ArticleScientific reports2023
The impact of over-distraction on adjacent segment pathology and cage subsidence in anterior cervical discectomy and fusion.
Article in Scientific reports, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effects of excessive distraction during anterior cervical spine surgery: a systematic review and meta-analysis of clinical outcomes, radiological changes, and complications.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Pooled it
- Risk of subsidence following ACDF with the coalition™ (Globus Medical) cage: a multivariable analysis identifying preoperative radiculopathy as the primary risk factor.Acta neurochirurgica · 2026Article
- Preoperative imaging predictors of subsidence of 3D-printed artificial cervical vertebral bodies: a cohort study of 102 patients with nomogram development and validation.BMC musculoskeletal disorders · 2026Article
- Interbody cage subsidence after ACDF: a predictor of non-union and neck pain despite normal bone mineral density.Neurosurgical review · 2026Article
- Preoperative Alignment and Interbody Cage Design Influence Radiographic Outcomes Following Anterior Cervical Discectomy and Fusion.Journal of clinical medicine · 2026Article
- Assessing cervical intervertebral disc height on MRI and X-ray versus CT; a single center retrospective cohort study.Brain & spine · 2026Article
- Predictors of Implant Subsidence and Its Impact on Cervical Alignment Following Anterior Cervical Discectomy and Fusion: A Retrospective Study.Journal of clinical medicine · 2025Article
- The Influence of Zero-Profile Implant Selection on the Outcomes of Anterior Cervical Discectomy and Fusion.Orthopaedic surgery · 2025Article
- Impact of resident versus specialist performed cervical spine surgery.Brain & spine · 2025Article
- Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery.Brain & spine · 2025Article
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7 authors.
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Abstract
Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical studies have demonstrated increased adjacent segment intradiscal pressure after ACDF. The purpose of this study is to determine if over-distraction of the index disc has an effect on adjacent segment pathology. A consecutive series of 145 patients who received primary ACDF for cervical degenerative pathologies from January 2010 to December 2017 were retrospectively reviewed. The patients were divided into: (1) Over-distraction group (postoperative-preoperative index disc height ≥ 2 mm), and (2) No-distraction group (postoperative-preoperative index disc height < 2 mm). Outcome measures included radiographic parameters, Japanese Orthopaedic Association (JOA) score, and incidences of cage subsidence, radiological and clinical adjacent segment pathologies (RASP and CASP) were compared between the two groups preoperatively, postoperatively, and at the final follow-up. The two groups were comparable with respect to age, follow-up length, JOA score, incidence of CASP, and radiographic parameters. The Over-distraction group (83 patients; 115 levels) had smaller preoperative index disc height (4.5 vs. 5.2 mm, p < 0.001), but taller postoperative index disc height (7.7 vs. 6.6 mm, p < 0.001) than No-distraction group (62 patients; 90 levels) Furthermore, significantly higher incidences of cage subsidence (47% vs. 31%, p = 0.04) and RASP (any progression: 48% vs. 15%, p < 0.001; progress ≥ 2 grades: 25% vs. 7%, p = 0.001) were observed in the Over-distraction group. The multivariate analysis indicated that over-distraction and multilevel fusion were independent risk factors for RASP. There were no clinical outcome differences between the Over-distraction group and the No-distraction group in ACDF. Over-distraction of the index level of ≥ 2 mm should be avoided because it significantly increases the incidences of RASP and cage subsidence.
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