{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:44:16Z","timestamp":1792071856970,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R01AR069543"],"award-info":[{"award-number":["R01AR069543"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JOR Spine"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Biomechanical cadaver studies consistently find that cervical arthrodesis leads to increased motion adjacent to the arthrodesis. However, in\u00a0vivo evidence indicates adjacent segment end range motion does not reliably increase at 1\u2009year after one\u2010level or two\u2010level cervical arthrodesis. Because changes beyond 1\u2009year remain unknown, this study assessed the effects of one\u2010 and two\u2010level cervical arthrodesis on adjacent segment motion 3\u2009years after arthrodesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010two patients were tested preoperatively (PRE), 1\u2009year postoperatively (1YR\u2010POST), and 3\u2009years postoperatively (3YR\u2010POST) along with 22 asymptomatic controls, who were tested once. A validated CT model\u2010based tracking technique was used to measure three\u2010dimensional (3D) vertebral motion from biplane radiographs acquired during dynamic flexion\u2010extension and axial rotation of the cervical spine. Adjacent segment intervertebral end range of motion (ROM) and midrange ROM (i.e.\n                      <jats:italic>,<\/jats:italic>\n                      head within 20\u00b0 of neutral) were compared between one\u2010level and two\u2010level arthrodesis patients and controls after accounting for head ROM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>End range adjacent segment motion tended to increase over time after arthrodesis; however, significant increases were found only after two\u2010level arthrodesis. In contrast, midrange adjacent segment motion increased significantly after one\u2010 and two\u2010level arthrodesis and was greater than in corresponding motion segments in controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Midrange adjacent segment motion may be better than end range motion for detecting early mechanical changes after cervical arthrodesis that could contribute to adjacent segment degeneration. In\u00a0vivo changes in adjacent segment motion are inconsistent across patients up to 3\u2009years after anterior cervical arthrodesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jsp2.70224","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:45:55Z","timestamp":1792068355000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Midrange and End Range Adjacent Segment Motion 3\u2009Years After One\u2010 Or Two\u2010Level Cervical Arthrodesis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7552-1765","authenticated-orcid":false,"given":"Clarissa M.","family":"LeVasseur","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Bethel Musculoskeletal Research Center University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel W.","family":"Pitcairn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Dan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2118-0392","authenticated-orcid":false,"given":"Yan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-0561","authenticated-orcid":false,"given":"Joon Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Bethel Musculoskeletal Research Center University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0535-0953","authenticated-orcid":false,"given":"William J.","family":"Anderst","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2025.123961","article-title":"Trends in Cervical Spine Surgery in the United States: A National Database Analysis","volume":"198","author":"Ibrahim M. T.","year":"2025","journal-title":"World Neurosurgery"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1097\/BRS.0b013e31826d60fb","article-title":"Predicting the Risk of Adjacent Segment Pathology in the Cervical Spine: A Systematic Review","volume":"37","author":"Lawrence B. D.","year":"2012","journal-title":"Spine"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"E571","DOI":"10.1097\/BRS.0000000000000846","article-title":"Adjacent Segment Pathology Requiring Reoperation After Anterior Cervical Arthrodesis: The Influence of Smoking, Sex, and Number of Operated Levels","volume":"40","author":"Lee J. C.","year":"2015","journal-title":"Spine"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1097\/00007632-199808010-00006","article-title":"A Kinematic Study of the Cervical Spine Before and After Segmental Arthrodesis","volume":"23","author":"Fuller D. A.","year":"1998","journal-title":"Spine"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1007\/s00586-011-1864-9","article-title":"Adjacent Segment Degenerative Disease: Is It due to Disease Progression or a Fusion\u2010Associated Phenomenon? Comparison Between Segments Adjacent to the Fused and Non\u2010Fused Segments","volume":"20","author":"Song K. J.","year":"2011","journal-title":"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"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1097\/00007632-199311000-00004","article-title":"Late Radiographic Findings After