discectomy and fusion (ACDF), as are cage-plate constructs (CPC). However, it remains controversial concerning the long-term effectiveness of both apparatuses. Our purpose is to compare long-term effectiveness of SSC with CPC in monosegmental ACDF. Methods Four electronic databases were queried to identify studies comparing SSC versus CPC in monosegmental ACDF. The meta-analysis was carried out with the use of the Stata MP 17.0 software package. Results Ten trials with 979 patients were included. Compared to CPC, SSC significantly reduced operative time, intraoperative blood loss, duration of hospitalisation, cervical Cobb angle at final follow-up, 1-month postoperative dysphagia rate, and incidence of adjacent segment degeneration (ASD) at final follow-up. No significant difference was found regarding 1-month postoperative cervical Cobb angle, JOA scores, NDI scores, fusion rate and cage subsidence rate at final follow-up. Conclusion Both devices achieved similar long-term effectiveness in monosegmental ACDF regarding JOA scores, NDI scores, fusion rate and cage subsidence rate. SSC had significant advantages over CPC in reducing surgical duration, intraoperative bleeding, duration of hospitalisation, as well as rates of dysphagia and ASD after surgery. Therefore, SSC is a better option than CPC in monosegmental ACDF. However, SSC is inferior to CPC in maintaining cervical curvature at long-term follow-up. Whether radiological changes affect clinical symptoms needs confirmation in trials with longer follow-up.

Background: Currently, self-locking stand-alone cages (SSC) are commonly applied in anterior cervical discectomy and fusion (ACDF), as are cage-plate constructs (CPC). However, it remains controversial concerning the long-term effectiveness of both apparatuses. Our purpose is to compare long-term effectiveness of SSC with CPC in monosegmental ACDF. Methods: Four electronic databases were queried to identify studies comparing SSC versus CPC in monosegmental ACDF. The meta-analysis was carried out with the use of the Stata MP 17.0 software package. Results: Ten trials with 979 patients were included. Compared to CPC, SSC significantly reduced operative time, intraoperative blood loss, duration of hospitalisation, cervical Cobb angle at final follow-up, 1-month postoperative dysphagia rate, and incidence of adjacent segment degeneration (ASD) at final follow-up. No significant difference was found regarding 1-month postoperative cervical Cobb angle, JOA scores, NDI scores, fusion rate and cage subsidence rate at final follow-up. Conclusion: Both devices achieved similar long-term effectiveness in monosegmental ACDF regarding JOA scores, NDI scores, fusion rate and cage subsidence rate. SSC had significant advantages over CPC in reducing surgical duration, intraoperative bleeding, duration of hospitalisation, as well as rates of dysphagia and ASD after surgery. Therefore, SSC is a better option than CPC in monosegmental ACDF. However, SSC is inferior to CPC in maintaining cervical curvature at long-term follow-up. Whether radiological changes affect clinical symptoms needs confirmation in trials with longer follow-up. [ABSTRACT FROM AUTHOR]

Cervical spinal fusion is the standard of care for treating intractable spinal diseases. However, frequent adjacent segment disease (ASD) has recently drawn a great deal of attention among clinicians and researchers. At present, the etiology of ASD remains controversial. The investigation of cervical spine biomechanics after fusion may contribute to understanding the causes of ASD. In the present study, a cervical spinal musculoskeletal fusion model, with multi-body dynamics method, was established. Dynamic head flexion–extension movements were simulated for both a fusion subject and a normal subject. The cervical spinal loading pattern, load sharing ratios, and translations of instant centers of the rotation at adjacent segments were then predicted. The average intervertebral compressive forces, shear forces, and facet joint forces against the intervertebral angle were also obtained. By comparison, some obvious differences in cervical spinal loading patterns were found between the fusion subject and the normal subject. Fusion surgery would alter the postoperative biomechanical surrounding of the cervical spine, especially the adjacent segments. These changes might affect the intervertebral disc-bearing capacity, and even weaken the physiological structure. From a purely biomechanical perspective, the cervical spinal fusion model can contribute to comprehending the etiology of ASD after spinal fusion.

