{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:49:20Z","timestamp":1785808160481,"version":"3.56.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and\/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1\u20133).<\/jats:p>\n Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion\/extension lateral radiographs measuring Cobb angle (overall C2\u20137 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck\/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow-up period.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Artificial cervical disc replacement in patients who have previously undergone cervical fusion surgery appears to be safe, with encouraging early clinical results based on this small case series, but more data from larger numbers of patients with long-term follow-up are needed. Arthroplasty may provide an additional tool for the management of post-fusion adjacent-level cervical disc disease in carefully selected patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.11.focus16412","type":"journal-article","created":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T03:37:11Z","timestamp":1485920231000},"page":"E5","source":"Crossref","is-referenced-by-count":16,"title":["Adjacent-level arthroplasty following cervical fusion"],"prefix":"10.3171","volume":"42","author":[{"given":"Deshpande V.","family":"Rajakumar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fortis Hospitals, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay","family":"Hari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fortis Hospitals, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fortis Hospitals, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhas","family":"Konar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fortis Hospitals, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankit","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fortis Hospitals, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16412","series-title":"Turk Neurosurg","first-page":"334","article-title":"Assessment of adjacent segment degeneration in and between patients treated with anterior or posterior cervical simple discectomy","volume":"20","author":"Acikbas","year":"2010"},{"key":"b2-focus16412","series-title":"J Neurosurg Spine","first-page":"308","article-title":"Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial","volume":"13","author":"Burkus","year":"2010"},{"key":"b3-focus16412","series-title":"J Neurosurg Spine","first-page":"516","article-title":"Clinical and radiographic analysis of an artificial cervical disc: 7-year follow-up from the Prestige prospective randomized controlled clinical trial: clinical article","volume":"21","author":"Burkus","year":"2014"},{"key":"b4-focus16412","series-title":"Neurosurgery","first-page":"139","article-title":"Adjacent segment disease after anterior cervical discectomy and fusion in a large series","volume":"74","author":"Bydon","year":"2014"},{"key":"b5-focus16412","series-title":"J Neurosurg","first-page":"602","article-title":"The anterior approach for removal of ruptured cervical disks","volume":"15","author":"Cloward","year":"1958"},{"key":"b6-focus16412","series-title":"J Neurosurg Spine","first-page":"31","article-title":"Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site","volume":"4","author":"Coric","year":"2006"},{"key":"b7-focus16412","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article","volume":"15","author":"Coric","year":"2011"},{"issue":"3","key":"b8-focus16412","series-title":"Neurosurg Focus","first-page":"E7","article-title":"In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant","volume":"17","author":"DiAngelo","year":"2004"},{"key":"b9-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2431","article-title":"Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion","volume":"27","author":"Eck","year":"2002"},{"key":"b10-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2047","article-title":"Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years","volume":"23","author":"Gore","year":"1998"},{"key":"b11-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"101","article-title":"Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial","volume":"34","author":"Heller","year":"2009"},{"key":"b12-focus16412","series-title":"J Bone Joint Surg Am","first-page":"519","article-title":"Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis","volume":"81","author":"Hilibrand","year":"1999"},{"issue":"6 Suppl","key":"b13-focus16412","series-title":"Spine J","first-page":"190S","article-title":"Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?","volume":"4","author":"Hilibrand","year":"2004"},{"key":"b14-focus16412","series-title":"Spine J","first-page":"624","article-title":"Adjacent segment disease after anterior cervical interbody fusion","volume":"4","author":"Ishihara","year":"2004"},{"key":"b15-focus16412","series-title":"Spine J","first-page":"1043","article-title":"Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials","volume":"10","author":"Jawahar","year":"2010"},{"key":"b16-focus16412","series-title":"Orthop Clin North Am","first-page":"53","article-title":"Management of adjacent segment disease after cervical spinal fusion","volume":"43","author":"Kepler","year":"2012"},{"key":"b17-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"E778","article-title":"Adjacent-level range of motion and intradiscal pressure after posterior cervical decompression and fixation: an in vitro human cadaveric model","volume":"37","author":"Kretzer","year":"2012"},{"key":"b18-focus16412","series-title":"J Neurosurg Spine","first-page":"198","article-title":"Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial","volume":"6","author":"Mummaneni","year":"2007"},{"issue":"4 Suppl 2","key":"b19-focus16412","series-title":"Neurosurgery","first-page":"310","article-title":"Cervical arthroplasty with the PRESTIGE LP cervical disc","volume":"60","author":"Mummaneni","year":"2007"},{"key":"b20-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"E105","article-title":"Intermediate results of the