Introduction: Anterior cervical fusion (ACF) is the most common cervical spine procedure performed. Unfortunately, many of the procedures lead to compromised sagital balance of the cervical spine than can adversely affect patient outcomes
Methods: Thirty two consecutive patients underwent ACF with wedge distractor instruments and technique. Pre and postoperative films were obtained in each case with 10 randomly selected patients studied six months postoperatively. The Cobb angle was measured on all films using Opalrad digital xray software. Results were compared to ten patients treated with standard ACF technique
Results: In the study group, the Cobb angle preoperatively averaged +1.71 (range +23.0 to -11.1) at the proposed level(s) of treatment. Postoperatively, the angle was corrected to an average of -4.6(range +4.4 to -13.0) providing an average correction of 6.31 degrees. At six months the Cobb angle average was little changed at -4.2. The control group had an average change from preoperative +2.2 to -0.5 postoperatively for an average increase in lordosis of 2.7 degrees.
Conclusions: Loss of cervical lordosis and failure to correct sagital plane deformity with ACF are not uncommon. Both may contribute to neck pain and potentially accelerate degeneration of the adjacent disc interspaces or facet joints. The wedge distractor technique is a simple method of enhancing lordosis and improving sagital balance in ACF surgery
Patient Care: persisting neck pain after ACF may relate to persisting or worsened sagital balance. Avoiding that pitfall could improve results. Further, avoiding accelerated degenerative disc disease at adjacent segments may decrease future repeat operations.
Learning Objectives: By the conclusion of this session, participants should be: 1) aware of the potential for ACF to negatively impact sagital balance, 2)familiar with a simple operative technique to correct balance, 3)conversant with the clinical aspects of loss of cervical lordosis