{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T03:59:08Z","timestamp":1790308748736,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32\u2010AR078751"],"award-info":[{"award-number":["T32\u2010AR078751"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JOR Spine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical arthrodesis is a common surgical technique utilized to treat many cervical spinal pathologies. The risk of re\u2010operation due to symptomatic adjacent segment disease (ASD) remains steady, and the cause of ASD, whether rigid fixation or disease progression, remains unknown. The purpose of this study was to develop a cervical fusion model and analyze motion of the subaxial cervical spine adjacent segments following single level, two\u2010level, and three\u2010level spine fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A in\u00a0vitro cervical arthrodesis biomechanics model was developed utilizing nine fresh\u2010frozen cervical spine specimens. Each spine underwent non\u2010destructive testing in flexion, extension, axial rotation, and lateral bending using a six degree\u2010of\u2010freedom robotic manipulator. Following intact specimen testing, testing was repeated after C5\u2010C6, C4\u2010C6, C5\u2010C7, C4\u2010C7 fusions. Changes in range of motion among tests were calculated at each segment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cervical arthrodesis model showed reduced motion significantly at all fused levels. Following single level fusion at C5\u2010C6, no statistically significant increases in adjacent segment motion occurred in any testing condition (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Fusion between C4\u2010C6 resulted in increased motion during flexion at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Two\u2010level fusion between C5\u2010C7 resulted in increased flexion at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and C4\u2010C5 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Lastly, three\u2010level fusion from C4\u2010C7 produced significant changes in extension at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), C3\u2010C4 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), and C4\u2010C5 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), in flexion at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and C4\u2010C5 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), right axial rotation at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and left axial rotation at C2\u2010C3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), C3\u2010C4 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.02), and C4\u2010C5 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We successfully developed a rigid cervical arthrodesis model and tested specimens in single, two\u2010level, and three\u2010level cervical fusion. No increases were found in adjacent segments following single level fusion and non\u2010contiguous motion was increased following C4\u20106 fusion. Three\u2010level fusion showed the greatest change in adjacent segment motion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jsp2.70208","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:33:09Z","timestamp":1786541589000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Single Level and Multilevel Cervical Fusion on Adjacent Segment Motion: A Biomechanical Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9136-8078","authenticated-orcid":false,"given":"Kyle W.","family":"Morse","sequence":"first","affiliation":[{"name":"Department of Spine Surgery Hospital for Special Surgery  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4888-0249","authenticated-orcid":false,"given":"Kathleen N.","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Biomechanics Hospital for Special Surgery  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick F.","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery Hospital for Special Surgery  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7139-1908","authenticated-orcid":false,"given":"Timothy M.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Biomechanics Hospital for Special Surgery  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren R.","family":"Lebl","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery Hospital for Special Surgery  New York New York 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