Anterior Cervical Discectomy and Fusion for Adjacent Segment Disease

Abstract

Performing ACDF for ASD resulted in significant improvements in patient pain, disability, and quality of life. Further, the mean 2-year cost-per-QALY was determined to be $60,526, which suggests surgical intervention to be cost effective. This study is the first to provide evidence that performing an ACDF for ASD is both clinically and cost effective.

Comparison between repeat anterior and posterior decompression and fusion in the treatment of two-level symptomatic adjacent segment disease after anterior cervical arthrodesis

“…Patients with acute or subacute neurological changes and invalid conservative treatment should be treated with further surgery. Revision surgery for symptomatic ASD was reported to be required in 5.1% and 22.2% of cases [ 3 , 4 , 7 – 9 ] and can be performed by second anterior fusion (ACDF or ACCF) [ 7 , 10 , 11 ], laminoplasty [ 12 ], posterior repeat cervical fusion [ 18 ], or artificial disc replacement [ 13 , 14 ]. However, two-level ASD is a special type of ASD that is rarely reported.…”

“…However, two-level ASD is a special type of ASD that is rarely reported. O'Neill et al [ 11 ] retrospectively reviewed 40 patients who underwent ACDF for ASD and described that ASD occurred at both adjacent levels in 10% of cases. Lee et al [ 8 ] analyzed 78 patients who required reoperation for ASD and found that 16 patients (20.5%) underwent treatment at both cephalad and caudal segments.…”

“…In this study, the quality (soft or ossified) and position (disc level or retrovertebral) of compression, presenting symptoms, and pathological extent were the main factors considered during selection of the surgical approaches. Second anterior cervical fusion had been reported to achieve favorable clinical results in patients who underwent one-level ACDF for symptomatic ASD [ 7 , 10 , 11 ]. Furthermore, radicular symptoms could be better relieved by decompressing the nerve root in anterior surgery.…”

“…According to the levels affected, ASD can be found in the superior, inferior, or both adjacent levels. Single-level ASD can be treated by second anterior fusion [ 7 , 10 , 11 ], laminoplasty [ 12 ], or artificial disc replacement [ 13 , 14 ]. Meanwhile, two-level ASD, defined as the development of new neurological symptoms in both cranial and caudal levels or two contiguous levels in directly adjacent discs, is less common [ 7 , 8 , 11 ], but represents a great challenge for surgeons.…”

Prevalence of and Risk Factors for Heterotopic Ossification After Cervical Total Disc Replacement: A Systematic Review and Meta-Analysis

“…Anterior cervical discectomy and fusion (ACDF) is the gold-standard surgical treatment for cervical degenerative disc disease. 1 One of the main complications of ACDF is the development of adjacent segment degeneration (ASD) and adjacent segment disease, which occurs when fusion of cervical spinal segments limits their range of motion (ROM) and increases intradiscal pressure of the adjacent intervertebral discs. 2 One alternative procedure is cervical total disc replacement (CTDR), theoretically preserving the ROM of spinal segments and minimize the risk of ASD.…”