To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed‐effect model or random‐effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta‐analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD = 1.61 days, 95% CI: 0.51, 2.71; P = 0.004), longer surgical time (WMD = 4.55, 95% CI: 1.04, 8.07; P = 0.011), higher mortality rate (RR = 3.01, 95% CI: 2.75, 3.29; P

Background: Certain demographics and/or risk factors contribute to complications following cervical spinal surgery including pseudarthrosis, prolonged pain, and reduced quality of life (QoL). Pulsed electromagnetic field (PEMF) stimulation is a non-invasive therapy that may enhance fusion success in at-risk patients., Objective: To evaluate the safety and efficacy of post-operative adjunctive PEMF therapy following cervical spinal surgery in subjects at risk for pseudarthrosis., Methods: This prospective, multicenter study investigated PEMF as an adjunctive therapy to cervical spinal fusion procedures in subjects at risk for pseudarthrosis based on having at least one of the following: prior failed fusion, multi-level fusion, nicotine use, osteoporosis, or diabetes. Radiographic fusion status and patient-reported outcomes (SF-36, EQ5D, NDI, and VAS-arm pain and VAS-neck pain) were assessed., Results: A total of 160 subjects were assessed for fusion 12-months postoperative, and 144 subjects were successfully fused (90.0%). Fusion success for subjects with 1, 2+, or 3+ risk factors was 91.7%, 89.0%%, and 90.9%, respectively. Significant improvements in NDI, VAS-arm and VAS-neck were observed compared to baseline scores (p < 0.001) along with improvements in SF-36 and EQ5D (p < 0.001)., Conclusions: Adjunctive treatment with PEMF provides a high rate of successful fusion and significant improvements in pain, function, and quality of life despite having risk factors for pseudarthrosis., Competing Interests: All authors have received financial support from Orthofix US LLC for their involvement in the study. Orthofix US LLC was involved in the design of the study, analyses, and interpretation of data and in writing of the manuscript. In addition, Ilyas Aleem reports receiving consulting fees from Globus. Peter Campbell reports receiving payment/honoraria from Stryker (speakers’ bureau) and serves as a consultant for Nexus Spine. Dom Coric reports royalties/licenses and consulting fees from Medtronic, Globus/Nuvasive, and SpineWave and stock/ stock options from SpineWave and Premia. Kristen Radcliff reports consulting fees from Orthofix, 4 web, and Stryker and stock/stock options from 4web and Orthoson. Amir Vokshoor reports research contracts from Spine Art, Orthofix, and Synergy and royalties/licenses from Globus Medical. Joshua Wind reports payment/honoraria from Orthofix (speaker’s fee). Hamid Hassanzadeh reports consulting fees from Nuvasive, Medtronic, DePuy, and Orthofix; payment/honoraria from Pfizer and Nuvasive; support for attending meetings from Nuvasive; and a leadership role at the Scoliosis Research Society.

To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed‐effect model or random‐effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta‐analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD = 1.61 days, 95% CI: 0.51, 2.71; P = 0.004), longer surgical time (WMD = 4.55, 95% CI: 1.04, 8.07; P = 0.011), higher mortality rate (RR = 3.01, 95% CI: 2.75, 3.29; P < 0.001), and higher postoperative rates of cardiac complication (RR = 1.30, 95% CI: 1.11, 1.52; P = 0.001), deep venous thromboembolism (RR = 2.29, 95% CI: 1.36, 3.86; P = 0.002), and wound complication (RR = 1.69, 95% CI: 1.26, 2.28; P < 0.001). However, there was no significant differences between high and normal BMI groups in terms of Neck Disability Index (WMD = 1.49, 95% CI: −2.34, 5.32; P = 0.447), SF‐36 Mental Component Score (MCS) (WMD = −0.87, 95% CI: −2.09, 0.35; P = 0.164), overall complications (RR = 1.18, 95% CI: 0.80, 1.76; P = 0.399), central nervous system (CNS) complications (RR = 0.68, 95% CI: 0.17, 2.76; P = 0.586), pulmonary complications (RR = 1.46, 95% CI: 0.87, 2.46; P = 0.150), and septic complications (RR = 0.87, 95% CI: 0.32, 2.38; P = 0.785).High BMI seemed to be associated with longer hospital stay, surgical time, and higher postoperative complication rates compared to normal BMI. Therefore, high BMI patients should be counseled carefully regarding the risk of postoperative complications and surgical outcomes after cervical fusion procedures. [ABSTRACT FROM AUTHOR]