Prestige LP cervical disc replacement: clinical and radiological analysis with minimum two-year follow-up","volume":"36","author":"Peng","year":"2011"},{"key":"b21-focus16412","series-title":"J Neurosurg Spine","first-page":"213","article-title":"Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial","volume":"25","author":"Radcliff","year":"2016"},{"key":"b22-focus16412","series-title":"J Bone Joint Surg Am","first-page":"607","article-title":"The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion","volume":"40-A","author":"Smith","year":"1958"},{"key":"b23-focus16412","series-title":"J Neurosurg Spine","first-page":"216","article-title":"Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials","volume":"16","author":"Upadhyaya","year":"2012"},{"key":"b24-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2138","article-title":"Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study","volume":"30","author":"Yue","year":"2005"},{"key":"b1-focus16412","series-title":"Turk Neurosurg","first-page":"334","article-title":"Assessment of adjacent segment degeneration in and between patients treated with anterior or posterior cervical simple discectomy","volume":"20","author":"Acikbas","year":"2010"},{"key":"b2-focus16412","series-title":"J Neurosurg Spine","first-page":"308","article-title":"Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial","volume":"13","author":"Burkus","year":"2010"},{"key":"b3-focus16412","series-title":"J Neurosurg Spine","first-page":"516","article-title":"Clinical and radiographic analysis of an artificial cervical disc: 7-year follow-up from the Prestige prospective randomized controlled clinical trial: clinical article","volume":"21","author":"Burkus","year":"2014"},{"key":"b4-focus16412","series-title":"Neurosurgery","first-page":"139","article-title":"Adjacent segment disease after anterior cervical discectomy and fusion in a large series","volume":"74","author":"Bydon","year":"2014"},{"key":"b5-focus16412","series-title":"J Neurosurg","first-page":"602","article-title":"The anterior approach for removal of ruptured cervical disks","volume":"15","author":"Cloward","year":"1958"},{"key":"b6-focus16412","series-title":"J Neurosurg Spine","first-page":"31","article-title":"Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site","volume":"4","author":"Coric","year":"2006"},{"key":"b7-focus16412","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article","volume":"15","author":"Coric","year":"2011"},{"issue":"3","key":"b8-focus16412","series-title":"Neurosurg Focus","first-page":"E7","article-title":"In vitro biomechanics of cervical disc arthroplasty with the ProDisc-C total disc implant","volume":"17","author":"DiAngelo","year":"2004"},{"key":"b9-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2431","article-title":"Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion","volume":"27","author":"Eck","year":"2002"},{"key":"b10-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2047","article-title":"Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years","volume":"23","author":"Gore","year":"1998"},{"key":"b11-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"101","article-title":"Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial","volume":"34","author":"Heller","year":"2009"},{"key":"b12-focus16412","series-title":"J Bone Joint Surg Am","first-page":"519","article-title":"Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis","volume":"81","author":"Hilibrand","year":"1999"},{"issue":"6 Suppl","key":"b13-focus16412","series-title":"Spine J","first-page":"190S","article-title":"Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?","volume":"4","author":"Hilibrand","year":"2004"},{"key":"b14-focus16412","series-title":"Spine J","first-page":"624","article-title":"Adjacent segment disease after anterior cervical interbody fusion","volume":"4","author":"Ishihara","year":"2004"},{"key":"b15-focus16412","series-title":"Spine J","first-page":"1043","article-title":"Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials","volume":"10","author":"Jawahar","year":"2010"},{"key":"b16-focus16412","series-title":"Orthop Clin North Am","first-page":"53","article-title":"Management of adjacent segment disease after cervical spinal fusion","volume":"43","author":"Kepler","year":"2012"},{"key":"b17-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"E778","article-title":"Adjacent-level range of motion and intradiscal pressure after posterior cervical decompression and fixation: an in vitro human cadaveric model","volume":"37","author":"Kretzer","year":"2012"},{"key":"b18-focus16412","series-title":"J Neurosurg Spine","first-page":"198","article-title":"Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial","volume":"6","author":"Mummaneni","year":"2007"},{"issue":"4 Suppl 2","key":"b19-focus16412","series-title":"Neurosurgery","first-page":"310","article-title":"Cervical arthroplasty with the PRESTIGE LP cervical disc","volume":"60","author":"Mummaneni","year":"2007"},{"key":"b20-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"E105","article-title":"Intermediate results of the Prestige LP cervical disc replacement: clinical and radiological analysis with minimum two-year follow-up","volume":"36","author":"Peng","year":"2011"},{"key":"b21-focus16412","series-title":"J Neurosurg Spine","first-page":"213","article-title":"Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial","volume":"25","author":"Radcliff","year":"2016"},{"key":"b22-focus16412","series-title":"J Bone Joint Surg Am","first-page":"607","article-title":"The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion","volume":"40-A","author":"Smith","year":"1958"},{"key":"b23-focus16412","series-title":"J Neurosurg Spine","first-page":"216","article-title":"Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials","volume":"16","author":"Upadhyaya","year":"2012"},{"key":"b24-focus16412","series-title":"Spine (Phila Pa 1976)","first-page":"2138","article-title":"Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year 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