Anterior Cervical Fusion for Spondylotic Myeloradiculopathy","volume":"18","author":"Baba H.","year":"1993","journal-title":"Spine"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1097\/00007632-199904010-00011","article-title":"Strain on Intervertebral Discs After Anterior Cervical Decompression and Fusion","volume":"24","author":"Matsunaga S.","year":"1999","journal-title":"Spine"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1097\/01.brs.0000239125.54761.23","article-title":"Motion Compensation Associated With Single\u2010Level Cervical Fusion: Where Does the Lost Motion Go?","volume":"31","author":"Schwab J. S.","year":"2006","journal-title":"Spine"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.spinee.2010.01.006","article-title":"Biomechanical Comparison of Single\u2010 and Two\u2010Level Cervical Arthroplasty Versus Arthrodesis: Effect on Adjacent\u2010Level Spinal Kinematics","volume":"10","author":"Cunningham B. W.","year":"2010","journal-title":"Spine Journal: Official Journal of the North American Spine Society"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1097\/00007632-200211150-00003","article-title":"Biomechanical Study on the Effect of Cervical Spine Fusion on Adjacent\u2010Level Intradiscal Pressure and Segmental Motion","volume":"27","author":"Eck J. C.","year":"2002","journal-title":"Spine"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.3171\/2011.10.SPINE11116","article-title":"Adjacent\u2010Level Biomechanics After Single Versus Multilevel Cervical Spine Fusion","volume":"16","author":"Prasarn M. L.","year":"2012","journal-title":"Journal of Neurosurgery. Spine"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/00024720-200608000-00006","article-title":"A Quantitative Analysis of Strain at Adjacent Segments After Segmental Immobilization of the Cervical Spine","volume":"19","author":"Ragab A. A.","year":"2006","journal-title":"Journal of Spinal Disorders & Techniques"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1007\/s00586-015-4040-9","article-title":"Limitations of Current in Vitro Test Protocols for Investigation of Instrumented Adjacent Segment Biomechanics: Critical Analysis of the Literature","volume":"24","author":"Volkheimer D.","year":"2015","journal-title":"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"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/jor.24702","article-title":"Assessing the Biofidelity of in Vitro Biomechanical Testing of the Human Cervical Spine","volume":"39","author":"Wawrose R. A.","year":"2020","journal-title":"Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1007\/s00586-015-3992-0","article-title":"Do in Vivo Kinematic Studies Provide Insight Into Adjacent Segment Degeneration? A Qualitative Systematic Literature Review","volume":"24","author":"Malakoutian M.","year":"2015","journal-title":"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"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"E221","DOI":"10.1097\/00007632-200406010-00022","article-title":"Changes in Segmental Intervertebral Motion Adjacent to Cervical Arthrodesis: A Prospective Study","volume":"29","author":"Reitman C. A.","year":"2004","journal-title":"Spine"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/j.jbiomech.2015.02.049","article-title":"Three\u2010Dimensional Intervertebral Kinematics in the Healthy Young Adult Cervical Spine During Dynamic Functional Loading","volume":"48","author":"Anderst W. J.","year":"2015","journal-title":"Journal of Biomechanics"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1007\/s10439-022-03088-8","article-title":"Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review","volume":"50","author":"Lindenmann S.","year":"2022","journal-title":"Annals of Biomedical Engineering"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"E533","DOI":"10.1097\/BRS.0b013e318289378d","article-title":"Cervical Motion Segment Percent Contributions to Flexion\u2010Extension During Continuous Functional Movement in Control Subjects and Arthrodesis Patients","volume":"38","author":"Anderst W. J.","year":"2013","journal-title":"Spine"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"E594","DOI":"10.1097\/BRS.0b013e31828ca5c7","article-title":"Motion Path of the Instant Center of Rotation in the Cervical Spine During in Vivo Dynamic Flexion\u2010Extension: Implications for Artificial Disc Design and Evaluation of Motion Quality After Arthrodesis","volume":"38","author":"Anderst W.","year":"2013","journal-title":"Spine"},{"key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s10439-022-02964-7","article-title":"In Vivo Changes in Dynamic Adjacent Segment Motion 1 Year After One and Two\u2010Level Cervical Arthrodesis","volume":"50","author":"LeVasseur C. M.","year":"2022","journal-title":"Annals of Biomedical Engineering"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/BSD.0b013e3181981632","article-title":"Normal Functional Range of Motion of the Cervical Spine During 15 Activities of Daily Living","volume":"23","author":"Bible J. E.","year":"2010","journal-title":"Journal of Spinal Disorders & Techniques"},{"key":"e_1_2_10_24_1","volume-title":"Bi\u2010Plane