Background: Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions., Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes., Results: 432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05)., Conclusion: Isolated baseline cannabis dependence/abuse was associated with increased risk of 90-day readmission following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may elucidate significant contributory factors. Level of Evidence: III ., Competing Interests: Disclosures: No conflicts of interest impacted this study in any aspect or manner. The following authors have no conflicts of interest to report: NVS, CRM, JDL, BK, GAB, CBP, BGD. PGP has received grant funding from CSRS, speaker and consultant honoraria from Globus Medical, Medicrea, SpineWave, and Zimmer, and other financial support from Allosource. RL has stock in Nemaris. HJK has received grant funding from ISSGF, speaker and consultant honoraria from Alphatec, royalties from K2M and Zimmer, and serves on boards or committees for AAOS, AO SPINE, CSRS, HSS, Asian Spine, and SRS. FJS has received grant funding from DePuy, NuVasive, Allosource, K2M, Medtronic, and Si Bone, speaker and consultant honoraria from Globus Medical, Mainstay Medical, Medtronic, and ZimmerBiomet, royalties from Medicrea, Medtronic, and Zimmer and serves on boards or committees for SRS, Spine Deformity, and ISSG. VL has received grant funding from DePuy, NuVasive, Allosource, K2M, Medtronic, and Si-Bone, speaker and consultant honoraria from Globus Medical, DePuy, and Stryker, stock in VFT Solutions, and serves on boards or committees for ISSG and SRS., (Copyright © The Iowa Orthopaedic Journal 2023.)

Purpose: Development of adjacent segment degeneration following anterior cervical decompression and fusion (ACDF) is still controversial, as adjacent-level kinematics is poorly understood. This study reports preliminary data from a high-accuracy 3D analysis technique developed for in vivo cervical kinematics. Methods: From nine cervical spondylosis patients, four underwent single-level ACDF, and five underwent two-level ACDF using cylindrical titanium cage implant(s). Pre- and post-surgical CT scans were taken in flexion, neutral and extended positions, allowing us to compute segmental ranges of motion for rotation and translation, and 3D disc-height distributions. Differences in segmental motions and disc-height between fused and adjacent levels were analyzed with a Wilcoxon signed-rank test. Results are presented as mean ± SEM. Results: The flexion/extension angular-ROM at the fusion level decreased after surgery (7.46 ± 1.17° vs. 3.14 ± 0.56°, p < 0.003). The flexion/extension angular-ROM at one caudal adjacent level to the fusion level (3.97 ± 1.29°) tended to be greater post-operatively (6.11 ± 1.44°, p = 0.074). Translation in the anterior-posterior direction during flexion/extension at the fusion level decreased after surgery (1.22 ± 0.20 mm vs. 0.32 ± 0.11 mm, p < 0.01). No differences were found in adjacent-level disc heights between both study time-points. Conclusions: This study showed increased segmental motion in flexion/extension angular-ROM at one level adjacent to ACDF. However, increases in the rotational angular-ROM were not statistically significant when cranial/caudal adjacent levels were analyzed separately. This preliminary study highlighted the capabilities of a 3D-kinematic analysis method to detect subtle changes in kinematics and disc height at the adjacent levels to ACDF. Thus, reliable evidence related to ACDF's influence on adjacent-level cervical kinematics can be collected. [ABSTRACT FROM AUTHOR]