X\u2010ray Imaging System","author":"Tashman S.","year":"2010"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0097-8493(99)00076-X","article-title":"Regularised Marching Tetrahedra: Improved Iso\u2010Surface Extraction","volume":"23","author":"Treece G. M.","year":"1999","journal-title":"Computers and Graphics"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1002\/jor.22437","article-title":"Cervical Disc Deformation During Flexion\u2010Extension in Asymptomatic Controls and Single\u2010Level Arthrodesis Patients","volume":"31","author":"Anderst W.","year":"2013","journal-title":"Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society"},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1115\/1.2206199","article-title":"Validation of a New Model\u2010Based Tracking Technique for Measuring Three\u2010Dimensional, in Vivo Glenohumeral Joint Kinematics","volume":"128","author":"Bey M. J.","year":"2006","journal-title":"Journal of Biomechanical Engineering"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"E393","DOI":"10.1097\/BRS.0b013e31820b7e2f","article-title":"Validation of a Noninvasive Technique to Precisely Measure in Vivo Three\u2010Dimensional Cervical Spine Movement","volume":"36","author":"Anderst W. J.","year":"2011","journal-title":"Spine"},{"key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S0021-9290(01)00222-6","article-title":"ISB Recommendation on Definitions of Joint Coordinate System of Various Joints for the Reporting of Human Joint Motion\u2014Part I: Ankle, Hip, and Spine. International Society of Biomechanics","volume":"35","author":"Wu G.","year":"2002","journal-title":"Journal of Biomechanics"},{"key":"e_1_2_10_30_1","doi-asserted-by":"crossref","DOI":"10.1002\/9780470549148","volume-title":"Biomechanics and Motor Control of Human Movement","author":"Winter D. A.","year":"2009"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jbiomech.2012.11.055","article-title":"Sensitivity, Reliability and Accuracy of the Instant Center of Rotation Calculation in the Cervical Spine During in Vivo Dynamic Flexion\u2010Extension","volume":"46","author":"Baillargeon E.","year":"2013","journal-title":"Journal of Biomechanics"},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/BRS.0b013e31817e7019","article-title":"Annual Frequency and Magnitude of Neck Motion in Healthy Individuals","volume":"33","author":"Sterling A. C.","year":"2008","journal-title":"Spine"},{"key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/BRS.0b013e31816044e8","article-title":"Quantifying the Effects of Age, Gender, Degeneration, and Adjacent Level Degeneration on Cervical Spine Range of Motion Using Multivariate Analyses","volume":"33","author":"Simpson A. K.","year":"2008","journal-title":"Spine"},{"key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1007\/s00586-012-2167-5","article-title":"Age\u2010Related Changes in Osseous Anatomy, Alignment, and Range of Motion of the Cervical Spine. Part I: Radiographic Data From Over 1,200 Asymptomatic Subjects","volume":"21","author":"Yukawa Y.","year":"2012","journal-title":"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"},{"key":"e_1_2_10_35_1","doi-asserted-by":"crossref","first-page":"E1593","DOI":"10.1097\/BRS.0b013e31821cfd47","article-title":"Segmental Contribution Toward Total Cervical Range of Motion: A Comparison of Cervical Disc Arthroplasty and Fusion","volume":"36","author":"Auerbach J. D.","year":"2011","journal-title":"Spine"},{"key":"e_1_2_10_36_1","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/BRS.0b013e3181df10fc","article-title":"Index and Adjacent Level Kinematics After Cervical Disc Replacement and Anterior Fusion: In\u00a0Vivo Quantitative Radiographic Analysis","volume":"36","author":"Park D. K.","year":"2011","journal-title":"Spine"},{"key":"e_1_2_10_37_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/BSD.0b013e3181991413","article-title":"Quality of Spinal Motion With Cervical Disk Arthroplasty: Computer\u2010Aided Radiographic Analysis","volume":"23","author":"Powell J. W.","year":"2010","journal-title":"Journal of Spinal Disorders & Techniques"},{"key":"e_1_2_10_38_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/BSD.0b013e3180500778","article-title":"Cervical Kinematics After Fusion and Bryan Disc Arthroplasty","volume":"21","author":"Sasso R. C.","year":"2008","journal-title":"Journal of Spinal Disorders & Techniques"}],"container-title":["JOR SPINE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jsp2.70224","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jsp2.70224","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jsp2.70224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:46:03Z","timestamp":1792068363000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jsp2.70224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/jsp2.70224"],"URL":"https:\/\/doi.org\/10.1002\/jsp2.70224","archive":["Portico"],"relation":{},"ISSN":["2572-1143","2572-1143"],"issn-type":[{"value":"2572-1143","type":"print"},{"value":"2572-1143","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-06-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70224"}}